Dihydroartemisinin–piperaquine
Antimalarials
Antimalarials
Oral artemisinin combination for uncomplicated malaria: a fast, short-lived artemisinin plus piperaquine, which stays in the body for weeks.
Also called: artenimol and piperaquine, DHA-PPQ
Quick facts
- Group
- Antimalarials
- Target
- Parasite heme (dihydroartemisinin is activated by heme iron; piperaquine blocks heme detoxification)
- Used for
- Uncomplicated malaria · Malaria by Plasmodium vivax
- Key effects
- Headache · Nausea · Small
- Monitor
- Fever and a blood film · Vomiting soon after a dose
- ATC
- P01BF05
No doses: the clinician sets them by the current guideline.
Mechanism of action
Dihydroartemisinin is the active form of the artemisinins: heme iron inside the parasite opens its endoperoxide bridge and the free radicals damage many parasite proteins, so the parasite load falls within hours. Piperaquine, a bisquinoline related to chloroquine, is thought to stop the parasite from turning toxic heme into hemozoin. Because it is eliminated very slowly, it kills the parasites that survive the short artemisinin course and protects for some weeks after treatment.
- Heme iron opens dihydroartemisinin's endoperoxide bridge
- Free radicals damage parasite proteins and clear parasites fast
- Piperaquine blocks heme detoxification in the food vacuole
- Slowly cleared piperaquine kills the remaining parasites
Indications
- Uncomplicated malaria by Plasmodium falciparum (WHO-recommended artemisinin-based combination) Malaria →
- Malaria by Plasmodium vivax (blood stage; primaquine or tafenoquine is still needed against liver hypnozoites) Malaria →
- Studied and considered by WHO for preventive therapy and mass drug administration
Adverse effects
Common
- Headache, dizziness and weakness
- Nausea, vomiting and abdominal pain
- Small, transient prolongation of the QT interval
Contraindications
- Allergy to either component
- Severe malaria (it is an oral treatment; severe malaria needs injectable artesunate)
Key interactions
- Other QT-prolonging medicines (some antiarrhythmics, macrolides, fluoroquinolones, antipsychotics, other quinoline antimalarials)
- Additive QT prolongation; caution, above all with heart disease or a family history of sudden death.
- Fatty food
- Raises piperaquine levels several-fold and with them the effect on the QT interval; taken on an empty stomach.
- A new antimalarial course soon after
- Piperaquine is still present for weeks; the overlap is taken into account when another antimalarial is started.
What is monitored
- Fever and a blood film or rapid test to confirm the parasites have gone
- ECG in people with heart disease, electrolyte disorders or other QT-prolonging drugs
- Vomiting soon after a dose (the dose may need repeating under medical guidance)
Administration and safety
- Oral three-day course, with water and away from meals
- Dispersible forms exist for small children
- Not for severe malaria: injectable artesunate is used instead
Pregnancy and breastfeeding
Choice of antimalarial in pregnancy follows WHO and national guidance, which differ by trimester; a clinician decides.
Nursing care
- Confirm malaria by microscopy or rapid test before treatment
- Give the doses away from food and check whether the patient vomits them
- Ask about heart disease, fainting and other QT-prolonging medicines
- Teach to return if fever persists or danger signs appear
Pharmacokinetics
- Absorption
- Oral. A high-fat meal raises piperaquine absorption about threefold, so the tablets are taken fasting.
- Half-life
- Dihydroartemisinin about 1 to 2 hours; piperaquine about 22 days in healthy volunteers.
Test yourself
Think of the answer, then tap the question to see it.
Why is dihydroartemisinin combined with piperaquine instead of being given alone?
The artemisinin acts fast but is cleared within hours; the slowly eliminated partner kills the survivors and protects against resistance.
Why are dihydroartemisinin–piperaquine tablets taken fasting?
A fatty meal raises piperaquine absorption several-fold, and higher levels prolong the QT interval more.
Which ECG effect is linked to piperaquine?
Prolongation of the QT interval, so other QT-prolonging drugs are used with caution.
Can dihydroartemisinin–piperaquine treat severe malaria?
No. It is an oral treatment for uncomplicated malaria; severe malaria needs injectable artesunate.
Connections
← Back to the class: Antimalarials
Educational content on how drugs work; not a prescribing guide and no substitute for a health professional's advice. No doses are given.
Sources: Notes on the Design of Bioequivalence Study: Dihydroartemisinin / Piperaquine Tetraphosphate (World Health Organization (WHO Prequalification), 2026); Meeting report of the Evidence Review Group on the cardiotoxicity of antimalarials (World Health Organization (WHO), 2017); eEML - Electronic Essential Medicines List (World Health Organization (WHO), 2026); Malaria (World Health Organization (WHO), 2026).
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Representative model, for educational purposes only.