Halofantrine for malaria therapy and sudden cardiac arrest

Recently read (CDC website) about instances of SCA and death in people with hypertrophic cardiomyopathies some days after being given halofantrine for treatment of malaria.  I've lived in the tropics (East and Central Africa)  for 20+ years and will be travelling to West Africa at Christmas for a two week work trip.  I plan to take doxycycline for malaria prophylaxis and carry Coartem (purchased from a reputable pharmacy in Nairobi Kenya) for emergency treatment.  I've used malarone in the past but cannot afford it with current insurance.  I have a mild IDC.

I want to ensure that even if very ill with suspected malaria, I am not given halofantrine.  How can a traveller find out if a particular medication is used in a foreign environment?  Make sure he/she doesn't take a drug with dangerous side effects?  Medic alert bracelets are in English, and cannot cover everything.  Internet may not be available in the Sahara or Somalia.

[Philip D Parks, MD, MPH, MOccH, FACOEM]

Hello,

I congratulate you for being so proactive regarding you upcoming trip to West Africa.

Unfortunately, and you know from residing in Africa in the past, there is no way of knowing with absolute certainty which anti-malarials will be used in a given hospital or care facility.

I would recommend that you wear a medical alert bracelet in English and possibly in the language of the primary destination that you are traveling to that is endemic with malaria.

Based on your history of "mild" idiopathic dilated cardiomyopathy (no history of bradycardia or atrial fibrillation, right?), I would recommend that you discuss your planned use of Coartem with your personal physician or health care provider.

From: http://www.malariaandhealth.com/professional/prescribing_coartem.htm

Coartem® is contraindicated in those with hypersensitivity to the active substances or any of the excipients; in cases of severe malaria and in the first trimester of pregnancy. During the second and third trimester, treatment should only be considered if the expected benefit to the mother outweighs the risk to the foetus. Coartem® is also contraindicated in patients with a history of symptomatic cardiac arrhythmias, clinical relevant bradycardia or severe heart disease. Also in patients with a family history of congential prolongation of the QTc interval or sudden death, disturbances of electrolyte balance, e.g. hypokalaemia or hypomagnesaemia. Drugs that are known to be metabolised by cytochrome enzyme CYP2D6 or drugs that are known to prolong the QTc interval should not be used concomitantly with Coartem®.

* ~ Dr. Parks

This answer is not intended as and does not substitute for medical advice. The information presented in this posting is for patients’ education only. As always, I encourage you to see your personal physician for further evaluation of your individual case.

[kibarisho]

Thank you very much. Just reviewed the packet insert on Coartem and decided to request doxy for prophylaxis and carry malarone for emergency treatment.  Working on the medical alert tag.  No arrythmias or long QTc but I don't want to take chances with a drug not used in the US. Look forward to other ACTs w/o lumefantrine.

[Philip D Parks, MD, MPH, MOccH, FACOEM]

Dear Kibarisho,

You are welcome.

Have an enjoyable and safe trip.

Stay well !

~ Dr. Parks

This answer is not intended as and does not substitute for medical advice. The information presented in this posting is for patients’ education only. As always, I encourage you to see your personal physician for further evaluation of your individual case.