Eurartesim

1 

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

 
ANNEX I 

 
SUMMARY OF PRODUCT CHARACTERISTICS 

 
 

 
 
 
 
  



 
 

2 

1. NAME OF THE MEDICINAL PRODUCT 
 
Eurartesim 160 mg/20 mg film-coated tablets. 
 
 
2. QUALITATIVE AND QUANTITATIVE COMPOSITION 
 
Each film-coated tablet contains 160 mg piperaquine tetraphosphate (as the tetrahydrate; PQP) and 
20 mg artenimol. 
 
For the full list of excipients, see section 6.1. 
 
 
3. PHARMACEUTICAL FORM 
 
Film-coated tablet (tablet). 
 
White oblong biconvex film-coated tablet (dimension 11.5x5.5mm / thickness 4.4mm) with a 
break-line and marked on one side with the letters “S” and “T”. 
 
The tablet can be divided into equal doses.  
 
 
4. CLINICAL PARTICULARS 
 
4.1 Therapeutic indications 
 
Eurartesim is indicated for the treatment of uncomplicated Plasmodium falciparum malaria in adults, 
adolescents, children and infants 6 months and over and weighing 5 kg or more. 
 
Consideration should be given to official guidance on the appropriate use of antimalarial medicinal 
products. 
 
4.2 Posology and method of administration 
 
Posology 
 
Eurartesim should be administered over three consecutive days for a total of three doses taken at the 
same time each day.  
 
Dosing should be based on body weight as shown in the table below.  
 

Body weight 
(kg) 

Daily dose (mg) 
Tablet strength and number of tablets per dose 

PQP Artenimol  
5 to <7 80 10 ½ x 160 mg / 20 mg tablet 

7 to <13 160 20 1 x 160 mg / 20 mg tablet 

13 to <24 320 40 1 x 320 mg / 40 mg tablet 

24 to <36 640 80 2 x 320 mg / 40 mg tablets 

36 to <75 960 120 3 x 320 mg / 40 mg tablets 

> 75*  1,280 160 4 x 320 mg / 40 mg tablets 

  
* see section 5.1 



 
 

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If a patient vomits within 30 minutes of taking Eurartesim, the whole dose should be re-administered; 
if a patient vomits within 30-60 minutes, half the dose should be re-administered. Re-dosing with 
Eurartesim should not be attempted more than once. If the second dose is vomited, alternative 
antimalarial therapy should be instituted. 
 
If a dose is missed, it should be taken as soon as realised and then the recommended regimen 
continued until the full course of treatment has been completed. 
 
There is no data on a second course of treatment. 
No more than two courses of Eurartesim may be given within a 12 month period (see sections 4.4 and 
5.3). 
A second course of Eurartesim should not be given within 2 months after the first course due to the 
long elimination half-life of piperaquine (see sections 4.4 and 5.2). 
 
Special populations 
 
Elderly 
Clinical studies of Eurartesim did not include patients aged 65 years and over, therefore no dosing 
recommendation can be made. Considering the possibility of age-associated decrease in hepatic and 
renal function, as well as a potential for heart disorders (see sections 4.3 and 4.4), caution should be 
exercised when administering the product to the elderly. 
 
Hepatic and renal impairment  
Eurartesim has not been evaluated in subjects with moderate or severe renal or hepatic insufficiency. 
Therefore, caution is advised when administering Eurartesim to these patients (see section 4.4). 
 
Paediatric population 
The safety and efficacy of Eurartesim in infants aged less than 6 months and in children weighing less 
than 5 kg has not been established. No data are available for these paediatric subsets. 
 
Method of administration 
 
Eurartesim should be taken orally with water and without food. 
Each dose should be taken no less than 3 hours after the last food intake. 
No food should be taken within 3 hours after each dose. 
For patients unable to swallow the tablets, such as infants and young children, Eurartesim may be 
crushed and mixed with water. The mixture should be used immediately after preparation. 
 



 
 

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4.3 Contraindications 
 
- Hypersensitivity to the active substances or to any of the excipients listed in section 6.1. 
 
- Severe malaria according to WHO definition. 
 
- Family history of sudden death or of congenital prolongation of the QTc interval. 
 
- Known congenital prolongation of the QTc-interval or any clinical condition known to prolong 

the QTc interval. 
 
- History of symptomatic cardiac arrhythmias or with clinically relevant bradycardia. 
 
- Any predisposing cardiac conditions for arrhythmia such as severe hypertension, left ventricular 

hypertrophy (including hypertrophic cardiomyopathy) or congestive cardiac failure 
accompanied by reduced left ventricle ejection fraction. 

 
- Electrolyte disturbances, particularly hypokalaemia, hypocalcaemia or hypomagnesaemia. 
 
- Taking medicinal products that are known to prolong the QTc interval. These include (but are 

not limited to):  
 

• Antiarrhythmics (e.g. amiodarone, disopyramide, dofetilide, ibutilide, procainamide, 
quinidine, hydroquinidine, sotalol).  

 
• Neuroleptics (e.g. phenothiazines, sertindole, sultopride, chlorpromazine, haloperidol, 

mesoridazine, pimozide, or thioridazine), antidepressive medicinal products. 
 
• Certain antimicrobial medicinal products, including medicinal products of the following 

classes:  
− macrolides (e.g. erythromycin, clarithromycin), 
− fluoroquinolones (e.g. moxifloxacin, sparfloxacin),  
− imidazole and triazole antifungal medicinal products,  
− and also pentamidine and saquinavir. 

 
• Certain non-sedating antihistamines (e.g. terfenadine, astemizole, mizolastine).  
 
• Cisapride, droperidol, domperidone, bepridil, diphemanil, probucol, levomethadyl, 

methadone, vinca alkaloids, arsenic trioxide.  
 

- Recent treatment with medicinal products known to prolong the QTc interval that may still be 
circulating at the time that Eurartesim is commenced (e.g. mefloquine, halofantrine, 
lumefantrine, chloroquine, quinine and other antimalarial medicinal products) taking into 
account their elimination half-life. 

 
4.4 Special warnings and precautions for use 
 
Eurartesim should not be used to treat severe falciparum malaria (see section 4.3) and, due to 
insufficient data, should not be used to treat malaria due to Plasmodium vivax, Plasmodium malariae 
or Plasmodium ovale. 
 
The long half-life of piperaquine (about 22 days) should be kept in mind in the event that another anti-
malarial agent is started due to treatment failure or a new malaria infection (see below and sections 4.3 
and 4.5). 
 
 
 



 
 

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Piperaquine is a mild inhibitor of CYP3A4. Caution is recommended when co-administering 
Eurartesim with medicinal products exhibiting variable patterns of inhibition, induction or competition 
for CYP3A4 as the therapeutic and/or toxic effects of some co-administered medicinal products could 
be altered.  
 
Piperaquine is also a substrate of CYP3A4. A moderate increase of piperaquine plasma concentrations 
(<2-fold) was observed when co-administered with strong CYP3A4 inhibitors, resulting in a potential 
exacerbation of the effect on QTc prolongation (see section 4.5).  
 
Exposure to piperaquine may also be increased when co-administered with mild or moderate 
CYP3A4-inhibitors (e.g. oral contraceptives). Therefore, caution should be applied when co-
administering Eurartesim with any CYP3A4-inhibitor and ECG monitoring should be considered. 
 
Due to the lack of multiple dose PK data for piperaquine, administration of any strong 
CYP3A4-inhibitors should be discouraged after initiation (i.e. the first dose) of Eurartesim (see 
sections 4.5 and 5.2). 
 
Eurartesim should not be used during the 1st trimester of pregnancy in situations where other suitable 
and effective antimalarials are available (see section 4.6). 
 
In the absence of carcinogenicity study data, and due to lack of clinical experience with repeated 
courses of treatment in humans, no more than two courses of Eurartesim should be given in a 
12-month period (see sections 4.2 and 5.3). 
 
Effects on cardiac repolarization 
In clinical trials with Eurartesim limited ECGs were obtained during treatment. These showed that 
QTc prolongation occurred more frequently and to a larger extent in association with Eurartesim 
therapy than with the comparators (see section 5.1 for details of the comparators). Analysis of cardiac 
adverse events in clinical trials showed that these were reported more frequently in Eurartesim treated 
patients than in those treated with comparator antimalarial (see section 4.8). Before the third dose of 
Eurartesim, in one of the two Phase III studies 3/767 patients (0.4%) were reported to have a QTcF 
value of  >500 ms versus none in the comparator group. 
 
The potential for Eurartesim to prolong the QTc interval was investigated in parallel groups of healthy 
volunteers who took each dose with high (~1000 Kcal) or low (~400 Kcal) fat/calorie meals or in 
fasting conditions. Compared to placebo, the maximum mean increases in QTcF on Day 3 of dosing 
with Eurartesim were 45.2, 35.5 and 21.0 msec under respective dosing conditions. The QTcF 
prolongation observed under fasting conditions lasted between 4 and 11 hours after the last dose was 
administered on Day 3. The mean QTcF prolongation compared to placebo decreased to 11.8 msec at 
24 hours and to 7.5 msec at 48 hours. No healthy subject dosed in fasting conditions showed a QTcF 
greater than 480 msec or an increase over baseline greater than 60 msec. The number of subjects with 
QTcF greater than 480 msec after dosing with low fat meals was 3/64, while 10/64 had QTcF values 
over this threshold after dosing with high fat meals. No subject had a QTcF value greater than 
500 msec in any of the dosing conditions. 
 
An ECG should be obtained as early as possible during treatment with Eurartesim and ECG 
monitoring should be applied in patients who may have a higher risk of developing arrhythmia in 
association with QTc prolongation (see below). 
 
When clinically appropriate, consideration should be given to obtaining an ECG from all patients 
before the last of the three daily doses is taken and approximately 4-6 hours after the last dose, since 
the risk of QTc interval prolongation may be greatest during this period (see section 5.2).  QTc 
intervals of more than 500 ms are associated with a pronounced risk for potentially life-threatening 
ventricular tachyarrhythmias. Therefore, ECG monitoring during the following 24-48 hours should be 
applied for patients found to have a prolongation to this extent. These patients should not receive 
another dose of Eurartesim and alternative antimalarial therapy should be instituted. 
 



 
 

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Compared to adult males, female patients and elderly patients have longer QTc intervals. Therefore, 
they may be more sensitive to the effects of QTc-prolonging medications such as Eurartesim so that 
special caution is required. 
 
Delayed Haemolytic Anaemia 
Delayed haemolytic anaemia has been observed up to one month following use of IV artesunate and 
oral artemisinin-based combination treatment (ACT) including reports involving Eurartesim. Risk 
factors may include young age (children under 5 years old) and previous treatment with IV artesunate. 
 
Patients and caregivers should be advised to be vigilant for signs and symptoms of post-treatment 
haemolysis such as pallor, jaundice, dark-coloured urine, fever, fatigue, shortness of breath, dizziness 
and confusion. 
 
Paediatric population 
Special precaution is advised in young children when vomiting, as they are likely to develop 
electrolyte disturbances. These may increase the QTc-prolonging effect of Eurartesim (see 
section 4.3). 
 
Hepatic and renal impairment 
Eurartesim has not been evaluated in patients with moderate or severe renal or hepatic insufficiency 
(see section 4.2). Due to the potential for higher plasma concentrations of piperaquine to occur, 
caution is advised if Eurartesim is administered to patients with jaundice and/or with moderate or 
severe renal or hepatic insufficiency, and ECG and blood potassium monitoring are advised. 
 
4.5 Interaction with other medicinal products and other forms of interaction 
 
Eurartesim is contraindicated in patients already taking other medicinal products that are known to 
prolong the QTc interval due to the risk of a pharmacodynamic interaction leading to an additive effect 
on the QTc interval (see sections 4.3 and 4.4). 
 
A limited number of drug-drug pharmacokinetic interaction studies with Eurartesim have been 
performed in healthy adult subjects. Therefore the assessment of the potential for drug-drug 
interactions to occur is based on either in vivo or in vitro studies. 
 
Effect of Eurartesim on co-administered medicinal products 
Piperaquine is metabolised by, and is an inhibitor of CYP3A4. The concurrent administration of oral 
Eurartesim with 7.5 mg oral midazolam, a CYP3A4 probe substrate, led to a modest increase (≤2-fold) 
in midazolam and its metabolites exposures in healthy adult subjects. This inhibitory effect was no 
longer evident one week after last administration of Eurartesim. Therefore, particular attention should 
be paid when medicinal products that have a narrow therapeutic index (e.g. antiretroviral medicinal 
products and cyclosporine) are co-administered with Eurartesim.  
 
From in vitro data, piperaquine undergoes a low level of metabolism by CYP2C19, and is also an 
inhibitor of this enzyme. There is the potential for reducing the rate of metabolism of other substrates 
of this enzyme, such as omeprazole, with consequent increase of their plasma concentration, and 
therefore, of their toxicity. 
 
Piperaquine has the potential to increase the rate of metabolism for CYP2E1 substrates resulting in a 
decrease in the plasma concentrations of substrates such as paracetamol or theophylline, and the 
anaesthetic gases enflurane, halothane and isoflurane. The main consequence of this interaction could 
be a reduction of efficacy of the co-administered medicinal products. 
 
Artenimol administration may result in a slight decrease in CYP1A2 activity. Caution is therefore, 
advised when Eurartesim is administered concomitantly with medicinal products metabolised by this 
enzyme that have a narrow therapeutic index, such as theophylline. Any effects are unlikely to persist 
beyond 24 hours after the last intake of artenimol.  
 



 
 

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Effect of co-administered medicinal products on Eurartesim  
Piperaquine is metabolised by CYP3A4 in vitro. The concurrent administration of a single dose of oral 
clarithromycin, (a strong CYP3A4 inhibitor probe) with a single dose of oral Eurartesim led to a 
modest increase (≤2-fold) in piperaquine exposure in healthy adult subjects. This increase in exposure 
to the antimalarial combination may result in an exacerbation of the effect on QTc (see section 4.4). 
Therefore, particular caution is required if Eurartesim is administered to patients taking potent 
CYP3A4 inhibitors (e.g. some protease inhibitors [amprenavir, atazanavir, indinavir, nelfinavir, 
ritonavir], nefazodone or verapamil), and ECG monitoring should be considered due to the risk of 
higher plasma concentrations of piperaquine (see section 4.4). 
 
Enzyme inducing medicinal products such as rifampicin, carbamazepine, phenytoin, phenobarbital, 
St. John’s wort (Hypericum perforatum) are likely to lead to reduced piperaquine plasma 
concentrations. The concentration of artenimol may also be reduced. Concomitant treatment with such 
medicinal products is not recommended. 
 
Paediatric population 
Drug-drug interaction studies have only been performed in adults. The extent of interactions in the 
paediatric population is not known. The above mentioned interactions for adults and the warnings in 
section 4.4 should be taken into account for the paediatric population. 
 
Oral contraceptives 
When co-administered to healthy women, Eurartesim exerted only a minimum  effect on an 
estrogen/progestinic combination oral contraceptive treatment increasing the ethynilestradiol rate of 
absorption (expressed by geometric mean Cmax) of about 28% but not significantly changing the 
exposure to ethynilestradiol and levonorgestrel and not influencing contraception activity as 
demonstrated by the similar plasma concentrations of follicle stimulating hormone (FSH), luteinizing 
hormone (LH) and progesterone observed after oral contraceptive treatment with or without 
concomitant Eurartesim administration. 
 
Food interaction 
Absorption of piperaquine is increased in the presence of fatty food (see sections 4.4 and 5.2) which 
may increase its effect on QTc interval. Therefore, Eurartesim should be taken with water only as 
described in section 4.2. Eurartesim should not be taken with grapefruit juice as it is likely to lead to 
increased piperaquine plasma concentrations. 
 
4.6 Fertility, pregnancy and lactation 
 
Pregnancy 
There are only limited (n=3) amount of data from the use of artenimol/piperaquine during the 1st 
trimester of pregnancy. 

Based on animal data, Eurartesim is suspected to cause serious birth defects when administered during 
the first trimester of pregnancy (see sections 4.4 and 5.3). Reproductive studies with artemisinin 
derivatives have demonstrated teratogenic potential with an increased risk during early gestation (see 
section 5.3). Piperaquine was not teratogenic in the rat or rabbit.  

Therefore Eurartesim should not be used during the 1st trimester of pregnancy in situations where other 
suitable and effective anti-malarials are available (see section 4.4). 

A large amount of data (more than 3000 exposed outcomes) from the use of artenimol/piperaquine 
during the 2nd and 3rd trimester indicate no fetotoxicity. In perinatal and postnatal studies in rats, 
piperaquine was associated with delivery complications. However, there was no delay in neonatal 
development following exposure in utero or via milk (see section 5.3). 

Consequently, if Eurartesim is more suitable for a pregnant woman than other artemisinin-based 
combination therapies with a higher range of experience (or sulfadoxine–pyrimethamine), Eurartesim 
may be used in the 2nd and 3 trimester. 



 
 

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Breast-feeding 
Animal data suggest excretion of piperaquine into breast milk but no data are available in humans. 
Women taking Eurartesim should not breast-feed during their treatment. 
 
