title: Artesunate/Amodiaquine-Induced Acute Extrapyramidal Reactions in Children and Younger Adults: Case Series Assessment.
abstract: Several studies conducted in African countries reported the artesunate and amodiaquine (AS/AQ) tablet as a safe and well-tolerated anti-malarial drug in children and younger adults. The aim of this case series assessment was to assess the causal relationship between the AS/AQ tablet and extrapyramidal reactions in children and younger adults and to investigate the factor(s) predisposing to the adverse drug reactions.
  
  
  
  The causal relationship of all the cases was first assessed individually using the Naranjo Probability Scale and then subjected to a case series assessment using Austin Bradford-Hill criteria.
  
  
  
  A total of 43 acute extrapyramidal reactions associated with the AS/AQ tablet were reported between 2012 and 16 November, 2015 to the Eritrean Pharmacovigilance Centre. The causality was found to be probable or highly probable for 33 (76.7 %) of the cases and the rest (10; 23.3 %) of the cases had a possible causal association. The extrapyramidal reactions had more or less similar clinical features in most of the cases and were characterized by abnormal involuntary contractions of muscles. The median age and body weight of the cases were 15 years and 40 kg, respectively, and 70 % of them were males. 90.7% of the reactions manifested in children and younger adults (aged <26 years). In most of the cases, reactions manifested in the third day from the start of treatment and 88.3 % of cases were hospitalized.
  
  
  
  The causal relationship between the AS/AQ tablet and extrapyramidal reactions in children and younger adults was found to be apparent and possibly owing to dose accumulation or an overdose of amodiaquine.
authors.affiliation: Eritrean Pharmacovigilance Centre, Ministry of Health, P.O. Box: 212, Asmara, Eritrea. satiswt@gmail.com.
authors.forename: Mulugeta
authors.initials: M
authors.lastname: Russom
authors.affiliation: School of Pharmacy, Asmara College of Health Sciences, Asmara, Eritrea.
authors.forename: Dawit
authors.initials: D
authors.lastname: Tesfai
authors.affiliation: World Health Organization Country Office, Asmara, Eritrea.
authors.forename: Semere
authors.initials: S
authors.lastname: Gebregiorgis
authors.affiliation: World Health Organization Country Office, Asmara, Eritrea.
authors.forename: Abdulmumini
authors.initials: A
authors.lastname: Usman
authors.affiliation: National Malaria Control Program, Ministry of Health, Asmara, Eritrea.
authors.forename: Selam
authors.initials: S
authors.lastname: Mihreteab
authors.affiliation: National Medicines and Food Administration, Ministry of Health, Asmara, Eritrea.
authors.forename: Iyassu
authors.initials: I
authors.lastname: Bahta
authors.affiliation: Eritrean Pharmacovigilance Centre, Ministry of Health, P.O. Box: 212, Asmara, Eritrea.
authors.forename: Elsa
authors.initials: E
authors.lastname: Mekonnen
authors.affiliation: Eritrean Pharmacovigilance Centre, Ministry of Health, P.O. Box: 212, Asmara, Eritrea.
authors.forename: Selamawit
authors.initials: S
authors.lastname: Ghebrehiwet
authors.affiliation: Tesseney Hospital, Tesseney, Eritrea.
authors.forename: Gelila
authors.initials: G
authors.lastname: Abrham
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000655:Amodiaquine / Q000008:administration & dosage / Q000009:adverse effects*; D000962:Antimalarials / Q000008:administration & dosage / Q000009:adverse effects*; D037621:Artemisinins / Q000008:administration & dosage / Q000009:adverse effects*; D001480:Basal Ganglia Diseases / Q000139:chemically induced* / Q000503:physiopathology; D002648:Child; D004305:Dose-Response Relationship, Drug; D004338:Drug Combinations; D062787:Drug Overdose / Q000453:epidemiology; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D060735:Pharmacovigilance; D013997:Time Factors; D055815:Young Adult
chemical_list: D000962:Antimalarials; D037621:Artemisinins; D004338:Drug Combinations; C515299:amodiaquine, artesunate drug combination; D000655:Amodiaquine