Bendeka
Bendeka
Generic Name
Bendeka
Mechanism
- Rapid parasite killing – Artesunate is converted to dihydroartemisinin (DHA) in plasma, which generates reactive oxygen species inside the parasite.
- Interference with protein synthesis – DHA covalently modifies parasite protein thiols and microtubule components, disrupting nuclear division and membrane integrity.
- Minimal host toxicity – Rapid clearance of DHA limits exposure to human tissues, allowing high therapeutic indices for severe malaria.
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Pharmacokinetics
| Parameter | Typical Value | Notes |
| Absorption | Immediate IV or IM; oral formulations unavailable for severe malaria | IM absorption ~80 % of IV dose |
| Distribution | Volume of distribution ≈ 3 L/kg; crosses the blood–brain barrier | Extensive distribution to reticuloendothelial and infection sites |
| Half‑life | 1–3 h for artesunate; 1–2 h for DHA | Short half‑life necessitates repeat dosing |
| Metabolism | Hydrolysis by esterases → DHA; minor CYP450 involvement | Mostly independent of genotypic enzyme variations |
| Elimination | Renal and biliary routes; 90 % excreted in urine within 24 h | No dose adjustment needed for mild–moderate hepatic impairment |
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Indications
- Severe *P. falciparum* malaria (e.g., cerebral malaria, hypoglycemia, multiorgan dysfunction)
- Therapeutic rescue for patients failing curative oral artemisinin‑based combination therapy
- Pre‑hospital or field use (IM) where IV access is limited
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Contraindications
- Hypersensitivity to artemisinin derivatives or excipients (rotenone)
- Caution in
- *Pregnancy* (Category B; data limited, but potential fetal exposure is low)
- *Neonates* (no established safety data)
- *Severe renal or hepatic failure* (monitor drug clearance closely)
- Avoid in patients with known G6PD deficiency until alternative therapy is confirmed – although artesunate is generally safe, hemolysis may occur.
- Interacts with drugs that lower blood glucose (e.g., sulfonylureas) – risk of hypoglycemia.
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Dosing
| Route | Dose | Schedule | Notes |
| IV | 2.5 mg kg⁻¹ loading dose | Doses at 0 h, 12 h, then every 24 h until oral therapy completed | Use 50 mL syringe; dilute 5 mg/mL in 0.9 % saline |
| IM (single‑dose formulation) | 2.5 mg kg⁻¹ | Administer as soon as IV access is not feasible; follow with IV artesunate per IV schedule | Injection into gluteus maximus or vastus lateralis; observe for pain / swelling |
• Loading dose decreases parasite burden within 48 h.
• Follow IV regimen until the patient is adequately oral‑ready (≥ 48 h parasite clearance, improved clinical status).
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Adverse Effects
Common (≤ 5 %)
• Injection‑site discomfort or mild erythema
• Nausea, vomiting
• Faintness or dizziness
Serious (≤ 1 %)
• Hypoglycemia – especially in patients with fasting or diabetes
• Lactic acidosis – rare but reported in severe malaria with organ failure
• Retinal pigmentary changes (long‑term artesunate use in endemic areas)
• Neuro‑psychiatric symptoms – confusion, delirium (post‑treatment)
• Hemolysis – in G6PD‑deficient patients
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Monitoring
| Parameter | Frequency | Rationale |
| Parasitemia | Slide or PCR at 0, 12, 24 h; then daily until negative | Confirm therapeutic response |
| Blood glucose | Every 4 h during the first 24 h | Early detection of hypoglycemia |
| CBC, bilirubin, LDH | Daily | Detect hemolysis, organ dysfunction |
| Renal & hepatic panels | Daily | Monitor for drug‑related organ toxicity |
| Temperature & vital signs | Continuous | Detect evolving organ failure |
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Clinical Pearls
- Early IV artesunate dramatically reduces mortality; treat with *Bendeka* as soon as severe malaria is suspected, even before confirmation.
- Three‑dose regimen (0, 12, 24 h) is essential; skipping doses increases treatment failure rates.
- In Southeast Asia, delayed parasite clearance has been linked to *P. falciparum* PfK13 mutations; consider lengthening the IV course until repeat parasitemia < 10⁴ parag. / µL.
- Avoid IM use in patients with leukopenia or platelet < 50 × 10⁹ L⁻¹ due to increased risk of injection‑site hematomas.
- Co‑administer with quinine or lumefantrine sparingly – monitor plasma drug concentrations to avoid additive cardiotoxicity.
- Record glucose immediately after the first dose; provide glucose supplementation if patient is diabetic or fasting.
- Consider alternative antimalarials in patients on high‑dose iron supplements, as artesunate metabolite may accelerate hemolysis in G6PD‑deficient individuals.
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• *This drug card is intended for educational and reference purposes. Clinical decisions should always be guided by the latest guidelines from the WHO, CDC, and local health authorities.*