 
Fertility 
There are no specific data relating to the effects of piperaquine on fertility, however, to date no 
adverse events have been reported during clinical use. Moreover, data obtained in animal studies show 
that fertility is unaffected by artenimol in both females and males. 
 
 
 
4.7 Effects on ability to drive and use machines 
 
Adverse event data collected in clinical trials suggest that Eurartesim has no influence on the ability to 
drive and operate machines once the patient has recovered from the acute infection. 
 
4.8 Undesirable effects 
 
Summary of the safety profile 
The safety of Eurartesim has been evaluated in two phase III open-label studies involving 
1,239 paediatric patients up to 18 years and 566 adult patients >18 years treated with Eurartesim. 
 
In a randomised trial in which 767 adults and children with uncomplicated P. falciparum malaria were 
exposed to Eurartesim, 25% of subjects were judged to have experienced an adverse drug reaction 
(ADR). No single type of ADR occurred at an incidence of ≥5%. The most frequent ADRs observed at 
an incidence ≥1.0% were: Headache (3.9%), Electrocardiogram QTc Prolonged (3.4%), P. falciparum 
infection (3.0%), Anaemia (2.8%), Eosinophilia (1.7%), Haemoglobin decreased (1.7%), Sinus 
tachycardia (1.7%), Asthenia (1.6%), Haematocrit [decreased] (1.6%), Pyrexia (1.5%), Red Blood 
Cell Count decreased (1.4%). A total of 6 (0.8%) subjects had serious ADRs in the study. 
 
In a second randomised trial, 1,038 children, aged between 6 months and 5 years, were exposed to 
Eurartesim and 71% were judged to have experienced an ADR. The following ADRs were observed at 
an incidence of ≥5.0%: Cough (32%), Pyrexia (22.4%), Influenza (16.0%), P. falciparum infection 
(14.1%), Diarrhoea (9.4%), Vomiting (5.5%) and Anorexia (5.2%). A total of 15 (1.5%) subjects had 
serious ADRs in the study. 
 
Tabulated list of adverse reactions 
In the tables below, ADRs are listed under system organ class (SOC), and ranked by headings of 
frequency. Within each frequency grouping, adverse reactions are presented in the order of decreasing 
seriousness, using the following convention: Very common (≥1/10), common (≥1/100 to <1/10), 
uncommon (≥1/1,000 to <1/100), rare (≥1/10,000 to <1/1,000), very rare (<1/10,000), not known 
(cannot be estimated from the available data). The table in this section is for adult patients only. A 
corresponding table for paediatric patients is presented in the specific section below.  
 
Frequency of ADRs in adult patients participating in clinical studies with Eurartesim: 
 

SOC Very Common Common Uncommon 

Infections and 
infestations  

P. falciparum 
infection 

Respiratory tract infection  
Influenza 

Blood and lymphatic 
system disorders  Anaemia  

Metabolism and 
nutrition  
disorders 

  Anorexia 



 
 

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Nervous system 
disorders  Headache 

Convulsion 
Dizziness 

Cardiac disorders  QTc prolonged Tachycardia 

Cardiac conduction disorders 
Sinus arrhythmias 
Bradycardia 

Respiratory, thoracic  
and mediastinal 
disorders 

  Cough 

Gastrointestinal 
disorders   

Vomiting  
Diarrhoea 
Nausea 
Abdominal pain 

Hepatobiliary disorders   
Hepatitis  
Hepatomegaly  
Abnormal liver function tests  

Skin and subcutaneous  
Tissue disorders   Pruritis 

Musculoskeletal and  
connective tissue 
disorders 

  Arthralgia Myalgia 

General disorders and  
administration site  
conditions 

 Asthenia  Pyrexia  

 
Description of selected adverse reactions  
The ADRs noted for Eurartesim were generally mild in severity, and the majority were non-serious. 
Reactions such as cough, pyrexia, headache, P. falciparum infection, anaemia, asthenia, anorexia and 
the observed changes in blood cell parameters are consistent with those expected in patients with acute 
malaria. The effect on prolongation of the QTc interval was observed on Day 2, and had resolved by 
Day 7 (the next time point at which ECGs were performed). 
 
Paediatric population 
A tabular overview of the frequency of the ADRs in paediatric patients is given below.  The majority 
of paediatric experience is derived from African children aged 6 months to 5 years. 
 
Frequency of ADRs in paediatric patients participating in clinical studies with Eurartesim: 
 

SOC Very Common Common Uncommon 

Infections and 
infestations 

Influenza  
P. falciparum 
infection 

Respiratory tract 
infection  
Ear infection 

 

Blood and lymphatic 
 system disorders  

Thrombocytopenia 
Leukopenia/neutrope
nia 
Leuckocytoses NEC 
Anaemia 

 
Thrombocythaemia 
Splenomegaly 
Lymphadenopathy 
Hypochromasia 

Metabolism and 
nutrition  
disorders 

 Anorexia  

Nervous system 
disorders   

Convulsion 
Headache 

Eye disorders  Conjunctivitis  

Cardiac disorders  QT/QTc prolonged Heart rate irregular 

Cardiac conduction 
disorders 
Cardiac murmur 



 
 

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SOC Very Common Common Uncommon 

Respiratory, thoracic  
and mediastinal 
disorders 

Cough  Rhinorrhoea Epistaxis 

Gastrointestinal 
disorders  

Vomiting  
Diarrhoea 
Abdominal pain 

 
Stomatitis 
Nausea 

Hepatobiliary disorders   

Hepatitis  
Hepatomegaly 
Abnormal liver function 
tests 
Jaundice 

Skin and subcutaneous  
Tissue disorders  

Dermatitis  
Rash 

Acanthosis 
Pruritis 

Musculoskeletal and  
connective tissue 
disorders 

  Arthralgia 

General disorders and  
administration site  
conditions 

Pyrexia Asthenia  

 
Reporting of suspected adverse reactions 
Reporting suspected adverse reactions after authorisation of the medicinal product is important. It 
allows continued monitoring of the benefit/risk balance of the medicinal product. Healthcare 
professionals are asked to report any suspected adverse reactions via the national reporting system 
listed in Appendix V 
 
4.9 Overdose 
 
In clinical trials, nine patients received double the cumulative intended dose of Eurartesim. The safety 
profile of these patients did not differ from that of patients receiving the recommended dose, with no 
patient reporting SAEs. 
 
In cases of suspected overdose, symptomatic and supportive therapy should be given as appropriate, 
including ECG monitoring because of the possibility of QTc interval prolongation (see section 4.4). 
 
 
5. PHARMACOLOGICAL PROPERTIES 
 
5.1  Pharmacodynamic properties 
 
Pharmacotherapeutic group: Antiprotozoals, antimalarials, artemisinin and derivatives, combinations, 
ATC code: P01BF05 
 
Pharmacodynamic effects 
Artenimol is able to reach high concentrations within the parasitized erythrocytes. Its endoperoxide 
bridge is thought to be essential for its antimalarial activity, causing free-radical damage to parasite 
membrane systems including:  
• Inhibition of falciparum sarcoplasmic-endoplasmic reticulum calcium ATPase, 
• Interference with mitochondrial electron transport 
• Interference with parasite transport proteins 
• Disruption of parasite mitochondrial function 
 
The exact mechanism of action of piperaquine is unknown, but it likely mirrors that of chloroquine, a 
close structural analogue. Chloroquine binds to toxic haeme (derived from the patient’s haemoglobin) 
within the malaria parasite, preventing its detoxification via a polymerisation step.  

http://www.ema.europa.eu/docs/en_GB/document_library/Template_or_form/2013/03/WC500139752.doc
http://www.ema.europa.eu/docs/en_GB/document_library/Template_or_form/2013/03/WC500139752.doc
http://www.whocc.no/atc_ddd_index/?code=P01
http://www.whocc.no/atc_ddd_index/?code=P01B
http://www.whocc.no/atc_ddd_index/?code=P01BF


 
 

11 

 
Piperaquine is a bisquinoline, and this class has shown good antimalarial activity against chloroquine-
resistant Plasmodium strains in vitro. The bulky bisquinolone structure may be important for activity 
against chloroquine-resistant strains, and may act through the following mechanisms: 
• Inhibition of the transporters that efflux chloroquine from the parasite food vacuole  
• Inhibition of haem-digestion pathway in the parasite food vacuole. 

 
Resistance to piperaquine (when used as monotherapy) has been reported.  
 
The efficacy and safety of Eurartesim have been assessed in two large randomised, open-label clinical 
trials: 
 
Study DM040010 was conducted in Asian adult and paediatric patients with uncomplicated 
P. falciparum malaria. Eurartesim treatment was compared with Artesunate + Mefloquine (AS + MQ). 
The primary end-point was the PCR-corrected cure rate at Day 63. 
 
Study DM040011 was conducted in African paediatric patients with uncomplicated P. falciparum 
malaria. Eurartesim treatment was compared with Artemether + Lumefantrine (A + L). The primary 
end-point was PCR-corrected cure rate at Day 28. 
 
The results for the primary endpoint in the modified intent to treat (m-ITT) populations (defined as all 
randomised patients who received at least one dose of the study treatment, with the exclusion of those 
patients lost to follow up for unknown reasons) were as follows: 
 

Study 

PCR-corrected cure rate (m-ITT) 

Eurartesim AS + MQ A + L 

95 % two-sided CI on 
the treatment difference 

(Eurartesim - 
Comparator); p-value 

DM040010 (n=1087) 97.0% 95.3% - (-0.84, 4.19) %; p=0.161 
DM040011 (n=1524) 92.7% - 94.8% (-4.59, 0.45) %; p=0.128 

 
In each case the results confirmed that Eurartesim was not inferior to the comparator medicinal 
product. In both studies, the true treatment failure rate was below the 5% efficacy threshold set by 
WHO. 
 
The age-specific PCR-corrected cure rates in the m-ITT populations are tabulated below for the Asian 
and African studies, respectively: 
 

Study 

PCR-corrected cure rate (m-ITT) 

Eurartesim AS + MQ A + L 

95% two-sided CI on the 
treatment difference 

(Eurartesim - Comparator); 
p-value 

DM04010 (n=1087) 
≤5 years 
>5 to ≤12 years 
>12 to ≤18 years 
>18 to ≤64 years 

 
100.0% 
98.2% 
97.3% 
96.6% 

 
100.0% 
96.5% 

100.0% 
94.4% 

 
- 
- 
- 
- 

 
- 

(-3.67, 7.09)%; 0.605 
(-6.40, 0.99)%; 1.000 
(-0.98, 5.30)%; 0.146 

DM04011 (n=1524) 
≤1 year 
>1 to ≤2 years 
>2 to ≤5 years 

 
91.5% 
92.6% 
93.0% 

 
- 
- 
- 

 
98.5% 
94.6% 
94.0% 

 
(-12.66, -1.32)%(1); 0.064 

(-6.76, 2.63)%; 0.413 
(-4.41, 2.47)%; 0.590 

(1) This CI is asymptotic because the exact CI could not be computed 



 
 

12 

In the European Safety Registry 25 patients weighing ≥ 100 kg (range 100 -121 kg) were treated with 4 
tablets 320/40 mg PQP/artenimol for 3 days. Twenty-two of these patients were shown to be parasitic 
free at the last microscopic analysis of the blood sample; three patients did not complete parasitological 
blood analysis. All patients were clinically cured. 

 
5.2 Pharmacokinetic properties 
 
Pharmacokinetic profiles of artenimol and piperaquine have been investigated in animal models and in 
different human populations (healthy volunteers, adult patients and paediatric patients). 
 
Absorption 
Artenimol is very rapidly absorbed, Tmax being approximately 1-2 hrs after single and multiple dosing. 
In patients, mean Cmax (CV %) and AUCINF of artenimol (observed after the first dose of Eurartesim) 
were 752 (47%) ng/ml and 2,002 (45%) ng/ml*h, respectively. 
 
Artenimol bioavailability appears to be higher in malaria patients than in healthy volunteers, possibly 
because malaria per se has an effect on artenimol disposition. This may reflect malaria-associated 
impairment of hepatic function, causing an increase in artenimol bioavailability (reduction of first 
hepatic effect) without affecting its apparent elimination half-life, which is absorption rate limited. In 
healthy male volunteers under fasting conditions, mean Cmax and AUCINF of artenimol ranged between 
180-252 ng/ml and 516-684 ng/ml*h, respectively. 
 
The systemic exposure to artenimol was slightly lower following the last dose of Eurartesim (lower 
than after the first dose by up to 15%). Artenimol pharmacokinetic parameters were found to be 
similar in healthy volunteers of Asian and Caucasian origin. artenimol systemic exposure on the last 
day of treatment was higher in females than in males, the difference being within 30%. 
 
In healthy volunteers, artenimol exposure was increased by 43% when administered with a high 
fat/high calorie meal.  
 
Piperaquine, a highly lipophilic compound, is slowly absorbed. In humans, piperaquine has a Tmax of 
approximately 5 hours following a single and repeated dose. In patients mean (CV %) Cmax and  
AUC0-24 (observed after the first dose of Eurartesim) were 179 (62%) ng/ml and 1,679 (47%) ng/ml*h, 
respectively. Due to its slow elimination, piperaquine accumulates in plasma after multiple doses with 
an accumulation factor of approximately 3. Piperaquine pharmacokinetic parameters were found to be 
similar in healthy volunteers of Asian and Caucasian origin. On the other hand, on the last day of 
Eurtartesim treatment, the piperaquine maximum plasma concentration was higher in female than in 
male healthy volunteers, the difference being in the order of 30 to 50%. 
 
In healthy volunteers, piperaquine exposure is increased approximately 3-fold when administered with 
a high fat/high calorie meal. This pharmacokinetic effect is accompanied by an increased effect on 
prolongation of the QT interval. Accordingly, Eurartesim should be administered with water no less 
than 3 hours after the last food intake, and no food should be taken within 3 hours after each dose  
(see section 4.2). 
 
Distribution 
Both piperaquine and artenimol are highly bound to human plasma proteins: the protein binding 
observed in in vitro studies was 44-93% for artenimol and >99% for piperaquine. Moreover, from in 
vitro and in vivo data in animals, piperaquine and artenimol tend to accumulate in RBC. 
 
Artenimolwas observed to have a small volume of distribution in humans (0.8 l/kg; CV 35.5%).  
Pharmacokinetic parameters observed for piperaquine in humans indicate that this active substance has 
a large volume of distribution (730 l/kg; CV 37.5%). 
 
Biotransformation 



 
 

13 

Artenimol is principally converted to α-artenimol-β-glucuronide (α-artenimol-G). Studies in human 
liver microsomes showed that artenimol was metabolised by the UDP-glucuronosyltransferase 
(UGT1A9 and UGT2B7) to α-artenimol-G with no cytochrome P450-mediated metabolism. In vitro 
drug-drug interaction studies revealed that artenimol is an inhibitor of CYP1A2; therefore, there is the 
potential for artenimol to increase plasma concentrations of CYP1A2 substrates (see section 4.5). 
 
In vitro metabolism studies demonstrated that piperaquine is metabolised by human hepatocytes 
(approximately 85% of piperaquine remained after 2 hours incubation at 37°C). Piperaquine was 
mainly metabolised by CYP3A4 and to a lesser extent by CYP2C9 and CYP2C19. Piperaquine was 
found to be an inhibitor of CYP3A4 (also in a time-dependent way) and to a lesser extent of 
CYP2C19, while it stimulated the activity of CYP2E1.  
 
No effect on the metabolite profile of piperaquine in human hepatocytes was observed when 
piperaquine was co-incubated with artenimol. The piperaquine major metabolites were a carboxyl 
acid cleavage product, and a mono-N-oxidated product. 
In human studies, piperaquine was found to be a mild inhibitor of CYP3A4 enzyme while potent 
inhibitors of CYP3A4 activity caused mild inhibition of piperaquine metabolism (see section 4.5). 
 
Elimination 
The elimination half-life of artenimol is approximately 1 hour. The mean oral clearance for adult 
patients with malaria was 1.34 l/h/kg. The mean oral clearance was slightly higher for paediatric 
patients, however the differences were minor in magnitude (<20%). Artenimol is eliminated by 
metabolism (mainly glucuroconjugation). Its clearance was found to be slightly lower in female than 
in male healthy volunteers. Data regarding artenimol excretion in humans are scarce. However, it is 
reported in the literature that the excretion of unchanged active substance in human urine and faeces is 
negligible for artemisinin derivatives. 
 
The elimination half-life of piperaquine is around 22 days for adult patients and around 20 days for 
paediatric patients. The mean oral clearance for adult patients with malaria was 2.09 l/h/kg, while in 
paediatric patients was 2.43 l/h/kg. Due to its long elimination half-life, piperaquine accumulates after 
multiple dosing. 
 
Animal studies showed that radiolabelled piperaquine is excreted by the biliary route, while urinary 
excretion is negligible. 
 
Pharmacokinetics in special patient populations 
No specific pharmacokinetic studies have been performed in patients with hepatic or renal 
insufficiency, or in elderly people. 
 
