Antimalarial Drug Toxicity: A Review

Antimalarial drug toxicity is viewed differently dependingupon whether the clinical indication is for malaria treatmentor prophylaxis. In the treatment of Plasmodium falciparummalaria, which has a high mortality if untreated, a greater riskof adverse reactions to antimalarial drugs is inevitable. Aschloroquine resistance has become widespread, alternative agents may be used in treatment regimens, however, thetoxicity of these antimalarial agents should be considered.Quinine is the mainstay for treating severe malaria due to itsrare cardiovascular or CNS toxicity, but its hypoglycemic effectmay be problematic. Mefloquine can cause dose-related serious neuropsychiatric toxicity and pyrimethamine dapsoneis associated with agranulocytosis, especially if therecommended dose is exceeded. Pyrimethamine-sulfadoxineandamodiaquine are associated with a relatively highincidence of potentially fatal reactions, and are no longerrecommended for prophylaxis. Atovaquone/proguanil is anantimalarial combination with good efficacy and tolerabilityas prophylaxis and for treatment. The artemisinin derivatives have remarkable efficacy and an excellent safety record. Prescribing in pregnancy is a particular problem for cliniciansbecause the risk-benefit ratio is often very unclear.