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Artesunate

Aka: Artesunate
  1. Pathophysiology
    1. Artesunate is a semisynthetic derivative of Artemisinin, which in turn is isolated from the plant Artemisia annua
  2. Indications: Severe Malaria (Intravenous Artesunate)
    1. Malaria confirmation by microscopy (may be waived in some cases by CDC clinician) AND
    2. One of the following criteria (or inability to take oral medications despite Antiemetics)
      1. High Parasite density (>5%)
      2. Altered Level of Consciousness
      3. Seizures
      4. Hemodynamic instability or shock
      5. Acute Respiratory Distress Syndrome (ARDS)
      6. Pulmonary Edema
      7. Acidosis
      8. Acute Kidney Injury
      9. Disseminated Intravascular Coagulation (ARDS) or other Abnormal Bleeding
      10. Jaundice AND one other of the criteria
      11. Severe Anemia (Hemoglobin <7 g/dl)
  3. Efficacy: Severe Malaria
    1. Artesunate (and other Artemisinin derivatives) are preferred for severe Malaria with reduced morbidity and mortality
  4. Adverse Effects: In Malaria Patients
    1. Acute Renal Failure requiringf Dialysis
    2. Hemoglobinuria
    3. Anemia
    4. Jaundice
  5. Preparations: Intravenous Artesunate
    1. Available from CDC (if not commercially available)
    2. Contact CDC Malaria Hotline
      1. https://www.cdc.gov/media/releases/2019/s0328-artesunate-first-line-treatment.html
  6. References
    1. Lovecchio (2021) Crit Dec Emerg Med 35(11): 26

artesunate (C0052432)

Definition (NCI) A water-soluble, semi-synthetic derivative of the sesquiterpine lactone artemisinin with anti-malarial, anti-shistosomiasis, antiviral, and potential anti-neoplastic activities. Upon hydrolysis of artesunate's active endoperoxide bridge moiety by liberated heme in parasite-infected red blood cells, reactive oxygen species and carbon-centered radicals form, which have been shown to damage and kill parasitic organisms. Additionally, in vitro studies demonstrate that this agent induces DNA breakage in a dose-dependent manner. Artesunate has also been shown to stimulate cell differentiation, arrest the cell cycle in the G1 and G2/M phases, inhibit cell proliferation, and induce apoptosis through mitochondrial and caspase signaling pathways. Artemisinin is isolated from the plant Artemisia annua.
Concepts Pharmacologic Substance (T121) , Organic Chemical (T109)
MSH C039726
SnomedCT 432410005, 432555000
English ARTESUNATE, Artesunate (substance), Artesunate (product), Artesunate, succinyl dihydroartemisinin, dihydroartemisinine-12-alpha-succinate, artesunate, artesunate [Chemical/Ingredient], 4-oxo-4-{[(3R,5aS,6R,8aS,9R,10S,12R,12aR)-3,6,9-trimethyldecahydro-3,12-epoxypyrano[4,3-j]-1,2-benzodioxepin-10-yl]oxy}butanoic acid
Spanish artesunato (producto), artesunato (sustancia), artesunato
Sources
Derived from the NIH UMLS (Unified Medical Language System)


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