In a paediatric pharmacokinetic study, and based on very limited sampling, minor differences were 
observed for artenimol pharmacokinetics between the paediatric and adult populations. The mean 
clearance (1.45 l/h/kg) was slightly faster in the paediatric patients than in the adult patients 
(1.34 l/h/kg), while the mean volume of distribution in the paediatric patients (0.705 l/kg) was lower 
than in the adults (0.801 l/kg). 
The same comparison showed that piperaquine absorption rate constant and terminal half-life in 
children were predominantly similar to those seen in adults. However, the apparent clearance was 
faster (1.30 versus 1.14 l/h/kg) and the apparent total volume of distribution was lower in the 
paediatric population (623 versus 730 l/kg). 
 
5.3 Preclinical safety data 
 
General toxicity 
Literature data concerning chronic toxicity of piperaquine in dogs and monkeys indicate some 
hepatotoxicity and mild reversible depression of total white cell and neutrophil counts. 
 
The most important nonclinical safety findings after repeated dosing were the infiltration of 
macrophages with intracytoplasmic basophilic granular material consistent with phospholipidosis and 



 
 

14 

degenerative lesions in numerous organs and tissues. These adverse reactions were seen in animals at 
exposure levels similar to clinical exposure levels, and with possible relevance to clinical use. It is not 
known whether these toxic effects are reversible. 
 
Artenimol and piperaquine were not genotoxic/clastogenic based on in vitro and in vivo testing. 
 
No carcinogenicity studies have been performed. 
 
Artenimol causes embryolethality and teratogenicity in rats and rabbits.  
 
Piperaquine did not induce malformation in rats and rabbits. In a perinatal and postnatal development 
study (segment III) in female rats treated with 80 mg/kg, some animals had a delay of delivery 
inducing mortality of the neonates. In females delivering normally the development, behaviour and 
growth of the surviving progeny was normal following exposure in utero or via milk. 
 
No reproduction toxicity studies have been performed with the combination of artenimol and 
piperaquine. 
 
Central nervous system (CNS) toxicity 
There is potential for neurotoxicity of artemisinin derivatives in man and animals, which is strongly 
related to the dose, route and formulations of the different artenimol pro-drugs. In humans, the 
potential neurotoxicity of orally administered artenimol can be considered highly unlikely, given the 
rapid clearance ofartenimol, and its short exposure (3 days of treatment for malaria patients). There 
was no evidence of artenimol-induced lesions in the specific nuclei in rats or dogs, even at lethal dose. 
 
Cardiovascular toxicity 
Effects on blood pressure and on PR and QRS duration were observed at high piperaquine doses. The 
most important potential cardiac effect was related to cardiac conduction. 
 
In the hERG test, the IC50 was 0.15 µmol for piperaquine and 7.7 µmol forartenimol. The association 
of artenimol and piperaquine does not produce hERG inhibition greater than that of the single 
compounds. 
 
Phototoxicity  
There are no phototoxicity concerns with artenimol, as it does not absorb in the range of 290-700 nm.  
Piperaquine has an absorption maximum at 352 nm. Since piperaquine is present in the skin (about 9% 
in the non-pigmented rat and only 3% in the pigmented rat), slight phototoxic reactions (swelling and 
erythema) were observed 24 hours after oral treatment in mice exposed to UV radiation.  
 
 
6. PHARMACEUTICAL PARTICULARS 
 
6.1 List of excipients 
 
Tablet core 
Pre-gelatinised starch 
Dextrin 
Hypromellose (E464) 
Croscarmellose sodium 
Magnesium stearate (E572) 
 
Film coating 
Hypromellose (E464) 
Titanium dioxide (E171) 
Macrogol 400 
 



 
 

15 

6.2 Incompatibilities 
 
Not applicable. 
 
6.3 Shelf life 
 
2 years. 
 
6.4 Special precautions for storage 
 
Do not store above 30°C. 
Store in the original package in order to protect from light and moisture. 
 
6.5 Nature and contents of container 
 
Eurartesim tablets are packaged in PVC/PVDC/aluminium blisters containing 3 tablets. 
 
6.6 Special precautions for disposal  
 
No special requirements. 
 
 
7. MARKETING AUTHORISATION HOLDER 
 
Alfasigma S.p.A. 
Via Ragazzi del ’99, n. 5 
40133 Bologna 
Italy 
 
Tel: +39  051 6489602 
Fax: +39  051 388689 
Email: antonietta.pazardjiklian@alfasigma.com 
 
 
8. MARKETING AUTHORISATION NUMBER(S)  
 
EU/1/11/716/005 
 
 
9. DATE OF FIRST AUTHORISATION/RENEWAL OF THE AUTHORISATION 
 
Date of first authorisation: 27 October 2011 
Date of latest renewal: 09 September 2016 
 
 
10. DATE OF REVISION OF THE TEXT 
 
 
Detailed information on this medicinal product is available on the website of the European Medicines 
Agency   http://www.ema.europa.eu. 
 
 
 
  

mailto:antonietta.pazardjiklian@alfasigma.com
http://www.ema.europa.eu/


 
 

16 

 
1. NAME OF THE MEDICINAL PRODUCT 
 
Eurartesim 320 mg/40 mg film-coated tablets. 
 
 
2. QUALITATIVE AND QUANTITATIVE COMPOSITION 
 
Each film-coated tablet contains 320 mg piperaquine tetraphosphate (as the tetrahydrate; PQP) and 
40 mg artenimol (artenimol). 
 
For the full list of excipients, see section 6.1. 
 
 
3. PHARMACEUTICAL FORM 
 
Film-coated tablet (tablet). 
 
White oblong biconvex film-coated tablet (dimension 16x8mm / thickness 5.5mm) with a break-line 
and marked on one side with two “σ” letters.  
 
The tablet can be divided into equal doses. 
 
 
4. CLINICAL PARTICULARS 
 
4.1 Therapeutic indications 
 
Eurartesim is indicated for the treatment of uncomplicated Plasmodium falciparum malaria in adults, 
adolescents, children and infants 6 months and over and weighing 5 kg or more. 
 
Consideration should be given to official guidance on the appropriate use of antimalarial medicinal 
products. 
 
4.2  Posology and method of administration 
 
Posology 
 
Eurartesim should be administered over three consecutive days for a total of three doses taken at the 
same time each day.  
 



 
 

17 

Dosing should be based on body weight as shown in the table below. 
 

Body weight 
(kg) 

Daily dose (mg) 
Tablet strength and number of tablets per dose 

PQP Artenimol 

5 to <7 80 10 ½ x 160 mg / 20 mg tablet 

7 to <13 160 20 1 x 160 mg / 20 mg tablet 

13 to <24 320 40 1 x 320 mg / 40 mg tablet 

24 to <36 640 80 2 x 320 mg / 40 mg tablets 

36 to <75 960 120 3 x 320 mg / 40 mg tablets 

> 75*  1,280 160 4 x 320 mg / 40 mg tablets 

  
* see section 5.1 
 
If a patient vomits within 30 minutes of taking Eurartesim, the whole dose should be re-administered; 
if a patient vomits within 30-60 minutes, half the dose should be re-administered. Re-dosing with 
Eurartesim should not be attempted more than once. If the second dose is vomited, alternative 
antimalarial therapy should be instituted. 
 
If a dose is missed, it should be taken as soon as realised and then the recommended regimen 
continued until the full course of treatment has been completed. 
 
There is no data on a second course of treatment. 
No more than two courses of Eurartesim may be given within a 12 month period (see sections 4.4 and 
5.3). 
A second course of Eurartesim should not be given within 2 months after the first course due to the 
long elimination half-life of piperaquine (see sections 4.4 and 5.2). 
 
Special populations 
 
Elderly  
Clinical studies of Eurartesim did not include patients aged 65 years and over, therefore no dosing 
recommendation can be made. Considering the possibility of age-associated decrease in hepatic and 
renal function, as well as a potential for heart disorders (see sections 4.3 and 4.4), caution should be 
exercised when administering the product to the elderly. 
 
 
Hepatic and renal impairment  
Eurartesim has not been evaluated in subjects with moderate or severe renal or hepatic insufficiency. 
Therefore, caution is advised when administering Eurartesim to these patients (see section 4.4). 
 
Paediatric population 
 
The safety and efficacy of Eurartesim in infants aged less than 6 months and in children weighing less 
than 5 kg has not been established. No data are available for these paediatric subsets. 
 
Method of administration 
 
Eurartesim should be taken orally with water and without food. 
Each dose should be taken no less than 3 hours after the last food intake. 
No food should be taken within 3 hours after each dose. 
 



 
 

18 

For patients unable to swallow the tablets, such as infants and young children, Eurartesim may be 
crushed and mixed with water. The mixture should be used immediately after preparation. 
 
4.3 Contraindications 
 
- Hypersensitivity to the active substances or to any of the excipients listed in section 6.1.  
 
- Severe malaria according to WHO definition. 
 
- Family history of sudden death or of congenital prolongation of the QTc interval. 
 
- Known congenital prolongation of the QTc-interval or any clinical condition known to prolong 

the QTc interval. 
 
- History of symptomatic cardiac arrhythmias or with clinically relevant bradycardia. 
 
- Any predisposing cardiac conditions for arrhythmia such as severe hypertension, left ventricular 

hypertrophy (including hypertrophic cardiomyopathy) or congestive cardiac failure 
accompanied by reduced left ventricle ejection fraction. 

 
- Electrolyte disturbances, particularly hypokalaemia, hypocalcaemia or hypomagnesaemia. 
 
- Taking medicinal products that are known to prolong the QTc interval. These include (but are 

not limited to): 
 

• Antiarrhythmics (e.g. amiodarone, disopyramide, dofetilide, ibutilide, procainamide, 
quinidine, hydroquinidine, sotalol). 

 
• Neuroleptics (e.g. phenothiazines, sertindole, sultopride, chlorpromazine, haloperidol, 

mesoridazine, pimozide, or thioridazine), antidepressive medicinal products. 
 
• Certain antimicrobialmedicinal products, including medicinal products of the following 

classes:  
− macrolides (e.g. erythromycin, clarithromycin), 
− fluoroquinolones (e.g. moxifloxacin, sparfloxacin),  
− imidazole and triazole antifungal medicinal products, 
− and also pentamidine and saquinavir. 

 
• Certain non-sedating antihistamines (e.g. terfenadine, astemizole, mizolastine).  
 
• Cisapride, droperidol, domperidone, bepridil, diphemanil, probucol, levomethadyl, 

methadone, vinca alkaloids, arsenic trioxide.  
 

- Recent treatment with medicinal products known to prolong the QTc interval that may still be 
circulating at the time that Eurartesim is commenced (e.g. mefloquine, halofantrine, 
lumefantrine, chloroquine, quinine and other antimalarial medicinal products) taking into 
account their elimination half-life. 

 
4.4 Special warnings and precautions for use 
 
Eurartesim should not be used to treat severe falciparum malaria (see section 4.3) and, due to 
insufficient data, should not be used to treat malaria due to Plasmodium vivax, Plasmodium malariae 
or Plasmodium ovale. 
 



 
 

19 

The long half-life of piperaquine (about 22 days) should be kept in mind in the event that another anti-
malarial agent is started due to treatment failure or a new malaria infection (see below and sections 4.3 
and 4.5). 
 
Piperaquine is a mild inhibitor of CYP3A4. Caution is recommended when co-administering 
Eurartesim with medicinal products exhibiting variable patterns of inhibition, induction or competition 
for CYP3A4 as the therapeutic and/or toxic effects of some co-administered medicinal products could 
be altered.  
 
Piperaquine is also a substrate of CYP3A4. A moderate increase of piperaquine plasma concentrations 
(<2-fold) was observed when co-administered with strong CYP3A4 inhibitors, resulting in a potential 
exacerbation of the effect on QTc prolongation (see section 4.5).  
 
Exposure to piperaquine may also be increased when co-administered with mild or moderate 
CYP3A4-inhibitors (e.g. oral contraceptives). Therefore, caution should be applied when 
co-administering Eurartesim with any CYP3A4-inhibitor and ECG monitoring should be considered. 
 
Due to the lack of multiple dose PK data for piperaquine, administration of any strong 
CYP3A4-inhibitors should be discouraged after initiation (i.e. the first dose) of Eurartesim (see 
sections 4.5 and 5.2). 
 
Eurartesim should not be used during the 1st trimester of pregnancy in situations where other suitable 
and effective antimalarials are available (see section 4.6). 
 
In the absence of carcinogenicity study data, and due to lack of clinical experience with repeated 
courses of treatment in humans, no more than two courses of Eurartesim should be given in a 
12-month period (see sections 4.2 and 5.3). 
 
Effects on cardiac repolarization 
In clinical trials with Eurartesim limited ECGs were obtained during treatment. These showed that 
QTc prolongation occurred more frequently and to a larger extent in association with Eurartesim 
therapy than with the comparators (see section 5.1 for details of the comparators). Analysis of cardiac 
adverse events in clinical trials showed that these were reported more frequently in Eurartesim treated 
patients than in those treated with comparator antimalarial (see section 4.8). Before the third dose of 
Eurartesim, in one of the two Phase III studies 3/767 patients (0.4%) were reported to have a QTcF 
value of >500 ms versus none in the comparator group. 
 
The potential for Eurartesim to prolong the QTc interval was investigated in parallel groups of healthy 
volunteers who took each dose with high (~1000 Kcal) or low (~400 Kcal) fat/calorie meals or in 
fasting conditions. Compared to placebo, the maximum mean increases in QTcF on Day 3 of dosing 
with Eurartesim were 45.2, 35.5 and 21.0 msec under respective dosing conditions. The QTcF 
prolongation observed under fasting conditions lasted between 4 and 11 hours after the last dose was 
administered on Day 3. The mean QTcF prolongation compared to placebo decreased to 11.8 msec at 
24 hours and to 7.5 msec at 48 hours. No healthy subject dosed in fasting conditions showed a QTcF 
greater than 480 msec or an increase over baseline greater than 60 msec. The number of subjects with 
QTcF greater than 480 msec after dosing with low fat meals was 3/64, while 10/64 had QTcF values 
over this threshold after dosing with high fat meals. No subject had a QTcF value greater than 
500 msec in any of the dosing conditions. 
 
An ECG should be obtained as early as possible during treatment with Eurartesim and ECG 
monitoring should be applied in patients who may have a higher risk of developing arrhythmia in 
association with QTc prolongation (see below).  
 
When clinically appropriate, consideration should be given to obtaining an ECG from all patients 
before the last of the three daily doses is taken and approximately 4-6 hours after the last dose, since 
the risk of QTc interval prolongation may be greatest during this period (see section 5.2).  QTc 
intervals of more than 500 ms are associated with a pronounced risk for potentially life-threatening 



 
 

20 

ventricular tachyarrhythmias. Therefore, ECG monitoring during the following 24-48 hours should be 
applied for patients found to have a prolongation to this extent. These patients should not receive 
another dose of Eurartesim and alternative antimalarial therapy should be instituted.  
 
Compared to adult males, female patients and elderly patients have longer QTc intervals. Therefore, 
they may be more sensitive to the effects of QTc-prolonging medications such as Eurartesim so that 
special caution is required. 
 
Delayed Haemolytic Anaemia 
Delayed haemolytic anaemia has been observed up to one month following use of IV artesunate and 
oral artemisinin-based combination treatment (ACT) including reports involving Eurartesim. Risk 
factors may include young age (children under 5 years old) and previous treatment with IV artesunate. 
 
Patients and caregivers should be advised to be vigilant for signs and symptoms of post-treatment 
haemolysis such as pallor, jaundice, dark-coloured urine, fever, fatigue, shortness of breath, dizziness 
and confusion. 
 
Paediatric population 
Special precaution is advised in young children when vomiting, as they are likely to develop 
electrolyte disturbances. These may increase the QTc-prolonging effect of Eurartesim (see section 
4.3). 
 
Hepatic and renal impairment 
Eurartesim has not been evaluated in patients with moderate or severe renal or hepatic insufficiency 
(see section 4.2). Due to the potential for higher plasma concentrations of piperaquine to occur, 
caution is advised if Eurartesim is administered to patients with jaundice and/or with moderate or 
severe renal or hepatic insufficiency, and ECG and blood potassium monitoring are advised. 
 
4.5 Interaction with other medicinal products and other forms of interaction 
 
Eurartesim is contraindicated in patients already taking other medicinal products that are known to 
prolong the QTc interval due to the risk of a pharmacodynamic interaction leading to an additive effect 
on the QTc interval (see section 4.3 and 4.4). 
 
A limited number of drug-drug pharmacokinetic interaction studies with Eurartesim have been 
performed in healthy adult subjects. Therefore the assessment of the potential for drug-drug 
interactions to occur is based on either in vivo or in vitro studies. 
 
Effect of Eurartesim on co-administered medicinal products 
Piperaquine is metabolised by, and is an inhibitor of CYP3A4. The concurrent administration of oral 
Eurartesim with 7.5 mg oral midazolam, a CYP3A4 probe substrate, led to a modest increase (≤2-fold) 
in midazolam and its metabolites exposures in healthy adult subjects. This inhibitory effect was no 
longer evident one week after last administration of Eurartesim. Therefore, particular attention should 
be paid when medicinal products that have a narrow therapeutic index (e.g. antiretroviral medicinal 
products and cyclosporine) are co-administered with Eurartesim.  
 
