07/10/2016
IRON, VITAMIN C, E AND ANTIMALARIAL DRUGS EFFICACY.
By Sade Oguntola - Nigeria
The best available treatment for malaria,
Artemisinin-based Combination Therapies (ACTs)
have come under a little scrutiny with experts
warning that taking them in combination with
multivitamins that contain iron and vitamins C and
E, renders the drug ineffective.
From the woman that sells pepper in the market to
the Chief Executive Officer, malaria is a health
problem that makes a person rush to the hospital
for its treatment. The headache, the body
temperature and lack of sleep are some of its
symptoms that are better imagined than
experienced.
Malaria drugs come in different brands and
constituents. From those that have lost their
efficacy such as chloroquine, paludrine,
amodiaquine, sulphadoxine-pyrimethamine (this
includes medicines like Fansider) to the newly
recommended highly effective Artemisinin-based
Combination Therapies (ACTs), compliance with
instructions in their attached leaflets is central to
their efficacy and prevention of unwanted side
effects.
Vitamin tablets
ACTs are basically drugs that contain the
artemisinin in various forms (Artemether, Arteether,
Artesunate, Artenilate) as their main ingredients.
Attached to artemisinin is another malaria killing
drug such as Lumefantrine.
ACT kills malaria parasites in a human bloodstream
within 24 to 36 hours. By combining drugs with
different mechanisms of action and different time
spans of activity, the combination of artemether and
lumefantrine deliver a two-punch attack on the
malaria parasite. Any malaria parasite not killed by
one drug will be killed by the other.
However, ACTs might be rendered less effective in
individuals with malaria if taken with multivitamins
that contain constituents such as Vitamin C, B-
carotene, Vitamin E and Iron.
Most multivitamin preparations contain some
amount of minerals and trace element such as zinc,
copper and iron, as well as vitamins that interact
with some constituents of ACTs, rendering the
malaria drug less effective.
Artemisinin is good at killing malaria parasites
because it reacts and becomes highly toxic in the
presence of iron. Malaria parasites cause illness in
humans by consuming red blood cells, which
contain iron in the hemoglobin protein that carries
oxygen in the blood.
There is a high level of self medication and poor
information-seeking attitude in many individuals, it
has been said. So, it is common to have
Artemisinin-based antimalarial drugs being
prescribed along with antioxidant vitamins such as
vitamin C, B-Carotene and Vitamin E.
No doubt, supplements which contain L-lysine,
Vitamins B1, B6, B12 and Sorbitol, are ideal for
malaria patients, as they promote appetite, quick
recovery and do not hinder the activity of the
antimalarial drug.
But many multivitamins also contain antioxidants
such as Vitamin C, B-Carotene and Vitamin E and
so are better continued after the ACT is completed
because they can cause this antimalarial drug to be
less absorbed by body.
Some medicines are better used after a meal.
Incidentally, one of such drugs is ACT. Experts have
evidences to show that food, especially those with
fat, enhances the efficacy of ACT. The effect is
more pronounced with lumefantrine.
In a double-blind trial of 260 patients with
uncomplicated malaria in Thailand, researchers
showed that both the extent and variability of
lumefantrine absorption improved with recovery from
malaria as normal food intake was resumed by the
person affected by malaria.
Individuals having malaria frequently feel nauseated
and unable to eat, making doctors’ advice that
these malaria medicines should not be taken on an
empty stomach difficult to comply with.
Nonetheless, for ACT to be very effective, it has to
be taken along with food, particularly those
containing fat.
How much fat is necessary to optimise lumefantrine
oral bioavailability and assure the efficacy of the
ACT? Surprisingly, researchers found that it does not
have to be a standard meal like amala or fufu with
the African stew. Incidentally, a glass of soya milk
will do the work.
Writing in the 2007 Tropical Medicine &
International Health, the researchers declared, “Co-
administration of artemether–lumefantrine with a
relatively small amount of fat (as soya milk) was
required to ensure maximum absorption of
lumefantrine in healthy adult volunteers.”
Dr. Olayemi Sofola, the former National Coordinator,
National Malaria Control Programme, said some
basic rules must be complied with to ensure ACT
works effectively.
She stated: “The use of ACT in the appropriate way
is important. For instance, the use of ACT with
Vitamin C is not advisable because of its anti-
oxidant properties. That is part of the reasons why
people who want to take ACT should be
appropriately counseled.”
Dr Sofola declared that in some instances, people
had assumed ACT was not effective because the
medicine was not used at the appropriate time.
According to her, “with ACTs, timing is important.
The second dose of the ACT for instance should be
taken eight hours after, not before or after. The
timing affects its absorption and bioavailability. The
second dose taken eight hours after is to reinforce
the first dose to ensure the body is rid of malaria
parasite.”
“People also need to be counseled that ACT is
better taken after a fatty meal. In developed
countries, people could take it with a glass of milk.
But African stews have oil in them, so we may not
have to worry about looking for an oily food. Most
of our foods in Africa have oil in them.’’
Dr Sofola explained that even where a child with
malaria cannot tolerate food because he or she has
lost his or her appetite or is vomiting, fluids like
milk can still be given along with ACT rather than a
blanch food.
According to her, “there is the need for people to
take ACT appropriately before saying the drug is not
working. They need to be sure that it is taken at the
right time, and that the appropriate dose is used
and in the right way.”
“Also, it is important that they complete the
dosage. Without doing this, the malaria parasite
would not be cleared from their blood stream and
resistance to ACT might start to develop. For now,
ACTs are the best options we have to treat
malaria.”
Dr Bala Mohammed, a malaria expert, remarked that
in a case where a person vomits ACT within 30
minutes of administration, it should be repeated.
According to him, this is to ensure adequate malaria
treatment.
Nonetheless, Dr Mohammed emphasised that the
use of ACT is discouraged in pregnant women until
they are in their second or third trimester. “There
are alternative medicines to treat malaria in
pregnancy,” he declared
Oguntola Sade (2006), Iron tablets, vitamin C affect efficacy of malaria drugs. journal on Eyeonmalaria, 7th ed.
