ARTEETHER INJECTION

DESCRIPTION:
TERTEL-150INECTION( Areether) is a synthetic derivative of artemisinin, a product of Chinese plant.
Artemisin annua.
TERTEL-IsINICTION (Arteether) is fast acting blood schizonticide specifically indicated for the treat of chloroquine resistant P. falciparum malaria and cerebral malaria cases.
TERTEL-150INJECTION (Arteether ) is developd by Central Drug Research Institute(C D.R.I.),Lucknow, and Themis Medicare Limited after extensive preclinical clinical and toxicological studies.
COMPOSITION:
Each 2ml ampoule of TERTEL-150 INECTION contains:
Arteether…150mg.
Arachis Oil...........…q·s.
PHARMACOLOGY:   
Arteether is fast acting blood schizonticidal agent for P. falciparum Malaria at the erythrocytic satge.
Arteether is concentrated in parasitized erythrocytes. The functional group responsible for antimalarial activity of Arteether is "endoperoxide bridge". The researchers believe that iron from the digested of the parasite's victim reduces this bridge releasing a highly reactive free radical iron (V) oxo species which rips apart the parasitic cells,
It is proposed that Arteether inhibits the protein synthesis and alter the ribosomal organisation and endoplasmic reticulum.
Arteether also acts on the membranes of the parasites through lipid peroxidation.
PHARMACOKINETICS:
Main metabolite of Arteether is Dihydroartemisinin. The half life of Dihydroartemisinin Is more than 20 hours. The elimination of the drug is through hepatic metabolism and gets eliminated at a low rate as compared to other artemisinin derivatives.
CLINICALDATA:
In multicentric clinical evaluation of Arteether in complicated and uncomplicated P.falciparum malaria, a total of 267 patients of uncomplicated P. falciparum malaria, having fever with chill/rigor and 211 patients of complicated P. falciparum malaria having fever, headache,vomiting, diarrhoea, convulsions, renal impairment, severe anaemia,spleenomegaly, hypotension and coma were treated with Arteether. Most of the cases became afebrile within 36 hours with the use of antipyretic drugs and parasite free with 72 hours The cure rate in uncomplicated malaria was nearly 100% and in complicated P falciparum malaria about 90%. Recrudescence was less than 7%.
Arteether is more lipophillic and has the advantage of greater accumulation in brain rissue, hence a potential drug for the treatment of cerebal malaria.
Arteether, also exhibits gametocytocidal action on P falciparum which wll vantage in cutting down the transmission of P falciparum malaria.
Arteether is well tolerated and compliance is very good with virually no drug related side effects.
INDICATIONS   
TERTEL-150INJECTION( Arteether) is indicated for use in severe Pfalciparum malaria including cerebral and as second line treatment in cholroquine.
CONTRAINDICATION  
TERTEL-150 INJECTION (Arteether) is contraindicated in patients hypersensitive to artemisinin derivatives.
DOSAGE AND ADMINISTRATION:   
TERTEL-150INJECTION (Arteether) Injection is for INTRAMUSCULAR USE ONLY
Adult:
150 mg i.e. I ampoule of TERTEL-150 INJECTION(Arteether)once daily for 3 consecutive days or as directed by the physician.
Children:   
3 mg/kg per day administered by intramuscular injection over a 3 day period or as directed by the physician.
The injection must be given in aseptic condition, deep intramuscularly in the upper-external quadrant of the buttock.
No other drug should be mixed in the same syringe.
OVERDOSE   
The pre-clinical studies of Arteether have shown that LD50 value is more than 1000 mg/kg,whereas the maximum dose injected in adult is about 2.5 mg/kg, per day. This confirms that the safety window for the dose administered is very wide. Hence this study conludes that Arteether is well tolerated even when overdose is administered.
PRECAUTIONS   
Pregnancy
Since no clinical data is available for the use of Arteether during pregnancy, it should be used with caution in pregnant women, if the potential benefits justify the potential risk to the foetus.
Nursing Mother:   
It is not know whether Arteether is excreted in human milk, because many drugs are excreted in human milk, a caution should be exercised while using Arteether.
DRUGINTERACTIONS   
TERTEL-1S0 INJECTION(Arteether) does not interfere with the action of other commonly used drugs for treatment of P falciparum malaria, eg Quinine  and  can  be  administered   along with   these drugs  for the treatment of severe form of malaria.(Except for other Artemisinin Derative like Artesunate and Artemether)
ADVERSE EFFECTS:   
Neurotoxicity is the common side effect associated with all artemisinin compounds in high doses Neurotoxicity manifests as gait disturbances, loss of spinal cord pain responses, incoordination respiratory depression, convulsions and cardio respiratory arrest.
Other side effects are nausea, dizziness and depressed GIT activity.
Clinical, neurological, electro-cardiographic and biochemical abnormality were seen.
In the mult centric trails of TERTEL-IS0 INJECTION(Arteether) involving 478 patients sufering from P falciparum malaria, no significant side effects were observed.
STORAGE:
Protect from light. Store in cool place.
PRESENTATION:
3 x 2 mI ampoules