From in vitro data, piperaquine undergoes a low level of metabolism by CYP2C19, and is also an 
inhibitor of this enzyme. There is the potential for reducing the rate of metabolism of other substrates 
of this enzyme, such as omeprazole, with consequent increase of their plasma concentration, and 
therefore, of their toxicity. 
 
Piperaquine has the potential to increase the rate of metabolism for CYP2E1 substrates resulting in a 
decrease in the plasma concentrations of substrates such as paracetamol or theophylline, and the 
anaesthetic gases enflurane, halothane and isoflurane. The main consequence of this interaction could 
be a reduction of efficacy of the co-administered medicinal products. 
 



 
 

21 

Artenimol administration may result in a slight decrease in CYP1A2 activity. Caution is therefore, 
advised when Eurartesim is administered concomitantly with medicinal products metabolised by this 
enzyme that have a narrow therapeutic index, such as theophylline. Any effects are unlikely to persist 
beyond 24 hours after the last intake of artenimol. 
 
Effect of co-administered medicinal products on Eurartesim  
Piperaquine is metabolised by CYP3A4 in vitro. The concurrent administration of a single dose of oral 
clarithromycin, (a strong CYP3A4 inhibitor probe) with a single dose of oral Eurartesim led to a 
modest increase (≤2-fold) in piperaquine exposure in healthy adult subjects. This increase in exposure 
to the antimalarial combination may result in an exacerbation of the effect on QTc (see section 4.4). 
Therefore, particular caution is required if Eurartesim is administered to patients taking potent 
CYP3A4 inhibitors (e.g. some protease inhibitors [amprenavir, atazanavir, indinavir, nelfinavir, 
ritonavir], nefazodone or verapamil), and ECG monitoring should be considered due to the risk of 
higher plasma concentrations of piperaquine (see section 4.4).  
 
 
Enzyme inducing medicinal products such as rifampicin, carbamazepine, phenytoin, phenobarbital, 
St. John’s wort (Hypericum perforatum) are likely to lead to reduced piperaquine plasma 
concentrations. The concentration of artenimol may also be reduced. Concomitant treatment with such 
medicinal products is not recommended.  
 
Paediatric population 
Drug-drug interaction studies have only been performed in adults. The extent of interactions in the 
paediatric population is not known. The above mentioned interactions for adults and the warnings in 
section 4.4 should be taken into account for the paediatric population. 
 
Oral contraceptives 
When co-administered to healthy women, Eurartesim exerted only a minimum effect on an 
estrogen/progestinic combination oral contraceptive treatment increasing the ethynilestradiol rate of 
absorption (expressed by geometric mean Cmax) of about 28% but not significantly changing the 
exposure to ethynilestradiol and levonorgestrel and not influencing contraception activity as 
demonstrated by the similar plasma concentrations of follicle stimulating hormone (FSH), luteinizing 
hormone (LH) and progesterone observed after oral contraceptive treatment with or without concomitant 
Eurartesim administration. 
 
Food interaction 
Absorption of piperaquine is increased in the presence of fatty food (see sections 4.4 and 5.2) which 
may increase its effect on QTc interval. Therefore, Eurartesim should be taken with water only as 
described in section 4.2. Eurartesim should not be taken with grapefruit juice as it is likely to lead to 
increased piperaquine plasma concentrations. 
 
4.6 Fertility, pregnancy and lactation 
 
Pregnancy 
There are only limited (n=3) amount of data from the use of artenimol/piperaquine during the 1st 
trimester of pregnancy. 

Based on animal data, Eurartesim is suspected to cause serious birth defects when administered during 
the first trimester of pregnancy (see sections 4.4 and 5.3). Reproductive studies with artemisinin 
derivatives have demonstrated teratogenic potential with an increased risk during early gestation (see 
section 5.3). Piperaquine was not teratogenic in the rat or rabbit.  

Therefore Eurartesim should not be used during the 1st trimester of pregnancy in situations where other 
suitable and effective anti-malarials are available (see section 4.4). 

A large amount of data (more than 3000 exposed outcomes) from the use of artenimol/piperaquine 
during the 2nd and 3rd trimester indicate no fetotoxicity. In perinatal and postnatal studies in rats, 



 
 

22 

piperaquine was associated with delivery complications. However, there was no delay in neonatal 
development following exposure in utero or via milk (see section 5.3). 

Consequently, if Eurartesim is more suitable for a pregnant woman than other artemisinin-based 
combination therapies with a higher range of experience (or sulfadoxine–pyrimethamine), Eurartesim 
may be used in the 2nd and 3rd trimester. 

 
Breast-feeding 
Animal data suggest excretion of piperaquine into breast milk but no data are available in humans. 
Women taking Eurartesim should not breast-feed during their treatment. 
 
Fertility 
There are no specific data relating to the effects of piperaquine on fertility, however, to date no 
adverse events have been reported during clinical use. Moreover, data obtained in animal studies show 
that fertility is unaffected by artenimol in both females and males. 
 
 
 
4.7 Effects on ability to drive and use machines 
 
Adverse event data collected in clinical trials suggest that Eurartesim has no influence on the ability to 
drive and operate machines once the patient has recovered from the acute infection. 
 
4.8 Undesirable effects 
 
Summary of the safety profile 
The safety of Eurartesim has been evaluated in two phase III open-label studies involving 
1,239 paediatric patients up to 18 years and 566 adult patients >18 years treated with Eurartesim. 
 
In a randomised trial in which 767 adults and children with uncomplicated P. falciparum malaria were 
exposed to Eurartesim, 25% of subjects were judged to have experienced an adverse drug reaction 
(ADR). No single type of ADR occurred at an incidence of ≥5%. The most frequent ADRs observed at 
an incidence ≥1.0% were: Headache (3.9%), Electrocardiogram QTc Prolonged (3.4%), P.  falciparum 
infection (3.0%), Anaemia (2.8%), Eosinophilia (1.7%), Haemoglobin decreased (1.7%), Sinus 
tachycardia (1.7%), Asthenia (1.6%), Haematocrit [decreased] (1.6%), Pyrexia (1.5%), Red Blood 
Cell Count decreased (1.4%). A total of 6 (0.8%) subjects had serious ADRs in the study. 
 
In a second randomised trial, 1,038 children, aged between 6 months and 5 years, were exposed to 
Eurartesim and 71% were judged to have experienced an ADR. The following ADRs were observed at 
an incidence of ≥5.0%: Cough (32%), Pyrexia (22.4%), Influenza (16.0%), P. falciparum infection 
(14.1%), Diarrhoea (9.4%), Vomiting (5.5%) and Anorexia (5.2%). A total of 15 (1.5%) subjects had 
serious ADRs in the study. 
 
Tabulated list of adverse reactions 
In the tables below, ADRs are listed under system organ class (SOC), and ranked by headings of 
frequency. Within each frequency grouping, adverse reactions are presented in the order of decreasing 
seriousness, using the following convention: Very common (≥1/10), common (≥1/100 to <1/10), 
uncommon (≥1/1,000 to <1/100), rare (≥1/10,000 to <1/1,000), very rare (<1/10,000), not known 
(cannot be estimated from the available data). The table in this section is for adult patients only. A 
corresponding table for paediatric patients is presented in the specific section below.  
 
Frequency of ADRs in adult patients participating in clinical studies with Eurartesim: 
 



 
 

23 

SOC Very Common Common Uncommon 

Infections and 
infestations  

P. falciparum 
infection 

Respiratory tract infection  
Influenza 

Blood and lymphatic 
system disorders  Anaemia  

Metabolism and 
nutrition  
disorders 

  Anorexia 

Nervous system 
disorders  Headache 

Convulsion 
Dizziness 

Cardiac disorders  QTc prolonged Tachycardia 

Cardiac conduction disorders 
Sinus arrhythmias 
Bradycardia 

Respiratory, thoracic  
and mediastinal 
disorders 

  Cough 

Gastrointestinal 
disorders   

Vomiting  
Diarrhoea 
Nausea 
Abdominal pain 

Hepatobiliary disorders   
Hepatitis  
Hepatomegaly  
Abnormal liver function tests  

Skin and subcutaneous  
Tissue disorders   Pruritis 

Musculoskeletal and  
connective tissue 
disorders 

  Arthralgia Myalgia 

General disorders and  
administration site  
conditions 

 Asthenia  Pyrexia  

 
Description of selected adverse reactions  
The ADRs noted for Eurartesim were generally mild in severity, and the majority were non-serious. 
Reactions such as cough, pyrexia, headache, P. falciparum infection, anaemia, asthenia, anorexia and 
the observed changes in blood cell parameters are consistent with those expected in patients with acute 
malaria. The effect on prolongation of the QTc interval was observed on Day 2, and had resolved by 
Day 7 (the next time point at which ECGs were performed).  
 
Paediatric population 
A tabular overview of the frequency of the ADRs in paediatric patients is given below.  The majority 
of paediatric experience is derived from African children aged 6 months to 5 years. 
 
Frequency of ADRs in paediatric patients participating in clinical studies with Eurartesim: 
 

SOC Very Common Common Uncommon 

Infections and 
infestations 

Influenza  
P. falciparum 
infection 

Respiratory tract 
infection  
Ear infection 

 

Blood and lymphatic 
 system disorders  

Thrombocytopenia 
Leukopenia/neutrope
nia 
Leuckocytoses NEC 
Anaemia 

 
Thrombocythaemia 
Splenomegaly 
Lymphadenopathy 
Hypochromasia 



 
 

24 

SOC Very Common Common Uncommon 

Metabolism and 
nutrition  
disorders 

 Anorexia  

Nervous system 
disorders   

Convulsion 
Headache 

Eye disorders  Conjunctivitis  

Cardiac disorders  QT/QTc prolonged Heart rate irregular 

Cardiac conduction 
disorders 
Cardiac murmur 

Respiratory, thoracic  
and mediastinal 
disorders 

Cough  Rhinorrhoea Epistaxis 

Gastrointestinal 
disorders  

Vomiting  
Diarrhoea 
Abdominal pain 

 
Stomatitis 
Nausea 

Hepatobiliary disorders   

Hepatitis  
Hepatomegaly 
Abnormal liver function 
tests 
Jaundice 

Skin and subcutaneous  
Tissue disorders  

Dermatitis  
Rash 

Acanthosis 
Pruritis 

Musculoskeletal and  
connective tissue 
disorders 

  Arthralgia 

General disorders and  
administration site  
conditions 

Pyrexia Asthenia  

 
Reporting of suspected adverse reactions 
Reporting suspected adverse reactions after authorisation of the medicinal product is important. It 
allows continued monitoring of the benefit/risk balance of the medicinal product. Healthcare 
professionals are asked to report any suspected adverse reactions via the national reporting system 
listed in Appendix V. 
 
4.9 Overdose 
 
In clinical trials, nine patients received double the cumulative intended dose of Eurartesim. The safety 
profile of these patients did not differ from that of patients receiving the recommended dose, with no 
patient reporting SAEs.  
 
In cases of suspected overdose, symptomatic and supportive therapy should be given as appropriate, 
including ECG monitoring because of the possibility of QTc interval prolongation (see section 4.4) 
 
 
5. PHARMACOLOGICAL PROPERTIES 
 
5.1  Pharmacodynamic properties  
 
Pharmacotherapeutic group: Antiprotozoals, antimalarials, Artemisinin and derivatives, combinations, 
ATC code: P01BF05. 
 

http://www.ema.europa.eu/docs/en_GB/document_library/Template_or_form/2013/03/WC500139752.doc
http://www.ema.europa.eu/docs/en_GB/document_library/Template_or_form/2013/03/WC500139752.doc
http://www.whocc.no/atc_ddd_index/?code=P01
http://www.whocc.no/atc_ddd_index/?code=P01B
http://www.whocc.no/atc_ddd_index/?code=P01BF


 
 

25 

Pharmacodynamic effects 
Artenimol is able to reach high concentrations within the parasitized erythrocytes. Its endoperoxide 
bridge is thought to be essential for its antimalarial activity, causing free-radical damage to parasite 
membrane systems including:  
• Inhibition of falciparum sarcoplasmic-endoplasmic reticulum calcium ATPase, 
• Interference with mitochondrial electron transport 
• Interference with parasite transport proteins 
• Disruption of parasite mitochondrial function 
 
The exact mechanism of action of piperaquine is unknown, but it likely mirrors that of chloroquine, a 
close structural analogue. Chloroquine binds to toxic haeme (derived from the patient’s haemoglobin) 
within the malaria parasite, preventing its detoxification via a polymerisation step.  
 
Piperaquine is a bisquinoline, and this class has shown good antimalarial activity against chloroquine-
resistant Plasmodium strains in vitro. The bulky bisquinolone structure may be important for activity 
against chloroquine- resistant strains, and may act through the following mechanisms: 
• Inhibition of the transporters that efflux chloroquine from the parasite food vacuole  
• Inhibition of haem-digestion pathway in the parasite food vacuole. 

 
Resistance to piperaquine (when used as monotherapy) has been reported.  
 
The efficacy and safety of Eurartesim have been assessed in two large randomised, open-label clinical 
trials: 
 
Study DM040010 was conducted in Asian adult and paediatric patients with uncomplicated 
P. falciparum malaria. Eurartesim treatment was compared with Artesunate + Mefloquine (AS + MQ). 
The primary end-point was the PCR-corrected cure rate at Day 63. 
 
Study DM040011 was conducted in African paediatric patients with uncomplicated P. falciparum 
malaria. Eurartesim treatment was compared with Artemether + Lumefantrine (A + L). The primary 
end-point was PCR-corrected cure rate at Day 28. 
 
The results for the primary endpoint in the modified intent to treat (m-ITT) populations (defined as all 
randomised patients who received at least one dose of the study treatment, with the exclusion of those 
patients lost to follow up for unknown reasons) were as follows: 
 

Study 

PCR-corrected cure rate (m-ITT) 

Eurartesim AS + MQ A + L 

95 % two-sided CI on 
the treatment difference 

(Eurartesim - 
Comparator); p-value 

DM040010 (n=1087) 97.0% 95.3% - (-0.84, 4.19)%; p=0.161 
DM040011 (n=1524) 92.7% - 94.8% (-4.59, 0.45)%; p=0.128 

 
In each case the results confirmed that Eurartesim was not inferior to the comparator medicinal 
product. In both studies, the true treatment failure rate was below the 5% efficacy threshold set by 
WHO. 
 
The age-specific PCR-corrected cure rates in the m-ITT populations are tabulated below for the Asian 
and African studies, respectively:  
 



 
 

26 

Study 

PCR-corrected cure rate (m-ITT) 

Eurartesim AS + MQ A + L 

95% two-sided CI on the 
treatment difference 

(Eurartesim - Comparator); 
p-value 

DM04010 (n=1087) 
≤5years 
>5 to ≤12years 
>12 to ≤18 years 
>18 to ≤64 years 

 
100.0% 
98.2% 
97.3% 
96.6% 

 
100.0% 
96.5% 

100.0% 
94.4% 

 
- 
- 
- 
- 

 
- 

(-3.67, 7.09)%; 0.605 
(-6.40, 0.99)%; 1.000 
(-0.98, 5.30)%; 0.146 

DM04011 (n=1524) 
≤1 year 
>1 to ≤ 2 years 
>2 to ≤5 years 

 
91.5% 
92.6% 
93.0% 

 
- 
- 
- 

 
98.5% 
94.6% 
94.0% 

 
(-12.66, -1.32)%(1); 0.064 

(-6.76, 2.63)%; 0.413 
(-4.41, 2.47)%; 0.590 

(1) This CI is asymptotic because the exact CI could not be computed 
 
In the European Safety Registry 25 patients weighing ≥ 100 kg (range 100 -121 kg) were treated with 4 
tablets 320/40 mg PQP/artenimol for 3 days. Twenty-two of these patients were shown to be parasitic 
free at the last microscopic analysis of the blood sample; three patients did not complete parasitological 
blood analysis. All patients were clinically cured. 

 
 
5.2 Pharmacokinetic properties  
 
Pharmacokinetic profiles of artenimol and piperaquine have been investigated in animal models and in 
different human populations (healthy volunteers, adult patients and paediatric patients). 
 
Absorption 
Artenimol is very rapidly absorbed, Tmax being approximately 1-2 hrs after single and multiple dosing. 
In patients, mean Cmax (CV%) and AUCINF of artenimol (observed after the first dose of Eurartesim) 
were 752 (47%) ng/ml and 2,002 (45 %) ng/ml*h, respectively. 
 
Artenimol bioavailability appears to be higher in malaria patients than in healthy volunteers, possibly 
because malaria per se has an effect on artenimol disposition. This may reflect malaria-associated 
impairment of hepatic function, causing an increase in artenimol bioavailability (reduction of first 
hepatic effect) without affecting its apparent elimination half-life, which is absorption rate limited. In 
healthy male volunteers under fasting conditions, mean Cmax and AUCINF of artenimol ranged between 
180-252 ng/ml and 516-684 ng/ml*h, respectively. 
 
