Artesunate (AS) is a medication used to treat malaria.[3][4][5] The intravenous form is preferred to quinine for severe malaria.[4] Often it is used as part of combination therapy, such as artesunate plus mefloquine.[5] It is not used for the prevention of malaria.[5] Artesunate can be given by injection into a vein, injection into a muscle, by mouth, and by rectum.[5][6][7]
The most common side effects include kidney failure requiring dialysis, hemoglobinuria (the presence of hemoglobin in urine) and jaundice.[8]
Artesunate is generally well tolerated.[6] Side effects may include a slow heartbeat, allergic reaction, dizziness, and low white blood cell levels.[5] During pregnancy it appears to be a safer option, even though animal studies have found harm to the baby.[9] Use is likely fine during breastfeeding.[10] It is in the artemisinin class of medication.[4]
Artesunate was developed by Liu Xu in 1977.[11] It is on the World Health Organization's List of Essential Medicines.[12] It was approved for medical use in the United States in May 2020.[13] It is in the class of medications known as artemisinins, which are derivatives from "qinghao," or sweet wormwood plant (Artemisia annua).[14][4]
Artesunate is the first-line treatment for children or adults with severe malaria,[15][16][17] usually in combination with another antimalarial drug. There is moderate-quality evidence that treatment with artesunate plus mefloquine is superior to treatment with artesunate plus amodiaquine or artesunate plus sulfadoxine-pyrimethamine.[18] Artemisinin-based combination therapy may be used by mouth in persons that can tolerate it after 24 hours by injection.[medical citation needed]
Artesunate is preferred over parenteral quinine for severe malaria treatment.[4] Artesunate was shown to prevent more deaths from severe malaria than quinine in two large multicentre randomized controlled trials from Africa[19] and Asia.[20] A subsequent systematic review of seven randomized controlled trials found this improvement in survival rates to be consistent across all trials.[21]