Effect of artemisinin-piperaquine treatment on the electrocardiogram of malaria patients

Abstract

Introduction: Concern regarding the cardiotoxicity of antimalarials has been renewed because of their potential to cause QT/QTc interval prolongation related to torsade de pointes (TdP). Artemisinin-piperaquine (AP) is considered an effective artemisininbased combination therapy (ACT) for malaria. Methods: This study involved a retrospective analysis of clinical data of 93 hospitalized malaria patients who had received AP orally. Electrocardiograms (ECGs) were obtained at specific time points in the original study. Results: Some cases of QT prolongation were observed. However, no TdP was found. Conclusions: AP may cause QT interval prolongation in some malaria patients but may not lead to TdP.

Electrocardiographic safety evaluation of extended artemether-lumefantrine treatment in patients with uncomplicated Plasmodium falciparum malaria in Bagamoyo District, Tanzania

“…It is important to note that none of the patients had risk factors that would have predisposed them to prolonged QTc interval, such as renal impairment (that would have deranged the electrolytes), hepatic impairment, concomitant medication with proarrhythmic effects, or know pre-existing cardiac conditions [30]. Moreover, significant myocardial dysfunction and arrhythmias are rarely seen even in severe malaria cases, and it has been argued that electrocardiographic monitoring for patients with malaria infection may be of questionable clinical value if the purpose is not to study potential drug induced cardiotoxicity [31,32]. However, one of the main findings of this study was the significant lengthening of the QTcF interval of 16.2 ms in the intervention arm (p < 0.001).…”

Electrocardiographic effect of artemisinin-piperaquine, dihydroartemisinin-piperaquine, and artemether-lumefantrine treatment in falciparum malaria patients

“…Though not all QT prolongations cause TdP, they are common biomarkers for identifying drugs that may cause it 23 . A study confirmed the effects of AP compounds on the ECG of malaria patients; it found that AP compounds caused QT interval prolongation in some malaria patients but without TdP 24 . The aim of this study was to compare the effects of dihydroartemisinin-piperaquine (DP), artemether-lumefantrine (AL), and AP on the ECGs of malaria patients.…”

Safety and efficacy of artemisinin-piperaquine for treatment of COVID-19: an open-label, non-randomised and controlled trial

“…And piperaquine disappears slowly in the body, with a long half-life (11.7 days) [26] . Continuous administration has the risk of accumulating toxicity and AP may cause heart rate prolongation in the QT phase [27] . Therefore, after the first dose of 2 tablets was administered, one tablet a day was chosen to minimize the side effects and maximize the efficacy of artemisinin.…”

“…These manifestations make the blood of the patient more viscous and result in thrombus formation [34] . As per studies, the adult dose of AP for malaria consists of four tablets (artemisinin 250 mg and piperaquine 1500 mg), which showed prolonged QT-interval in some people [35] . The total recommended AP adult dose for the treatment of COVID-19 consists of eight tablets (artemisinin 500 mg and piperaquine 3000 mg).…”