The systemic exposure to artenimol was slightly lower following the last dose of Eurartesim (lower 
than after the first dose by up to 15%). Artenimol pharmacokinetic parameters were found to be 
similar in healthy volunteers of Asian and Caucasian origin. artenimol systemic exposure on the last 
day of treatment was higher in females than in males, the difference being within 30%. 
 
In healthy volunteers, artenimol exposure was increased by 43% when administered with a high 
fat/high calorie meal.  
 
Piperaquine, a highly lipophilic compound, is slowly absorbed. In humans, piperaquine has a Tmax of 
approximately 5 hours following a single and repeated dose. In patients mean (CV%) Cmax and  
AUC0-24 (observed after the first dose of Eurartesim) were 179 (62%) ng/ml and 1,679 (47%) ng/ml*h, 
respectively. Due to its slow elimination, piperaquine accumulates in plasma after multiple doses with 
an accumulation factor of approximately 3. Piperaquine pharmacokinetic parameters were found to be 
similar in healthy volunteers of Asian and Caucasian origin. On the other hand, on the last day of 



 
 

27 

Eurtartesim treatment, the piperaquine maximum plasma concentration was higher in female than in 
male healthy volunteers, the difference being in the order of 30 to 50%. 
 
In healthy volunteers, piperaquine exposure is increased approximately 3-fold when administered with 
a high fat/high calorie meal. This pharmacokinetic effect is accompanied by an increased effect on 
prolongation of the QT interval. Accordingly, Eurartesim should be administered with water no less 
than 3 hours after the last food intake, and no food should be taken within 3 hours after each dose  
(see section 4.2). 
 
Distribution 
Both piperaquine and artenimol are highly bound to human plasma proteins: the protein binding 
observed in in vitro studies was 44-93% for artenimol and >99% for piperaquine. Moreover, from 
in vitro and in vivo data in animals, piperaquine and artenimol tend to accumulate in RBC. 
 
Artenimol was observed to have a small volume of distribution in humans (0.8 l/kg; CV 35.5%).  
Pharmacokinetic parameters observed for piperaquine in humans indicate that this active substance has 
a large volume of distribution (730 l/kg; CV 37.5%). 
 
Biotransformation 
Artenimol is principally converted to α- artenimol-β-glucuronide (α- artenimol-G). Studies in human 
liver microsomes showed that artenimol was metabolised by the UDP-glucuronosyltransferase 
(UGT1A9 and UGT2B7) to α- artenimol-G with no cytochrome P450-mediated metabolism. In vitro 
drug-drug interaction studies revealed that artenimol is an inhibitor of CYP1A2; therefore, there is the 
potential for artenimol to increase plasma concentrations of CYP1A2 substrates (see section 4.5). 
 
In vitro metabolism studies demonstrated that piperaquine is metabolised by human hepatocytes 
(approximately 85% of piperaquine remained after 2 hours incubation at 37°C). Piperaquine was 
mainly metabolised by CYP3A4 and to a lesser extent by CYP2C9 and CYP2C19. Piperaquine was 
found to be an inhibitor of CYP3A4 (also in a time-dependent way) and to a lesser extent of 
CYP2C19, while it stimulated the activity of CYP2E1.  
 
No effect on the metabolite profile of piperaquine in human hepatocytes was observed when 
piperaquine was co-incubated with artenimol. The piperaquine major metabolites were a carboxyl 
acid cleavage product, and a mono-N-oxidated product. 
 
In human studies, piperaquine was found to be a mild inhibitor of CYP3A4 enzyme while potent 
inhibitors of CYP3A4 activity caused mild inhibition of piperaquine metabolism (see section 4.5). 
 
Elimination 
The elimination half-life of artenimol is approximately 1 hour. The mean oral clearance for adult 
patients with malaria was 1.34 l/h/kg. The mean oral clearance was slightly higher for paediatric 
patients, however the differences were minor in magnitude (<20%). artenimol is eliminated by 
metabolism (mainly glucuroconjugation). Its clearance was found to be slightly lower in female than 
in male healthy volunteers. Data regarding artenimol excretion in humans are scarce. However, it is 
reported in the literature that the excretion of unchanged active substance in human urine and faeces is 
negligible for artemisinin derivatives.  
 
The elimination half-life of piperaquine is around 22 days for adult patients and around 20 days for 
paediatric patients. The mean oral clearance for adult patients with malaria was 2.09 l/h/kg, while in 
paediatric patients was 2.43 l/h/kg. Due to its long elimination half-life, piperaquine accumulates after 
multiple dosing. 
 
Animal studies showed that radiolabelled piperaquine is excreted by the biliary route, while urinary 
excretion is negligible.  
 



 
 

28 

Pharmacokinetics in special patient populations 
No specific pharmacokinetic studies have been performed in patients with hepatic or renal 
insufficiency, or in elderly people.  
 
In a paediatric pharmacokinetic study, and based on very limited sampling, minor differences were 
observed for artenimol pharmacokinetics between the paediatric and adult populations. The mean 
clearance (1.45 l/h/kg) was slightly faster in the paediatric patients than in the adult patients 
(1.34 l/h/kg), while the mean volume of distribution in the paediatric patients (0.705 l/kg) was lower 
than in the adults (0.801 l/kg).   
 
The same comparison showed that piperaquine absorption rate constant and terminal half-life in 
children were predominantly similar to those seen in adults. However, the apparent clearance was 
faster (1.30 versus 1.14 l/h/kg) and the apparent total volume of distribution was lower in the 
paediatric population (623 versus 730 l/kg).  
 
5.3 Preclinical safety data 
 
General toxicity 
Literature data concerning chronic toxicity of piperaquine in dogs and monkeys indicate some 
hepatotoxicity and mild reversible depression of total white cell and neutrophil counts. 
 
The most important nonclinical safety findings after repeated dosing were the infiltration of 
macrophages with intracytoplasmic basophilic granular material consistent with phospholipidosis and 
degenerative lesions in numerous organs and tissues. These adverse reactions were seen in animals at 
exposure levels similar to clinical exposure levels, and with possible relevance to clinical use. It is not 
known whether these toxic effects are reversible. 
 
Artenimol and piperaquine were not genotoxic/clastogenic based on in vitro and in vivo testing. 
 
No carcinogenicity studies have been performed. 
 
Artenimol causes embryolethality and teratogenicity in rats and rabbits.  
 
Piperaquine did not induce malformation in rats and rabbits. In a perinatal and postnatal development 
study (segment III) in female rats treated with 80 mg/kg, some animals had a delay of delivery 
inducing mortality of the neonates. In females delivering normally the development, behaviour and 
growth of the surviving progeny was normal following exposure in utero or via milk. 
 
No reproduction toxicity studies have been performed with the combination of artenimol and 
piperaquine. 
 
Central nervous system (CNS) toxicity 
There is potential for neurotoxicity of artemisinin derivatives in man and animals, which is strongly 
related to the dose, route and formulations of the different artenimol pro-drugs. In humans, the 
potential neurotoxicity of orally administered artenimol can be considered highly unlikely, given the 
rapid clearance ofartenimol, and its short exposure (3 days of treatment for malaria patients). There 
was no evidence of artenimol-induced lesions in the specific nuclei in rats or dogs, even at lethal dose. 
 



 
 

29 

Cardiovascular toxicity 
Effects on blood pressure and on PR and QRS duration were observed at high piperaquine doses. The 
most important potential cardiac effect was related to cardiac conduction. 
 
In the hERG test, the IC50 was 0.15 µmol for piperaquine and 7.7 µmol forartenimol. The association 
of artenimol and piperaquine does not produce hERG inhibition greater than that of the single 
compounds. 
 
Phototoxicity  
There are no phototoxicity concerns withartenimol, as it does not absorb in the range of 290-700 nm.  
Piperaquine has an absorption maximum at 352 nm. Since piperaquine is present in the skin (about 9% 
in the non-pigmented rat and only 3% in the pigmented rat), slight phototoxic reactions (swelling and 
erythema) were observed 24 hours after oral treatment in mice exposed to UV radiation.  
 
 
6. PHARMACEUTICAL PARTICULARS 
 
6.1 List of excipients 
 
Tablet core 
Pre-gelatinised starch 
Dextrin  
Hypromellose (E464)  
Croscarmellose sodium 
Magnesium stearate (E572) 
 
Film coating  
Hypromellose (E464) 
Titanium dioxide (E171) 
Macrogol 400 
 
6.2 Incompatibilities 
 
Not applicable. 
 
6.3 Shelf life 
 
2 years. 
 
6.4 Special precautions for storage 
 
Do not store above 30°C. 
Store in the original package in order to protect from light and moisture. 
 
6.5 Nature and contents of container 
 
Eurartesim tablets are packaged in PVC/PVDC/aluminium blisters containing 3, 6, 9 or 12 tablets. 
 
6.6 Special precautions for disposal 
 
No special requirements. 
 
 



 
 

30 

7. MARKETING AUTHORISATION HOLDER 
 
Alfasigma S.p.A. 
Via Ragazzi del ’99, n. 5 
40133 Bologna 
Italy 
 
Tel: +39  051 6489602 
Fax: +39  051 388689 
Email:  antonietta.pazardjiklian@alfasigma.com 
 
 
8. MARKETING AUTHORISATION NUMBER(S)  
 
EU/1/11/716/001  
EU/1/11/716/002  
EU/1/11/716/003  
EU/1/11/716/004  
 
 
9. DATE OF FIRST AUTHORISATION/RENEWAL OF THE AUTHORISATION 
 
Date of first authorisation: 27 October 2011 
Date of latest renewal: 09 September 2016 
 
 
10. DATE OF REVISION OF THE TEXT 
 
 
Detailed information on this medicinal product is available on the website of the European Medicines 
Agency http://www.ema.europa.eu. 
 
 
  

mailto:antonietta.pazardjiklian@alfasigma.com
http://www.ema.europa.eu/


 
 

31 

 
 
 
 
 
 

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

ANNEX II 

A MANUFACTURER RESPONSIBLE FOR BATCH RELEASE 

B. CONDITIONS OR RESTRICTIONS REGARDING SUPPLY AND USE 

C. OTHER CONDITIONS AND REQUIREMENTS OF THE MARKETING 
AUTHORISATION 

D.  CONDITIONS OR RESTRICTIONS WITH REGARD TO THE SAFE AND 
EFFECTIVE USE OF THE MEDICINAL PRODUCT 



 
 

32 

A. MANUFACTURER RESPONSIBLE FOR BATCH RELEASE 
 
Name and address of the manufacturer responsible for batch release 
 
Alfasigma S.p.A. 
Via Pontina Km 30.400 
IT-00071 Pomezia (RM) 
Italy 
 
 
B. CONDITIONS OR RESTRICTIONS REGARDING SUPPLY AND USE 
 
Medicinal product subject to medical prescription. 
 
 
C. OTHER CONDITIONS AND REQUIREMENTS OF THE MARKETING 

AUTHORISATION 
 

• Periodic Safety Update Reports  
 
The requirements for submission of periodic safety update reports for this medicinal product are 
set out in the list of Union reference dates (EURD list) provided for under Article 107c(7) of 
Directive 2001/83/EC and any subsequent updates published on the European medicines web-
portal. 
 
 
 
D. CONDITIONS OR RESTRICTIONS WITH REGARD TO THE SAFE AND 

EFFECTIVE USE OF THE MEDICINAL PRODUCT 
 

• Risk Management Plan (RMP) 
 
The MAH shall perform the required pharmacovigilance activities and interventions detailed in the 
agreed RMP presented in Module 1.8.2. of the Marketing Authorisation and any agreed subsequent 
updates of the RMP. 
  
An updated RMP should be submitted: 
− At the request of the European Medicines Agency. 
− Whenever the risk management system is modified, especially as the result of new information 

being received that may lead to a significant change to the benefit/risk profile or as the result of 
an important (pharmacovigilance or risk minimisation) milestone being reached.  

 
If the dates for submission of a PSUR and the update of a RMP coincide, they can be submitted at the 
same time. 
 
• Additional risk minimisation measures  
 
The Marketing Authorisation Holder shall ensure that all physicians who are expected to prescribe or 
use Eurartesim are provided with a healthcare profession educational pack containing the following: 
• The Summary of Product Characteristics 
• The Patient Information Leaflet 
• The Physician Leaflet including the Contraindicated Conditions of Use and Contraindicated 

Concomitant Medication checklist 
 



 
 

33 

The Physician Leaflet should contain the following key messages: 
• That Eurartesim has a potential to prolong the QTc interval that may lead to potentially lethal 

arrhythmias.  
• That piperaquine absorption is increased in the presence of food, therefore to reduce this risk of 

QTc interval prolongation, the patients should be advised to take the tablets with water, without 
food, no less than three hours after the last food intake.  No food should be taken within 3 hours 
after each dose. 

• That Eurartesim is contraindicated in patients with severe malaria according to WHO definition 
and in patients with a history of clinical conditions that may lead to QTc interval prolongation, 
and in patients taking drugs that are known to prolong the QTc interval. 

• The ECG monitoring recommendations. 
• The scope and use of the Contraindicated Conditions of Use and Contraindicated Concomitant 

Medication checklist 
• That there is a potential risk of teratogenicity and so Eurartesim should not be used in the 1st 

trimester of pregnancy in situations where other suitable and effective anti-malarials are 
available. 

• The need to counsel patients on important risks associated with Eurartesim therapy and 
appropriate precautions when using the medicine.  

• That patients should be advised to contact their doctor about adverse events and that 
physicians/pharmacists should report suspected adverse reactions to Eurartesim, and in 
particular, those associated with a QT prolongation. 

 
 
  



 
 

34 

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

ANNEX III 
 

LABELLING AND PACKAGE LEAFLET 
 

 
  



 
 

35 

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

A. LABELLING 
 

  



 
 

36 

PARTICULARS TO APPEAR ON THE OUTER PACKAGING  
OUTER CARTON  
 
 
1. NAME OF THE MEDICINAL PRODUCT 
 
Eurartesim 160 mg/20 mg film-coated tablets 
piperaquine tetraphosphate/artenimol 
 
 
2. STATEMENT OF ACTIVE SUBSTANCE(S) 
 
Each film-coated tablet contains 160 mg of piperaquine tetraphosphate (as the tetrahydrate) and 20 mg 
of artenimol. 
 
 
3. LIST OF EXCIPIENTS 
 
 
4. PHARMACEUTICAL FORM AND CONTENTS 
 
Film-coated tablet 
3 tablets 
 
 
5. METHOD AND ROUTE(S) OF ADMINISTRATION 
 
Oral use. 
Read the package leaflet before use. 
 
 
6. SPECIAL WARNING THAT THE MEDICINAL PRODUCT MUST BE STORED OUT 

OF THE SIGHT AND REACH OF CHILDREN 
 
Keep out of the sight and reach of children. 
 
 
7. OTHER SPECIAL WARNING(S), IF NECESSARY 
 
Take at least 3 hours before or after food. 
 
 
8. EXPIRY DATE 
 
EXP 
 
 
9. SPECIAL STORAGE CONDITIONS 
 
Do not store above 30°C 
Store in the original package in order to protect from light and moisture. 
 
 
 



 
 

37 

 
 
10. SPECIAL PRECAUTIONS FOR DISPOSAL OF UNUSED MEDICINAL PRODUCTS 

OR WASTE MATERIALS DERIVED FROM SUCH MEDICINAL PRODUCTS, IF 
APPROPRIATE 

 
 
11. NAME AND ADDRESS OF THE MARKETING AUTHORISATION HOLDER 
 
Alfasigma S.p.A. 
Via Ragazzi del ’99, n. 5 40133 Bologna  
Italy 
 
 
12. MARKETING AUTHORISATION NUMBER(S)  
 
EU/1/11/716/005 3 film-coated tablets 
 
 
13. BATCH NUMBER 
 
Lot  
 
 
14. GENERAL CLASSIFICATION FOR SUPPLY 
 
Medicinal product subject to medical prescription. 
 
 
15. INSTRUCTIONS ON USE 
 
 
16. INFORMATION IN BRAILLE 
 
Eurartesim  
 
 
17. UNIQUE IDENTIFIER – 2D BARCODE 
 
2D barcode carrying the unique identifier included. 
 
 
18. UNIQUE IDENTIFIER - HUMAN READABLE DATA 
 
PC: {number} [product code] 
SN: {number} [serial number] 
NN: {number} [national reimbursement number or other national number identifying the medicinal 
product] 
 
  



 
 

38 

MINIMUM PARTICULARS TO APPEAR ON BLISTERS OR STRIPS 
 
BLISTER 

 
 

1. NAME OF THE MEDICINAL PRODUCT 
 
Eurartesim 160 mg/20 mg tablets 
piperaquine tetraphosphate/artenimol 
 
 

2. NAME OF THE MARKETING AUTHORISATION HOLDER 
 
Alfasigma S.p.A. 
 
 

3. EXPIRY DATE 
 
EXP 
 
 

4. BATCH NUMBER 
 
Lot  
 
 

5. OTHER 



 
 

39 

PARTICULARS TO APPEAR ON THE OUTER PACKAGING  
OUTER CARTON 
 
 
1. NAME OF THE MEDICINAL PRODUCT 
 
Eurartesim 320 mg/40 mg film-coated tablets 
piperaquine tetraphosphate / artenimol 
 
 
2. STATEMENT OF ACTIVE SUBSTANCE(S) 
 
Each film-coated tablet contains 320 mg of piperaquine tetraphosphate (as the tetrahydrate ) and 
40 mg of artenimol. 
 
