DUE TO THE POTENTIAL FOR INCREASED CONCENTRATIONS OF LUMEFANTRINE WHICH COULD LEAD TO QT PROLONGATION, ARTEMETHER LUMEFANTRINE TABLETS SHOULD BE USED CAUTIOUSLY WITH DRUGS THAT INHIBIT CYP3A4. ARTEMETHER LUMEFANTRINE TABLETS MAY REDUCE THE EFFECTIVENESS OF HORMONAL CONTRACEPTIVES. ANTI-RETROVIRAL DRUGS (ARTS), SUCH AS PROTEASE INHIBITORS AND NON-NUCLEOSIDE REVERSE TRANSCRIPTASE INHIBITORS, ARE KNOWN TO HAVE VARIABLE PATTERNS OF INHIBITION, INDUCTION OR COMPETITION FOR CYP3A4. NO FORMAL DRUG-DRUG INTERACTION STUDIES BETWEEN ARTEMETHER LUMEFANTRINE TABLETS AND ARTS HAVE BEEN PERFORMED. HOWEVER, ARTEMETHER LUMEFANTRINE TABLETS SHOULD BE USED CAUTIOUSLY IN PATIENTS ON ARTS AS THE RESULT MAY BE AN INCREASE IN LUMEFANTRINE CONCENTRATIONS CAUSING QT PROLONGATION OR A DECREASE IN CONCENTRATIONS OF THE ART RESULTING IN LOSS OF EFFICACY, OR A DECREASE IN ARTEMETHER AND/OR LUMEFANTRINE CONCENTRATIONS RESULTING IN LOSS OF ANTIMALARIAL EFFICACY OF COARTEM TABLETS. LUMEFANTRINE INHIBITS CYP2D6. MANY OF THE DRUGS METABOLIZED BY CYP2D6 CAN PROLONG THE QT INTERVAL AND SHOULD NOT BE ADMINISTERED WITH ARTEMETHER LUMEFANTRINE TABLETS DUE TO THE POTENTIAL ADDITIVE EFFECT ON THE QT INTERVAL (E.G., FLECAINIDE, IMIPRAMINE, AMITRIPTYLINE, CLOMIPRAMINE). ARTEMETHER LUMEFANTRINE TABLETS HAVE BEEN ASSOCIATED WITH PROLONGATION OF THE QT INTERVAL ON THE ELECTROCARDIOGRAM.
LUMEFANTRINE TABLETS SHOULD BE AVOIDED IN PATIENTS RECEIVING OTHER MEDICATIONS THAT PROLONG THE QT INTERVAL, SUCH AS CLASS IA (QUINIDINE, PROCAINAMIDE, DISOPYRAMIDE), OR CLASS III (AMIODARONE, SOTALOL) ANTIARRHYTHMIC AGENTS; ANTIPSYCHOTICS (PIMOZIDE, ZIPRASIDONE); ANTIDEPRESSANTS; CERTAIN ANTIBIOTICS (MACROLIDE ANTIBIOTICS, FLUOROQUINOLONE ANTIBIOTICS, IMIDAZOLE, AND TRIAZOLE ANTIFUNGAL AGENTS);
CERTAIN NON-SEDATING ANTIHISTAMINICS (TERFENADINE, ASTEMIZOLE), OR CISAPRIDE.
RECEIVING MEDICATIONS THAT ARE METABOLIZED BY THE CYTOCHROME ENZYME CYP2D6 WHICH ALSO HAVE CARDIAC EFFECTS (E.G., FLECAINIDE, IMIPRAMINE, AMITRIPTYLINE, CLOMIPRAMINE). HALOFANTRINE, QUININE & QUINIDINE AND ARTEMETHER-LUMEFANTRINE TABLETS SHOULD NOT BE ADMINISTERED WITHIN ONE MONTH OF EACH OTHER DUE TO THE LONG ELIMINATION HALF-LIFE OF LUMEFANTRINE (3-6 DAYS) AND POTENTIAL ADDITIVE EFFECTS ON THE QT INTERVAL.