Artesunate Injectable: Severe Malaria Dosing
Two-step injectable artesunate guidance for severe malaria and initial treatment when oral therapy is not possible.
Source reviewed
June 2025
Guide category
Injectable drugs
Safety boundary
Prescription medicine information for clinician-guided use.
Kenza Health Hub presents this medicine page as structured health education. Check dose, route, interactions, pregnancy or breast-feeding considerations, and local protocol with a qualified clinician or pharmacist. Read our medical editorial policy.
Therapeutic action
Antimalarial.
Indications
- Treatment of severe malaria.
- Initial treatment of uncomplicated malaria, when persistent vomiting precludes oral therapy.
Forms and strengths, route of administration
- Powder for injection (artesunate), 60 mg vial, plus solvent: 5% sodium bicarbonate 1 ml ampoule, plus diluent: 0.9% sodium chloride 5 ml ampoule.
- For reconstitution, add the sodium bicarbonate into the vial and shake gently until clear.
- For slow IV, add 5 ml of 0.9% sodium chloride into the vial to obtain 10 mg/ml.
- For slow IM, add 2 ml of 0.9% sodium chloride into the vial to obtain 20 mg/ml.
- Never administer by IV infusion.
Dose and duration
One dose on admission, then 12 hours after admission, then 24 hours after admission, then once daily.
Administer for at least 24 hours, minimum 3 doses, then if the patient can tolerate the oral route, change to a full 3-day course of an artemisinin-based combination.
- Child under 6 kg: seek specialist advice.
- Child 6 kg to under 20 kg: 3 mg/kg per dose.
- Child 20 kg and over and adult: 2.4 mg/kg per dose.
- If the patient still cannot tolerate the oral route, continue one daily parenteral dose until oral therapy is possible, not exceeding 7 days of parenteral treatment.
| Weight | Dose per injection (mg) | Artesunate 10 mg/ml solution for IV Dose per injection (ml) | Artesunate 20 mg/ml solution for IM Dose per injection (ml) |
|---|---|---|---|
| Child 6 to < 20 kg | |||
| 6 to < 7 kg | 20 mg | 2 ml | 1 ml |
| 7 to < 11 kg | 30 mg | 3 ml | 2 ml |
| 11 to < 14 kg | 40 mg | 4 ml | 2 ml |
| 14 to < 17 kg | 50 mg | 5 ml | 3 ml |
| 17 to < 20 kg | 60 mg | 6 ml | 3 ml |
| Child ≥ 20 kg and adult | |||
| 20 to < 26 kg | 60 mg | 6 ml | 3 ml |
| (a) 26 to < 30 kg | 70 mg | 7 ml | 4 ml |
| 30 to < 34 kg | 80 mg | 8 ml | 4 ml |
| 34 to < 38 kg | 90 mg | 9 ml | 5 ml |
| 38 to < 42 kg | 100 mg | 10 ml | 5 ml |
| 42 to < 46 kg | 110 mg | 11 ml | 6 ml |
| 46 to < 51 kg | 120 mg | 12 ml | 6 ml |
| (a) 51 to < 55 kg | 130 mg | 13 ml | 7 ml |
| 55 to < 59 kg | 150 mg | 14 ml | 7 ml |
| 59 to < 63 kg | 150 mg | 15 ml | 8 ml |
| 63 to < 67 kg | 160 mg | 16 ml | 8 ml |
| 71 to < 76 kg | 180 mg | 18 ml | 9 ml |
|---|---|---|---|
| (a) 76 to < 80 kg | 190 mg | 19 ml | 10 ml |
| 80 to < 84 kg | 200 mg | 20 ml | 10 ml |
| 84 to < 88 kg | 210 mg | 21 ml | 11 ml |
Contra-indications, adverse effects, precautions
- Once reconstituted, the solution must be used immediately.
- May cause gastrointestinal disturbances, dizziness, headache, fever, muscle and joint pain, pruritus, and rarely rash or delayed haemolytic anaemia.
- Pregnancy and breast-feeding: no contra-indication.
- The solution should be clear; do not use if cloudy or if a precipitate is present.
- The 2-step and 1-step artesunate 60 mg formulations are bioequivalent and can be used interchangeably during the course of treatment, but use only the solvent or diluent provided by the manufacturer for each formulation.
Source
MSF Essential drugs practical guidelines (January 2026)
This page combines source-derived medicine reference sections with Kenza editorial context, while leaving out the Storage and Remarks sections from the source batch.
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