 
3. LIST OF EXCIPIENTS 
 
 
4. PHARMACEUTICAL FORM AND CONTENTS 
 
Film-coated tablets. 3 tablets 
Film-coated tablets. 6 tablets 
Film-coated tablets. 9 tablets 
Film-coated tablets. 12 tablets 
 
 
5. METHOD AND ROUTE(S) OF ADMINISTRATION 
 
Oral use. 
Read the package leaflet before use. 
 
 
6. SPECIAL WARNING THAT THE MEDICINAL PRODUCT MUST BE STORED OUT 

OF THE SIGHT AND REACH OF CHILDREN 
 
Keep out of the sight and reach of children. 
 
7. OTHER SPECIAL WARNING(S), IF NECESSARY 
 
Take at least 3 hours before or after food. 
 
8. EXPIRY DATE 
 
EXP 
 
 
9. SPECIAL STORAGE CONDITIONS 
 
Do not store above 30°C 
Store in the original package in order to protect from light and moisture. 
 
 
 
 



 
 

40 

 
10. SPECIAL PRECAUTIONS FOR DISPOSAL OF UNUSED MEDICINAL PRODUCTS 

OR WASTE MATERIALS DERIVED FROM SUCH MEDICINAL PRODUCTS, IF 
APPROPRIATE 

 
 
11. NAME AND ADDRESS OF THE MARKETING AUTHORISATION HOLDER 
 
Alfasigma S.p.A. 
Via Ragazzi del ’99, n. 5 40133 Bologna 
Italy 
 
 
12. MARKETING AUTHORISATION NUMBER(S)  
 
EU/1/11/716/001 3 film-coated tablets  
EU/1/11/716/002 6 film-coated tablets 
EU/1/11/716/003 9 film-coated tablets 
EU/1/11/716/004 12 film-coated tablets 
 
 
13. BATCH NUMBER 
 
Lot  
 
 
14. GENERAL CLASSIFICATION FOR SUPPLY 
 
Medicinal product subject to medical prescription. 
 
 
15. INSTRUCTIONS ON USE 
 
 
16. INFORMATION IN BRAILLE 
 
Eurartesim  
 
 
17. UNIQUE IDENTIFIER – 2D BARCODE 
 
2D barcode carrying the unique identifier included. 
 
 
 
18. UNIQUE IDENTIFIER - HUMAN READABLE DATA 
 
PC: {number} [product code] 
SN: {number} [serial number] 
NN: {number} [national reimbursement number or other national number identifying the medicinal 
product] 
 
 
 
 



 
 

41 

MINIMUM PARTICULARS TO APPEAR ON BLISTERS OR STRIPS 
 
BLISTER 

 
 

1. NAME OF THE MEDICINAL PRODUCT 
 
Eurartesim 320 mg/40 mg tablets 
piperaquine tetraphosphate / artenimol 
 
 

2. NAME OF THE MARKETING AUTHORISATION HOLDER 
 
Alfasigma S.p.A 
 
 

3. EXPIRY DATE 
 
EXP 
 
 

4. BATCH NUMBER 
 
Lot 
 
 

5. OTHER 
 
 

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 



 
 

42 

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

B.  PACKAGE LEAFLET  



 
 

43 

Package leaflet: information for the user 
 

Eurartesim 160 mg/20 mg film-coated tablets  
Piperaquine tetraphosphate/artenimol 

 
 

 
Read all of this leaflet carefully before you start using this medicine because it contains 
important information for you. 
− Keep this leaflet. You may need to read it again. 
− If you have any further questions, ask your doctor or pharmacist. 
− This medicine has been prescribed for you only.  Do not pass it on to others. It may harm them, 

even if their signs of illness are the same as yours. 
− If you get any side effects, talk to your doctor or pharmacist. This includes any possible side 

effects not listed in this leaflet. See section 4. 
 
What is in this leaflet: 
 
1. What Eurartesim is and what it is used for 
2. What you need to know before you or your child takes Eurartesim  
3. How to take Eurartesim  
4. Possible side effects 
5. How to store Eurartesim 
6. Contents of the pack and other information 
 
 
1. What Eurartesim is and what it is used for 
 
Eurartesim contains the active substances piperaquine tetraphosphate and artenimol. It is used to treat 
uncomplicated malaria when use of a medicine given by mouth is appropriate. 
 
Malaria is caused by infection with a parasite called Plasmodium, spread by the bite of an infected 
mosquito.There are different types of Plasmodium parasite. Eurartesim kills the Plasmodium 
falciparum parasite. 
 
The medicine can be taken by adults, adolescents, children and infants over 6 months old who weigh 5 
kilograms or more. 
 
 
2.  What you need to know before you or your child takes Eurartesim 
 
Do not take Eurartesim if you or your child: 
• is allergic to the active substances, piperaquine tetraphosphate or artenimol, or to any of the 

other ingredients of this medicine (listed in section 6);  
• has a severe type of malaria infection which has affected parts of the body such as the brain, 

lungs or kidneys; 
• has a heart condition, such as changes to the rhythm or rate of heart beat, or heart disease; 
• knows that any member of your family (parents, grandparents, brothers or sisters) died suddenly 

due to a heart problem or was born with heart problems; 
• suffers from changes to the levels of salts in the body (electrolyte imbalances); 
• is taking other medicines that can have an effect on heart rhythm, such as: 



 
 

44 

- quinidine, disopyramide, procainamide, amiodarone, dofetilide, ibutilide, hydroquinidine 
or sotalol; 

- medicines used to treat depression such as amitriptyline, fluoxetine or sertraline; 
- medicines used to treat mental health problems such as phenothiazines, sertindole, 

sultopride, chlorpromazine, haloperidol, mesoridazine, pimozide, or thioridazine; 
- medicines used to treat infections. These include some of the types of medicines used to 

treat bacterial infections (macrolides [such as erythromycin or clarithromycin] and 
fluoroquinolones [such as moxifloxacin and sparfloxacin]) or fungal infections (including 
fluconazole and imidazole) as well as pentamidine (used to treat a specific type of 
pneumonia) and saquinavir (for treatment of HIV); 

- antihistamines used to treat allergies or inflammation such as terfenadine, astemizole or 
mizolastine; 

- certain medicines used to treat stomach problems such as cisapride, domperidone or 
droperidol; 

- other medicines such as vinca alkaloids and arsenic trioxide (used to treat certain 
cancers), bepridil (used to treat angina), diphemanil (used to treat stomach disturbances), 
levomethadyl and methadone (used to treat drug addiction), and probucol (used to treat 
high blood cholesterol levels). 

• has recently (for example within about one month) been treated for malaria with certain 
medicines or has taken certain medicines to prevent malaria. These medicines include: 
mefloquine, halofantrine, lumefantrine, chloroquine or quinine 

 
If any of the above applies to you or your child or if you are unsure, tell your doctor or pharmacist 
before taking or giving Eurartesim. 
 
Warnings and precautions 
Talk to your doctor or pharmacist before taking this medicine if you or your child: 
• has liver or kidney problems; 
• has a malaria infection caused by a parasite other than Plasmodium falciparum; 
• is taking or has taken any other medicines for the treatment of malaria (other than those 

mentioned above);  
• is in the 1st trimester of pregnancy or breastfeeding (see below); 
• is female, elderly (over 65 years) or vomiting; 
• is taking certain other medicines which could cause possible metabolic interactions. Examples 

are listed in the section “Other medicines and Eurartesim”. 
If you are not sure about any of the above, please ask your doctor or pharmacist. 
 
Children 
Do not give this medicine to infants under 6 months or below 5 kg in weight. 
 
Other medicines and Eurartesim 
Tell your doctor or pharmacist if you or your child is taking, has recently taken or might take any other 
medicines. Some medicines can affect the way Eurartesim works and your doctor may decide that 
Eurartesim is not suitable or that extra checks are needed while you or your child is taking the 
medicines which could cause possible interactions. Examples are listed below (but there are several 
others): 
- some medicines used to treat high cholesterol in the blood (such as atorvastatin, lovastatin, 

simvastatin); 
- medicines used to treat hypertension and heart problems (such as diltiazem, nifedipine, 

nitrendipine, verapamil, felodipine, amlodipine); 
- some medicines used to treat HIV (antiretroviral medicinese): protease inhibitors (such as 

amprenavir, atazanavir, indinavir, nelfinavir, ritonavir), non-nucleoside reverse transcriptase 
inhibitors (such as efavirenz, nevirapine); 

- some medicines used to treat microbial infections (such as telithromycin, rifampicin, dapsone); 
- medicines used to help you fall asleep: benzodiazepines (such as midazolam, triazolam, 

diazepam, alprazolam), zaleplon, zolpidem; 



 
 

45 

- medicines used to prevent/treat epileptic seizures: barbiturates (such as phenobarbital), 
carbamazepine or phenytoin; 

- medicines used after organ transplantation and in autoimmune diseases (such as cyclosporin, 
tacrolimus); 

- sex hormones, including those contained in hormonal contraceptives (such as gestodene, 
progesterone, estradiol),  testosterone; 

- glucocorticoids (hydrocortisone, dexamethasone); 
- omeprazole (used to treat diseases related to gastric acid production); 
- paracetamol (used to treat pain and fever); 
- theophylline (used to improve bronchial air flow); 
- nefazodone (used to treat depression); 
- aprepitant (used to treat nausea); 
- some gases (such as enflurane, halothane and isoflurane) used to give a general anaesthetic. 
 
Eurartesim with food and drink 
You should take the Eurartesim tablets with water only. 
You should not take Eurartesim with grapefruit juice due to possible interactions. 
 
Pregnancy and breast-feeding 
Tell your doctor if you are in the 1st trimester of pregnancy, think you may be pregnant or become 
pregnant, or if you are breast-feeding. Based on animal data Eurartesim is suspected to harm the 
unborn child when used during the first three months of pregnancy. Therefore Eurartesim must not be 
used in the 1st trimester of pregnancy if your doctor can give you an alternative medicine. If you find 
out that you are pregnant within one month from taking Eurartesim, please inform your doctor. The 
exposure of pregnant women during the 2nd and 3rd trimester was not associated with any harm of the 
unborn child. If Eurartesim is more suitable for a pregnant woman than other artemisinin-based 
combination therapies with a higher range of experience (or sulfadoxine–pyrimethamine), Eurartesim 
may be used in the 2nd and 3rd trimester. 

 
You should not breast-feed your baby while taking this medicine because the medicine may pass 
through breast milk to your baby. 
 
If you are taking folate supplements to prevent possible neural tube birth defects, you can continue 
taking them at the same time as Eurartesim. 
 
Ask your doctor or pharmacist for advice before taking any medicine during pregnancy or breast-
feeding. 
 
 
Driving and using machines 
You can drive or use machines after taking Eurartesim once you have recovered from your illness. 
 
 
3. How to take Eurartesim 
 
Always take Eurartesim exactly as your doctor has told you to. Check with your doctor or pharmacist 
if you are not sure. 
  
You or your child should take this medicine on an empty stomach. You or your child should take each 
dose no less than 3 hours after the last food intake, and no food should be taken within 3 hours after 
each dose of Eurartesim. You or your child can drink water at any time. 
 
If the tablets are difficult to swallow, you can crush  and mix them with water; drink the mixture 
immediately. 
 



 
 

46 

A course of Eurartesim lasts 3 consecutive days. Take one dose on each day. You should try to take 
the dose at about the same time on each of the three days. 
 
The daily dose depends on the patient’s body weight. Your doctor should have prescribed a dose that 
is appropriate for your weight or your child’s weight as follows: 
 

Body weight 
(kg) Daily dose (mg) 

Total number of tablets for 
treatment  

5 to less than 7 Half 160 mg/20 mg  tablet a day 1.5 tablet  

7 to less than 13 One 160 mg/20 mg tablet a day 3 tablets 

13 to less than 24 One 320 mg/40 mg  tablet a day 3 tablets 

24 to less than 36 Two 320 mg/40 mg tablets a day 6 tablets 

36 to less than 75 Three 320 mg/40 mg tablets a day 9 tablets 

>75  Four 320 mg/40 mg tablets a day 12 tablets 
 
 
Vomiting when taking this medicine 
If this happens within: 
• 30 minutes of taking Eurartesim, the whole dose must be taken again. 
• 31-60 minutes, half the dose must be taken again. 
If you or your child vomit also the second dose, do not take or give your child another dose. Contact 
your doctor urgently to obtain an alternative treatment for malaria. 
 
Taking this medicine, if the malaria infection returns  
• If you or your child gets another attack of malaria, you may take a second course of Eurartesim 

within one year if your doctor thinks this is a suitable treatment. You or your child must not take 
more than two courses within one year. If this happens, talk to your doctor. You or your child 
should not take a second course of Eurartesim within 2 months of the first course. 

• If you or your child is infected more than twice in a year, your doctor will prescribe an 
alternative treatment. 

 
If you or your child takes more Eurartesim tablets than you should 
If you or your child takes more than the recommended dose, tell your doctor. Your doctor may suggest 
special monitoring for you or your child because doses higher than those recommended may have an 
unwanted, severe effect on the heart (see also section 4). 
 
If you or your child forgets to take Eurartesim 
If you or your child forgets to take the second dose of Eurartesim at the right time, take it as soon as 
you remember. Then take the third (last) dose approximately 24 hours after the second dose. 
If you or your child forgets to take the third (last) dose at the right time, take it as soon as you 
remember. Never take more than one dose on the same day to make up for a missed dose. 
Check with your doctor or pharmacist if you are not sure. 
 
If you or your child stops taking Eurartesim 
For the medicine to work effectively, you or your child should take the tablets as instructed and should 
complete the 3 days course of treatment.  If you or your child is not able to do this, talk to your doctor 
or pharmacist. 
 
If you have any further questions on the use of this medicine, ask your doctor or pharmacist. 
 
 
4. Possible side effects 
 



 
 

47 

Like all medicines, this medicine can cause side effects, although not everybody gets them. Most of 
the side effects are not severe and normally disappear within a few days or weeks after treatment.  
 
If you or your child gets a rash, swelling of the face, lips, tongue or throat with difficulty in 
swallowing or breathing, these may be signs of an allergic reaction. Tell your doctor immediately, or 
go immediately to the emergency department of your nearest hospital, taking this leaflet with you. 
 
A heart problem, called QT prolongation, can occur while taking Eurartesim and for some days after 
taking the last dose. This can cause a life-threatening abnormality of the heart rhythm. 
Your doctor may take electrical recordings of the heart (electrocardiogram, ECG) while you or 
your child is being treated and after the last dose is given. Your doctor will advise you when 
these readings will be taken.  
If you notice anything different about your or your child’s heart rhythm or have symptoms 
(such as palpitations or irregular heart beat) you should contact your doctor as soon as possible 
and before the next dose is due.  
 
Sometimes a problem with your red blood cells, called haemolytic anaemia can occur after receiving 
malaria treatment. Contact your doctor immediately if you or your child develops one or more of the 
following symptoms after treatment with Eurartesim: pale skin, general weakness, headache, shortness 
of breath and rapid heartbeat; particularly with exercise, confusion, dizziness, or dark-coloured urine.  
 
Side effects in adults 
 
Common (may affect up to 1 in 10 people) 
Anaemia, headache, heart rhythm disturbances (ECG changes or noticing unusually fast heart beats or 
palpitations), fever, general weakness. 
 
Uncommon (may affect up to 1 in 100 people) 
Influenza, respiratory infections, poor appetite or loss of appetite, dizziness, convulsions (fits),  
irregular or slow heart rate, cough, vomiting, abdominal pain, diarrhoea, nausea, inflammation or 
enlargement of the liver, abnormal liver function tests, itching, pain in the muscles or joints.  
 
Side effects in children 
 
Very common (may affect more than 1 in 10 people) 
Influenza, cough, fever. 
 
Common (may affect up to 1 in 10 people) 
Respiratory infections, ear infection, anaemia, abnormalities in various types of blood cells (white 
blood cells and platelets), poor appetite or loss of appetite, eye infection, heart rhythm disturbances 
(change as in adults, ECG changes), abdominal pain, vomiting, diarrhoea, skin inflammation, rash, 
general weakness. 
 
Uncommon (may affect up to 1 in 100 people) 
Abnormalities in red blood cells, excessive numbers of platelets, enlargement of some organs (such as 
liver or spleen), swollen lymph glands, convulsions (fits), headache, abnormal heart sounds (heard by 
your doctor with a stethoscope), nose bleeds, runny nose, nausea, inflammation of the mouth, 
inflammation or enlargement of the liver, jaundice, abnormal liver function blood tests, skin itching 
and inflammation, pain in the joints. 
 
Reporting of side effects 
 
If you get any side effects, talk to your doctor or pharmacist. This includes any possible side effects 
not listed in this leaflet. You can also report side effects directly via the national reporting system 
listed in Appendix V. By reporting side effects you can help provide more information on the safety of 
this medicine. 

http://www.ema.europa.eu/docs/en_GB/document_library/Template_or_form/2013/03/WC500139752.doc
http://www.ema.europa.eu/docs/en_GB/document_library/Template_or_form/2013/03/WC500139752.doc


 
 

48 

 
 
5. How to store Eurartesim 
 
Keep this medicine out of the sight and reach of children. 
 
