dihydroartemisininpiperaquine

Dihydroartemisinin-piperaquine, abbreviated DHA-PPQ, is a fixed-dose oral antimalarial medicine that combines dihydroartemisinin, an artemisinin derivative, with piperaquine, a long-acting 4-aminoquinoline. It is used as an artemisinin-based combination therapy (ACT) for the treatment of uncomplicated malaria caused by Plasmodium falciparum and, in some regions, for Plasmodium vivax malaria according to local guidelines.

DHA-PPQ is typically administered as a three-day course, with a fixed daily dose that is adjusted for patient weight. The dihydroartemisinin component acts rapidly to reduce parasite biomass, while piperaquine provides sustained antimalarial activity to prevent recrudescence after treatment and may offer some post-treatment prophylaxis in endemic areas.

Pharmacokinetics and mechanism: Dihydroartemisinin has a rapid onset of action and a short half-life, contributing to quick parasite clearance. Piperaquine has a longer half-life, maintaining drug levels that help suppress residual parasites. The combination exploits the fast-acting kill of the artemisinin derivative with the prolonged activity of piperaquine to improve treatment efficacy and reduce the risk of relapse.

Safety and considerations: DHA-PPQ is generally well tolerated, but adverse effects can include nausea, vomiting, dizziness, and headaches. A notable safety concern is the potential for QT interval prolongation due to piperaquine, which requires caution in patients with cardiac conditions, electrolyte disturbances, or concomitant QT-prolonging medications. As with other ACTs, pregnancy safety follows regional guidelines and current malaria treatment policies.

Resistance and surveillance: Efficacy of DHA-PPQ can vary by region. Piperaquine resistance has been reported in parts of Southeast Asia, associated with treatment failures in some settings, underscoring the importance of monitoring efficacy and adherence to dosing regimens.