Amodiaquine, malaria, pregnancy: the old new drug

Abstract

In todays Lancet Harry Tagbor and colleagues report on the efficacy safety and tolerability of amodiaquine alone and combined with sulfadoxine-pyrimethamine in the treatment of malaria in pregnant women in Ghana. In endemic countries malaria during pregnancy has a major effect on pregnant womens health birthweight fetal loss infant morbidity and survival. Infections during pregnancy require prompt and effective treatment. Sulfadoxine-pyrimethamine alone is the most commonly used combination for both treatment and prevention of malaria in pregnancy in Africa but resistance is increasing alarmingly4 and the arsenal of alternative antimalarials for use in pregnancy is remarkably limited for a disease with such a high public-health impact. In recent years several new antimalarials have become available or are at an advanced stage of development including several artemisinin-based combination therapies. However little information on the safety pharmacokinetics and efficacy of these new drugs is available in pregnant women because they are systematically excluded from trials for fear of toxicity to the fetus. Amodiaquine is structurally related to chloroquine and has been around for 60 years. The drug was widely used between 1948 and 1990 before being temporarily removed from the essential drug list after reports of serious adverse events in travellers using chemoprophylaxis. (excerpt)