Do not take this medicine after the expiry date which is stated on the package after ‘EXP’. The expiry 
date refers to the last day of that month. 
 
Do not store above 30°C. 
Store in the original package in order to protect from light and moisture. 
 
Do not use this medicine if you notice the blister is open.  
 
Do not throw away any medicines via wastewater or household waste. Ask your pharmacist how to 
throw away medicines you no longer use. These measures will help protect the environment. 
 
 
6. Contents of the pack and other information 
 
What Eurartesim contains 
The active substances are piperaquine tetraphosphate and artenimol. 
Each film-coated tablet contains 160 mg piperaquine tetraphosphate (as the tetrahydrate) and 20 mg 
artenimol.  
 
The other ingredients are: 
Tablet core: pre-gelatinised starch, dextrin, hypromellose (E464), croscarmellose sodium, magnesium 
stearate (E572). 
Film coating: hypromellose, titanium dioxide (E171), macrogol 400. 
 
What Eurartesim looks like and contents of the pack 
Eurartesim are white film-coated tablets, embossed and with a break line along the middle. 
 
The 160 mg/20 mg tablets have the letters ‘S’ and ‘T’ on one side and come in blisters containing 3 
tablets. 
 
Marketing Authorisation Holder  
 
Alfasigma S.p.A. 
Via Ragazzi del ’99, n. 5 
40133 Bologna 
Italy 
 
Tel: +39  051 6489602 
Fax: +39  051 388689 
Email:  antonietta.pazardjiklian@alfasigma.com 
 
Manufacturer 
 
Alfasigma S.p.A. 
Via Pontina km. 30.400 
00071 Pomezia (Rome) 
Italy 
 
 
For any information about this medicine, please contact the local representative of the Marketing 
Authorisation Holder: 

mailto:antonietta.pazardjiklian@alfasigma.com


 
 

49 

 
 
 
België/Belgique/Belgien  
Luxembourg/Luxemburg 
Alfasigma Belgium sprl/bvba  
Tel: +32 (0)2 420 93 16 
eurartesim.be@alfasigma.com 
 
Nederland       Deutschland 
Alfasigma Nederland BV     Pharmore GmbH 
Tel: +31 30 6702020     Tel: +49 (0) 5451 9690-0  
 info.nl@alfasigma.com      service@pharmore.de 
 
España       Portugal 
Alfasigma España, S.L.     Alfasigma Portugal, Lda 
Tel: +34 93 415 48 22      Tel: + 351 217 226 110  
info.es@alfasigma.com      geral@alfasigma.com 
 
France        
Alfasigma France   
Tél: +33 1 45 21 02 69      
regulatory.fr@alfasigma.com     
      
 Ελλάδα 
A VIPharma International A.E. 
Τηλ: +30 210-6194170   
info@avipharma.gr 
 
Italy 
Alfasigma S.p.A. 
Tel: +39 051 6489602 
antonietta.pazardjiklian@alfasigma.com 
 
Κύπρος 
ISANGEN PHARMA CYPRUS LTD 
Τηλ: +357 24-638833  
info@isangenpharma.com.cy 
 
България,  Česká republika, Danmark, Eesti, Hrvatska, Ireland, Ísland, Latvija, Lietuva, 
Magyarország, Malta, Norge, Österreich, Polska, România, Slovenija, Slovenská republika, 
Suomi/Finland, Sverige, UK. 
 
Alfasigma S.p.A. 
Италия, Olaszország, Itàlie, Italja, Italien, Italia, Itaalia, Włochy, Italija, Ítalía, taliansko, Itālija 
 
Teл/Tel/Tlf/Sími/Puh: +39  051 6489602 
alfasigmaspa@legalmail.it 
 
This leaflet was last revised in month YYYY 
 
Detailed information on this medicine is available on the European Medicines Agency web site: 
http://www.ema.europa.eu 
 

  

mailto:service@pharmore.de
mailto:info.es@alfasigma.com
mailto:regulatory.fr@alfasigma.com
mailto:info@avipharma.gr
mailto:antonietta.pazardjiklian@alfasigma.com
mailto:info@isangenpharma.com.cy
mailto:alfasigmaspa@legalmail.it
http://www.ema.europa.eu/


 
 

50 

Package leaflet: information for the user 
 

Eurartesim 320 mg/40 mg film-coated tablets  
Piperaquine tetraphosphate/artenimol 

 
 

 
Read all of this leaflet carefully before you start using this medicine because it contains 
important information for you. 
− Keep this leaflet. You may need to read it again. 
− If you have any further questions, ask your doctor or pharmacist. 
− This medicine has been prescribed for you only.  Do not pass it on to others. It may harm them, 

even if their signs of illness are the same as yours. 
− If you get any side effects, talk to your doctor or pharmacist. This includes any possible side 

effects not listed in this leaflet. See section 4. 
 
What is in this leaflet: 
 
1. What Eurartesim is and what it is used for 
2. What you need to know before you or your child takes Eurartesim  
3. How to take Eurartesim  
4. Possible side effects 
5. How to store Eurartesim 
6. Contents of the pack and other information 
 
 
1. What Eurartesim is and what it is used for 
 
Eurartesim contains the active substances piperaquine tetraphosphate and artenimol. It is used to treat 
uncomplicated malaria when use of a medicine given by mouth is appropriate. 
 
Malaria is caused by infection with a parasite called Plasmodium, spread by the bite of an infected 
mosquito.There are different types of Plasmodium parasite. Eurartesim kills the Plasmodium 
falciparum parasite. 
 
The medicine can be taken by adults, adolescents, children and infants over 6 months old who weigh 
5 kilograms or more. 
 
 
2. What you need to know before you or your child takes Eurartesim 
 
Do not take Eurartesim if you or your child: 
• is allergic to the active substances, piperaquine tetraphosphate or artenimol, or to any of the 

other ingredients of this medicine (listed in section 6);  
• has a severe type of malaria infection which has affected parts of the body such as the brain, 

lungs or kidneys; 
• has a heart condition, such as changes to the rhythm or rate of heart beat, or heart disease; 
• knows that any member of your family (parents, grandparents, brothers or sisters) died suddenly 

due to a heart problem or was born with heart problems; 
• suffers from changes to the levels of salts in the body (electrolyte imbalances); 
• is taking other medicines that can have an effect on heart rhythm, such as: 

- quinidine, disopyramide, procainamide, amiodarone, dofetilide, ibutilide, hydroquinidine 
or sotalol; 

- medicines used to treat depression such as amitriptyline, fluoxetine or sertraline; 
- medicines used to treat mental health problems such as phenothiazines, sertindole, 

sultopride, chlorpromazine, haloperidol, mesoridazine, pimozide, or thioridazine; 



 
 

51 

- medicines used to treat infections. These include some of the types of medicines used to 
treat bacterial infections (macrolides [such as erythromycin or clarithromycin] and 
fluoroquinolones [such as moxifloxacin and sparfloxacin]) or fungal infections (including 
fluconazole and imidazole) as well as pentamidine (used to treat a specific type of 
pneumonia) and saquinavir (for treatment of HIV); 

- antihistamines used to treat allergies or inflammation such as terfenadine, astemizole or 
mizolastine; 

- certain medicines used to treat stomach problems such as cisapride, domperidone or 
droperidol; 

- other medicines such as vinca alkaloids and arsenic trioxide (used to treat certain 
cancers), bepridil (used to treat angina), diphemanil (used to treat stomach disturbances), 
levomethadyl and methadone (used to treat drug addiction), and probucol (used to treat 
high blood cholesterol levels). 

• has recently (for example within about one month) been treated for malaria with certain 
medicines or has taken certain medicines to prevent malaria. These medicines include: 
mefloquine, halofantrine, lumefantrine, chloroquine or quinine 

 
If any of the above applies to you or your child or if you are unsure, tell your doctor or pharmacist 
before taking or giving Eurartesim. 
 
Warnings and precautions 
Talk to your doctor or pharmacist before taking this medicine if you or your child: 
• has liver or kidney problems; 
• has a malaria infection caused by a parasite other than Plasmodium falciparum; 
• is taking or has taken any other medicines for the treatment of malaria (other than those 

mentioned above);  
• is in the 1st trimester of pregnancy or breastfeeding (see below); 
• is female, elderly (over 65 years) or vomiting; 
• is taking certain other medicines which could cause possible metabolic interactions. Examples 

are listed in the section “Other medicines and Eurartesim”. 
If you are not sure about any of the above, please ask your doctor or pharmacist. 
Children 
Do not give this medicine to infants under 6 months or below 5 kg in weight. 
 
Other medicines and Eurartesim 
Tell your doctor or pharmacist if you or your child is taking, has recently taken or might take any other 
medicines. Some medicines can affect the way Eurartesim works and your doctor may decide that 
Eurartesim is not suitable or that extra checks are needed while you or your child is taking the 
medicines which could cause possible interactions. Examples are listed below (but there are several 
others): 
- some medicines used to treat high cholesterol in the blood (such as atorvastatin, lovastatin, 

simvastatin); 
- medicines used to treat hypertension and heart problems (such as diltiazem, nifedipine, 

nitrendipine, verapamil, felodipine, amlodipine); 
- some medicines used to treat HIV (antiretroviral medicines): protease inhibitors (such as 

amprenavir, atazanavir, indinavir, nelfinavir, ritonavir), non-nucleoside reverse transcriptase 
inhibitors (such as efavirenz, nevirapine); 

- some medicines used to treat microbial infections (such as telithromycin, rifampicin, dapsone); 
- medicines used to help you fall asleep: benzodiazepines (such as midazolam, triazolam, 

diazepam, alprazolam), zaleplon, zolpidem; 
- medicines used to prevent/treat epileptic seizures: barbiturates (such as phenobarbital), 

carbamazepine or phenytoin; 
- medicines used after organ transplantation and in autoimmune diseases (such as cyclosporin, 

tacrolimus); 
- sex hormones, including those contained in hormonal contraceptives (such as gestodene, 

progesterone, estradiol), testosterone; 
- glucocorticoids (hydrocortisone, dexamethasone); 



 
 

52 

- omeprazole (used to treat diseases related to gastric acid production); 
- paracetamol (used to treat pain and fever); 
- theophylline (used to improve bronchial air flow); 
- nefazodone (used to treat depression); 
- aprepitant (used to treat nausea); 
- some gases (such as enflurane, halothane and isoflurane) used to give a general anaesthetic. 
 
Eurartesim with food and drink 
You should take the Eurartesim tablets with water only. 
You should not take Eurartesim with grapefruit juice due to possible interactions. 
 
Pregnancy and  breast-feeding 
Tell your doctor if you are in the 1st trimester of pregnancy, think you may be pregnant or become 
pregnant, or if you are breast-feeding. Based on animal data Eurartesim is suspected to harm the 
unborn child when used during the first three months of pregnancy. Therefore Eurartesim must not be 
used in the 1st trimester of pregnancy if your doctor can give you an alternative medicine. If you find 
out that you are pregnant within one month from taking Eurartesim, please inform your doctor. The 
exposure of pregnant women during the 2nd and 3rd trimester was not associated with any harm of the 
unborn child. If Eurartesim is more suitable for a pregnant woman than other artemisinin-based 
combination therapies with a higher range of experience (or sulfadoxine–pyrimethamine), Eurartesim 
may be used in the 2nd and 3rd trimester. 

 
You should not breast-feed your baby while taking this medicine because the medicine may pass 
through breast milk to your baby. 
 
If you are taking folate supplements to prevent possible neural tube birth defects, you can continue 
taking them at the same time as Eurartesim. 
 
Ask your doctor or pharmacist for advice before taking any medicine during pregnancy or breast-
feeding. 
 
 
 
Driving and using machines 
You can drive or use machines after taking Eurartesim once you have recovered from your illness. 
 
 
3. How to take Eurartesim 
 
Always take  Eurartesimexactly as your doctor has told you to. Check with your doctor or pharmacist 
if you are not sure. 
  
You or your child should take this medicine on an empty stomach. You or your child should take each 
dose no less than 3 hours after the last food intake, and no food should be taken within 3 hours after 
each dose of Eurartesim. You or your child can drink water at any time. 
 
If the tablets are difficult to swallow, you can crush  and mix them with water; drink the mixture 
immediately. 
 
A course of Eurartesim lasts 3 consecutive days. Take one dose on each day. You should try to take 
the dose at about the same time on each of the three days. 
 
The daily dose depends on the patient’s body weight. Your doctor should have prescribed a dose that 
is appropriate for your weight or your child’s weight as follows: 
 



 
 

53 

Body weight 
(kg) Daily dose (mg) 

Total number of tablets for 
treatment  

5 to less than 7 Half 160 mg/20 mg  tablet a day 1.5 tablet  

7 to less than 13 One 160 mg/20 mg tablet a day 3 tablets 

13 to less than 24 One 320 mg/40 mg tablet a day 3 tablets 

24 to less than 36 Two 320 mg/40 mg tablets a day 6 tablets 

36 to less than 75 Three 320 mg/40 mg tablets a day 9 tablets 

>75  Four 320 mg/40 mg tablets a day 12 tablets 
 
 
Vomiting when taking this medicine 
If this happens within: 
• 30 minutes of taking Eurartesim, the whole dose must be taken again. 
• 31-60 minutes, half the dose must be taken again. 
If you or your child vomit also the second dose, do not take or give your child another dose. Contact 
your doctor urgently to obtain an alternative treatment for malaria. 
 
Taking this medicine, if the malaria infection returns  
• If you or your child gets another attack of malaria you may take a second course of Eurartesim 

within one year if your doctor thinks this is a suitable treatment. You or your child must not take 
more than two courses within one year. If this happens, talk to your doctor. You or your child 
should not take a second course of Eurartesim within 2 months of the first course. 

• If you or your child is infected more than twice in a year, your doctor will prescribe an 
alternative treatment. 

 
If you or your child takes more Eurartesim tablets than you should 
If you or your child takes more than the recommended dose, tell your doctor. Your doctor may suggest 
special monitoring for you or your child because doses higher than those recommended may have an 
unwanted, severe effect on the heart (see also section 4). 
 
If you or your child forgets to take Eurartesim 
If you or your child forgets to take the second dose of Eurartesim at the right time, take it as soon as 
you remember. Then take the third (last) dose approximately 24 hours after the second dose. 
If you or your child forgets to take the third (last) dose at the right time, take it as soon as you 
remember. 
Never take more than one dose on the same day to make up for a missed dose. 
Check with your doctor or pharmacist if you are not sure. 
 
If you or your child stops taking Eurartesim 
For the medicine to work effectively, you or your child should take the tablets as instructed and should 
complete the 3 days course of treatment.  If you or your child is not able to do this, talk to your doctor 
or pharmacist. 
 
If you have any further questions on the use of this medicine, ask your doctor or pharmacist. 
 
 
4. Possible side effects 
 
Like all medicines, this medicine can cause side effects, although not everybody gets them. Most of 
the side effects are not severe and normally disappear within a few days or weeks after treatment.  
 



 
 

54 

If you or your child gets a rash, swelling of the face, lips, tongue or throat with difficulty in 
swallowing or breathing, these may be signs of an allergic reaction. Tell your doctor immediately, or 
go immediately to the emergency department of your nearest hospital, taking this leaflet with you. 
 
A heart problem, called QT prolongation, can occur while taking Eurartesim and for some days after 
taking the last dose. This can cause a life-threatening abnormality of the heart rhythm. 
Your doctor may take electrical recordings of the heart (electrocardiogram, ECG) while you or 
your child is being treated and after the last dose is given. Your doctor will advise you when 
these readings will be taken.  
If you notice anything different about your or your child’s heart rhythm or have symptoms 
(such as palpitations or irregular heart beat) you should contact your doctor as soon as possible 
and before the next dose is due.  
 
Sometimes a problem with your red blood cells, called haemolytic anaemia can occur after receiving 
malaria treatment. Contact your doctor immediately if you or your child develops one or more of the 
following symptoms after treatment with Eurartesim: pale skin, general weakness, headache, shortness 
of breath and rapid heartbeat; particularly with exercise, confusion, dizziness, or dark-coloured urine.  
 
Side effects in adults 
 
Common (may affect up to 1 in 10 people) 
Anaemia, headache, heart rhythm disturbances (ECG changes or noticing unusually fast heart beats or 
palpitations), fever, general weakness. 
 
Uncommon (may affect up to 1 in 100 people) 
Influenza, respiratory infections, poor appetite or loss of appetite, dizziness, convulsions (fits),  
irregular or slow heart rate, cough, vomiting, abdominal pain, diarrhoea, nausea, inflammation or 
enlargement of the liver, abnormal liver function tests, itching, pain in the muscles or joints.  
 
Side effects in children 
 
Very common (may affect more than 1 in 10 people) 
Influenza, cough, fever. 
 
