Co-Mal (available in standard and Forte strengths) is an Artemisinin-based Combination Therapy (ACT) antimalarial that combines artemether and lumefantrine.
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Artemether: A lipophilic semi-synthetic artemisinin derivative. Upon administration, it generates intra-parasitic reactive oxygen species (free radicals) that rapidly reduce the blood-stage parasite load and clear clinical fever within hours.
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Lumefantrine: A synthetic fluorene derivative. It acts by inhibiting the clearance of toxic free heme inside the parasite’s food vacuole, preventing its conversion into hemozoin. Its long half-life eliminates residual parasites and prevents recrudescence.
The fixed-dose combination ensures high efficacy while mitigating the development of drug resistance compared to single-agent antimalarial monotherapies.
Primary Medical Indications
Co-Mal is indicated for adults and pediatric patients for the treatment of acute parasitic infections:
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Uncomplicated Plasmodium falciparum Malaria: First-line curative treatment for acute, uncomplicated malaria infections caused by P. falciparum or mixed species containing P. falciparum.
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Multi-Drug Resistant Strains: Effective in endemic regions with known parasite resistance to older antimalarial agents such as chloroquine or sulfadoxine-pyrimethamine.
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Erythrocytic Blood-Stage Infections: Clears blood-stage schizonts across sensitive Plasmodium species (P. falciparum, P. vivax, P. ovale, P. malariae).
Key Product Specifications & Dosing Forms
| Feature | Specification |
| Active Ingredients | Artemether + Lumefantrine |
| Pharmacological Class | Artemisinin-based Combination Therapy (ACT) Antimalarial |
| Available Strengths |
• Co-Mal Standard: Artemether 20 mg / Lumefantrine 120 mg per tablet • Co-Mal Forte: Artemether 80 mg / Lumefantrine 480 mg per tablet |
| Standard Regimen | 6-dose regimen taken over 3 days (Hours 0, 8, 24, 36, 48, and 60) |
| Adult Dosing (>35 kg / >12 yrs) |
• Co-Mal (20/120 mg): 4 tablets per dose at 0, 8, 24, 36, 48, and 60 hours (24 tablets total) • Co-Mal Forte (80/480 mg): 1 tablet per dose at 0, 8, 24, 36, 48, and 60 hours (6 tablets total) |
| Pediatric Dosing (20/120 mg) |
• 5 kg to <15 kg: 1 tablet per dose (6 tablets total) • 15 kg to <25 kg: 2 tablets per dose (12 tablets total) • 25 kg to <35 kg: 3 tablets per dose (18 tablets total) |
| Administration | Take orally with fatty food or milk. Lipids significantly enhance lumefantrine bio-absorption. |
Critical Safety Guidelines & Precautions
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Co-administration with Fatty Meals: Lumefantrine absorption depends heavily on dietary fat intake. Encourage the patient to resume normal eating or consume a small fatty meal (or milk) with each dose to ensure adequate therapeutic blood levels.
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Re-Dosing for Vomiting: If the patient vomits within 1 hour of taking a dose, re-administer a full replacement dose. If vomiting persists, switch to parenteral antimalarial therapy (e.g., IV/IM artesunate).
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Cardiac Effects & QTc Prolongation: Lumefantrine has the potential to cause mild QTc prolongation. Avoid co-administration with other QTc-prolonging drugs or strong CYP3A4 inhibitors/inducers unless monitored.
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Not for Severe/Complicated Malaria: Contraindicated for severe, complicated, or cerebral malaria. Severe infections require immediate intravenous or intramuscular artesunate administration.
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Prophylaxis Restriction: Co-Mal is strictly a therapeutic agent and must never be used for malaria prophylaxis.
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