Common (may affect up to 1 in 10 people) 
Respiratory infections, ear infection, anaemia, abnormalities in various types of blood cells (white 
blood cells and platelets), poor appetite or loss of appetite, eye infection, heart rhythm disturbances 
(change as in adults, ECG changes), abdominal pain, vomiting, diarrhoea, skin inflammation, rash, 
general weakness. 
 
Uncommon ( may affect up to 1 in 100 people) 
Abnormalities in red blood cells, excessive numbers of platelets, enlargement of some organs (such as 
liver or spleen), swollen lymph glands, convulsions (fits), headache, abnormal heart sounds (heard by 
your doctor with a stethoscope), nose bleeds, runny nose, nausea, inflammation of the mouth, 
inflammation or enlargement of the liver, jaundice, abnormal liver function blood tests, skin itching 
and inflammation, pain in the joints. 
 
Reporting of side effects 
 
If you get any side effects, talk to your doctor or pharmacist. This includes any possible side effects 
not listed in this leaflet. You can also report side effects directly via the national reporting system 
listed in Appendix V. By reporting side effects you can help provide more information on the safety of 
this medicine. 
 
 

http://www.ema.europa.eu/docs/en_GB/document_library/Template_or_form/2013/03/WC500139752.doc
http://www.ema.europa.eu/docs/en_GB/document_library/Template_or_form/2013/03/WC500139752.doc


 
 

55 

5. How to store Eurartesim  
 
Keep this medicine out of the sight and reach of children. 
 
Do not take this medicine after the expiry date which is stated on the package after ‘EXP’. The expiry 
date refers to the last day of that month. 
 
Do not store above 30°C. 
Store in the original package in order to protect from light and moisture. 
 
Do not use this medicine if you notice the blister is open.  
 
Do not throw away any medicines via wastewater or household waste. Ask your pharmacist how to 
throw away medicines you no longer use. These measures will help protect the environment. 
 
 
6. Contents of the pack and other information 
 
What Eurartesim contains 
The active substances are piperaquine tetraphosphate and artenimol. 
Each film-coated tablet contains 320 mg piperaquine tetraphosphate (as the tetrahydrate) and 40 mg 
artenimol.  
 
The other ingredients are: 
Tablet core: pre-gelatinised starch, dextrin, hypromellose (E464), croscarmellose sodium, magnesium 
stearate (E572). 
Film coating: hypromellose, titanium dioxide (E171), macrogol 400. 
 
What Eurartesim looks like and contents of the pack 
Eurartesim are white film-coated tablets, embossed and with a break line along the middle. 
 
The 320 mg/40 mg tablets have two ’σ’ letters on one side and come in blisters containing 3, 6, 9 or 12 
tablets. 
 
Marketing Authorisation Holder  
 
Alfasigma S.p.A. 
Via Ragazzi del ’99, n. 5  
40133 Bologna 
Italy 
 
Tel: +39  051 6489602 
Fax: +39  051 388689 
Email:  antonietta.pazardjiklian@alfasigma.com 
 
Manufacturer 
 
Alfasigma S.p.A. 
Via Pontina km. 30.400 
00071 Pomezia (Rome) 
Italy 
 
 
For any information about this medicine, please contact the local representative of the Marketing 
Authorisation Holder: 
 

mailto:antonietta.pazardjiklian@alfasigma.com


 
 

56 

België/Belgique/Belgien  
Luxembourg/Luxemburg 
Alfasigma Belgium sprl/bvba 
Tel: +32 (0)2 420 93 16 
 eurartesim.be@alfasigma.com 
 
Nederland       Deutschland 
Alfasigma Nederland BV     Pharmore GmbH 
Tel: +31 30 6702020     Tel: +49 (0) 5451 9690-0  
info.nl@alfasigma.com     service@pharmore.de 
 
España       Portugal 
Alfasigma España, S.L.      Alfasigma Portugal, Lda  
Tel: +34 93 415 48 22     Tel: +351 217 226 110  
info.es@alfasigma.com      geral@alfasigma.com  
 
France        
Alfasigma France    
Tél: +33 1 45 21 0269      
regulatory.fr@alfasigma.com   
 
Ελλάδα 
A VIPharma International A.E. 
Τηλ: +30 210-6194170 
info@avipharma.gr 
 
Italy 
Alfasigma S.p.A. 
Tel: +39 051 6489602 
 antonietta.pazardjiklian@alfasigma.com 
 
Κύπρος 
ISANGEN PHARMA CYPRUS LTD 
Τηλ: +357 24-638833,  
info@isangenpharma.com.cy 
 
 
България,  Česká republika, Danmark, Eesti, Hrvatska, Ireland, Ísland, Latvija, Lietuva, 
Magyarország, Malta, Norge, Österreich, Polska, România, Slovenija, Slovenská republika, 
Suomi/Finland, Sverige, UK. 
 
Alfasigma S.p.A. 
Италия, Olaszország, Itàlie, Italja, Italien, Italia, Itaalia, Włochy, Italija, Ítalía, taliansko, Itālija 
 
Teл/Tel/Tlf/Sími/Puh: +39  051 6489602 
alfasigmaspa@legalmail.it 
 
This leaflet was last revised in month YYYY 
 
Detailed information on this medicine is available on the European Medicines Agency web site: 
http://www.ema.europa.eu 

 
 
 
 
 

 

mailto:service@pharmore.de
mailto:info.es@alfasigma.com
mailto:regulatory.fr@alfasigma.com
mailto:info@avipharma.gr
mailto:antonietta.pazardjiklian@alfasigma.com
mailto:info@isangenpharma.com.cy
mailto:alfasigmaspa@legalmail.it
http://www.ema.europa.eu/

	SUMMARY OF PRODUCT CHARACTERISTICS
	4.1 Therapeutic indications
	4.2 Posology and method of administration
	4.4 Special warnings and precautions for use
	Eurartesim should not be used to treat severe falciparum malaria (see section 4.3) and, due to insufficient data, should not be used to treat malaria due to Plasmodium vivax, Plasmodium malariae or Plasmodium ovale.
	The long half-life of piperaquine (about 22 days) should be kept in mind in the event that another anti-malarial agent is started due to treatment failure or a new malaria infection (see below and sections 4.3 and 4.5).
	Piperaquine is a mild inhibitor of CYP3A4. Caution is recommended when co-administering Eurartesim with medicinal products exhibiting variable patterns of inhibition, induction or competition for CYP3A4 as the therapeutic and/or toxic effects of some ...
	Due to the lack of multiple dose PK data for piperaquine, administration of any strong CYP3A4-inhibitors should be discouraged after initiation (i.e. the first dose) of Eurartesim (see sections 4.5 and 5.2).
	Effects on cardiac repolarization
	In clinical trials with Eurartesim limited ECGs were obtained during treatment. These showed that QTc prolongation occurred more frequently and to a larger extent in association with Eurartesim therapy than with the comparators (see section 5.1 for de...
	The potential for Eurartesim to prolong the QTc interval was investigated in parallel groups of healthy volunteers who took each dose with high (~1000 Kcal) or low (~400 Kcal) fat/calorie meals or in fasting conditions. Compared to placebo, the maximu...
	An ECG should be obtained as early as possible during treatment with Eurartesim and ECG monitoring should be applied in patients who may have a higher risk of developing arrhythmia in association with QTc prolongation (see below).
	When clinically appropriate, consideration should be given to obtaining an ECG from all patients before the last of the three daily doses is taken and approximately 4-6 hours after the last dose, since the risk of QTc interval prolongation may be grea...
	Compared to adult males, female patients and elderly patients have longer QTc intervals. Therefore, they may be more sensitive to the effects of QTc-prolonging medications such as Eurartesim so that special caution is required.
	Paediatric population
	Special precaution is advised in young children when vomiting, as they are likely to develop electrolyte disturbances. These may increase the QTc-prolonging effect of Eurartesim (see section 4.3).
	Hepatic and renal impairment
	4.5 Interaction with other medicinal products and other forms of interaction
	Absorption of piperaquine is increased in the presence of fatty food (see sections 4.4 and 5.2) which may increase its effect on QTc interval. Therefore, Eurartesim should be taken with water only as described in section 4.2. Eurartesim should not be ...
	4.6 Fertility, pregnancy and lactation
	4.7 Effects on ability to drive and use machines
	The ADRs noted for Eurartesim were generally mild in severity, and the majority were non-serious. Reactions such as cough, pyrexia, headache, P. falciparum infection, anaemia, asthenia, anorexia and the observed changes in blood cell parameters are co...
	Paediatric population
	A tabular overview of the frequency of the ADRs in paediatric patients is given below.  The majority of paediatric experience is derived from African children aged 6 months to 5 years.
	Reporting of suspected adverse reactions
	Reporting suspected adverse reactions after authorisation of the medicinal product is important. It allows continued monitoring of the benefit/risk balance of the medicinal product. Healthcare professionals are asked to report any suspected adverse re...
	4.9 Overdose
	5.1  Pharmacodynamic properties
	The age-specific PCR-corrected cure rates in the m-ITT populations are tabulated below for the Asian and African studies, respectively:
	(1) This CI is asymptotic because the exact CI could not be computed
	5.2 Pharmacokinetic properties
	5.3 Preclinical safety data
	No carcinogenicity studies have been performed.
	Artenimol causes embryolethality and teratogenicity in rats and rabbits.
	Cardiovascular toxicity
	Effects on blood pressure and on PR and QRS duration were observed at high piperaquine doses. The most important potential cardiac effect was related to cardiac conduction.
	Phototoxicity

	6.1 List of excipients
	6.2 Incompatibilities
	6.3 Shelf life
	6.4 Special precautions for storage
	6.5 Nature and contents of container
	6.6 Special precautions for disposal
	4.1 Therapeutic indications
	4.2  Posology and method of administration
	4.4 Special warnings and precautions for use
	Eurartesim should not be used to treat severe falciparum malaria (see section 4.3) and, due to insufficient data, should not be used to treat malaria due to Plasmodium vivax, Plasmodium malariae or Plasmodium ovale.
	The long half-life of piperaquine (about 22 days) should be kept in mind in the event that another anti-malarial agent is started due to treatment failure or a new malaria infection (see below and sections 4.3 and 4.5).
	Piperaquine is a mild inhibitor of CYP3A4. Caution is recommended when co-administering Eurartesim with medicinal products exhibiting variable patterns of inhibition, induction or competition for CYP3A4 as the therapeutic and/or toxic effects of some ...
	Due to the lack of multiple dose PK data for piperaquine, administration of any strong CYP3A4-inhibitors should be discouraged after initiation (i.e. the first dose) of Eurartesim (see sections 4.5 and 5.2).
	Effects on cardiac repolarization
	In clinical trials with Eurartesim limited ECGs were obtained during treatment. These showed that QTc prolongation occurred more frequently and to a larger extent in association with Eurartesim therapy than with the comparators (see section 5.1 for de...
	The potential for Eurartesim to prolong the QTc interval was investigated in parallel groups of healthy volunteers who took each dose with high (~1000 Kcal) or low (~400 Kcal) fat/calorie meals or in fasting conditions. Compared to placebo, the maximu...
	An ECG should be obtained as early as possible during treatment with Eurartesim and ECG monitoring should be applied in patients who may have a higher risk of developing arrhythmia in association with QTc prolongation (see below).
	When clinically appropriate, consideration should be given to obtaining an ECG from all patients before the last of the three daily doses is taken and approximately 4-6 hours after the last dose, since the risk of QTc interval prolongation may be grea...
	Compared to adult males, female patients and elderly patients have longer QTc intervals. Therefore, they may be more sensitive to the effects of QTc-prolonging medications such as Eurartesim so that special caution is required.
	Paediatric population
	Special precaution is advised in young children when vomiting, as they are likely to develop electrolyte disturbances. These may increase the QTc-prolonging effect of Eurartesim (see section 4.3).
	Hepatic and renal impairment
	4.5 Interaction with other medicinal products and other forms of interaction
	Absorption of piperaquine is increased in the presence of fatty food (see sections 4.4 and 5.2) which may increase its effect on QTc interval. Therefore, Eurartesim should be taken with water only as described in section 4.2. Eurartesim should not be ...
	4.6 Fertility, pregnancy and lactation
	4.7 Effects on ability to drive and use machines
	The ADRs noted for Eurartesim were generally mild in severity, and the majority were non-serious. Reactions such as cough, pyrexia, headache, P. falciparum infection, anaemia, asthenia, anorexia and the observed changes in blood cell parameters are co...
	Paediatric population
	A tabular overview of the frequency of the ADRs in paediatric patients is given below.  The majority of paediatric experience is derived from African children aged 6 months to 5 years.
	Reporting of suspected adverse reactions
	Reporting suspected adverse reactions after authorisation of the medicinal product is important. It allows continued monitoring of the benefit/risk balance of the medicinal product. Healthcare professionals are asked to report any suspected adverse re...
	4.9 Overdose
	5.1  Pharmacodynamic properties
	The age-specific PCR-corrected cure rates in the m-ITT populations are tabulated below for the Asian and African studies, respectively:
	(1) This CI is asymptotic because the exact CI could not be computed
	5.2 Pharmacokinetic properties
	5.3 Preclinical safety data
	No carcinogenicity studies have been performed.
	Artenimol causes embryolethality and teratogenicity in rats and rabbits.
	Cardiovascular toxicity
	Effects on blood pressure and on PR and QRS duration were observed at high piperaquine doses. The most important potential cardiac effect was related to cardiac conduction.
	Phototoxicity

	6.1 List of excipients
	6.2 Incompatibilities
	6.3 Shelf life
	6.4 Special precautions for storage
	6.5 Nature and contents of container
	6.6 Special precautions for disposal
	ANNEX III
	LABELLING AND PACKAGE LEAFLET
	A. LABELLING
	1. NAME OF THE MEDICINAL PRODUCT
	2. STATEMENT OF ACTIVE SUBSTANCE(S)
	3. LIST OF EXCIPIENTS
	4. PHARMACEUTICAL FORM AND CONTENTS
	5. METHOD AND ROUTE(S) OF ADMINISTRATION
	6. SPECIAL WARNING THAT THE MEDICINAL PRODUCT MUST BE STORED OUT OF THE SIGHT AND REACH OF CHILDREN
	Keep out of the sight and reach of children.
	7. OTHER SPECIAL WARNING(S), IF NECESSARY
	8. EXPIRY DATE
	9. SPECIAL STORAGE CONDITIONS
	10. SPECIAL PRECAUTIONS FOR DISPOSAL OF UNUSED MEDICINAL PRODUCTS OR WASTE MATERIALS DERIVED FROM SUCH MEDICINAL PRODUCTS, IF APPROPRIATE
	11. NAME AND ADDRESS OF THE MARKETING AUTHORISATION HOLDER
	12. MARKETING AUTHORISATION NUMBER(S)
	13. BATCH NUMBER
	14. GENERAL CLASSIFICATION FOR SUPPLY
	15. INSTRUCTIONS ON USE
	16. INFORMATION IN BRAILLE
	1. NAME OF THE MEDICINAL PRODUCT
	2. STATEMENT OF ACTIVE SUBSTANCE(S)
	3. LIST OF EXCIPIENTS
	4. PHARMACEUTICAL FORM AND CONTENTS
	5. METHOD AND ROUTE(S) OF ADMINISTRATION
	6. SPECIAL WARNING THAT THE MEDICINAL PRODUCT MUST BE STORED OUT OF THE SIGHT AND REACH OF CHILDREN
	Keep out of the sight and reach of children.
	7. OTHER SPECIAL WARNING(S), IF NECESSARY
	8. EXPIRY DATE
	9. SPECIAL STORAGE CONDITIONS
	10. SPECIAL PRECAUTIONS FOR DISPOSAL OF UNUSED MEDICINAL PRODUCTS OR WASTE MATERIALS DERIVED FROM SUCH MEDICINAL PRODUCTS, IF APPROPRIATE
	11. NAME AND ADDRESS OF THE MARKETING AUTHORISATION HOLDER
	12. MARKETING AUTHORISATION NUMBER(S)
	13. BATCH NUMBER
	14. GENERAL CLASSIFICATION FOR SUPPLY
	15. INSTRUCTIONS ON USE
	16. INFORMATION IN BRAILLE
	B.  PACKAGE LEAFLET
	Package leaflet: information for the user
	What is in this leaflet:
	Do not take Eurartesim if you or your child:
	Eurartesim with food and drink
	You should take the Eurartesim tablets with water only.
	You should not take Eurartesim with grapefruit juice due to possible interactions.
	You should not breast-feed your baby while taking this medicine because the medicine may pass through breast milk to your baby.
	Driving and using machines
	If you or your child takes more Eurartesim tablets than you should
	If you or your child forgets to take Eurartesim
	If you or your child stops taking Eurartesim
	This leaflet was last revised in month YYYY
	Package leaflet: information for the user
	What is in this leaflet:
	Do not take Eurartesim if you or your child:
	Warnings and precautions
	You should take the Eurartesim tablets with water only.
	You should not take Eurartesim with grapefruit juice due to possible interactions.
	You should not breast-feed your baby while taking this medicine because the medicine may pass through breast milk to your baby.
	Driving and using machines
	If you or your child takes more Eurartesim tablets than you should
	If you or your child forgets to take Eurartesim
	If you or your child stops taking Eurartesim
	This leaflet was last revised in month YYYY