Parenteral Manual


Disclaimer: Official controlled document is the CHEO online copy. It is the responsibility of user to ensure that any paper copy version is the same as the online version before use.

Alternate Name(s): 
Artesunic acid
Antimalarial; Anti-Protozoal agent; Artemisinin derivative
Original Date: 
August 2009
Revised Date: 
August 2017
  • Treatment for severe and complicated malaria and infections due to chloroquine-resistant or multi-drug resistant strains of malaria
Reconstitution and Stability: 

US product (Walter Reed supply):

  • Available as 110 mg/vial sterile powder with diluent (phosphate buffer) for reconstitution.
  • Refrigerate vials  (2-10 C).  Buffer may be stored at room temperature or refrigerated (phosphate crystals may form in the buffer at low temperatures  - use only if solution is clear and colourless after gentle warming)
  • Withdraw 11.5 mL from vial of phosphate buffer into a 20 mL syringe
  • Attach a 0.2 micron filter to syringe containing phosphate buffer
  • Add  11.5 mL of  phosphate buffer, through the filter, slowly (against vial wall) into each vial of 110 mg artesunate to get 10 mg/mL
  • Gently swirl for 5 - 6 minutes until completely dissolved.
  • Stable 1 hour after reconstitution. Administer as soon as possible following reconstitution or further dilution. Discard unused solution.
  • For IM administration:  use the same preparation, dilution and dosage as for IV administration


Chinese product (Artesun):

  • Available as 120 mg/vial  with diluent (sodium bicarbonate 50 mg/mL ampoule) and 0.9% NaCl ampoule
  • Store at room temperature.  Protect from light.
  • Reconstitute vial with 2 mL of sodium bicarbonate solvent  (provided ampoule)
  • Shake for several minutes (not too vigorously) until powder is complete dissolved and solution is clear.  Discard if solution not clear or a precipitate is present.
  • For IV administration: Add 10 mL 0.9 % NaCl  (provided vial) to the reconstituted solution to get 10 mg/mL
  • Shake to mix well.  Solution should be clear. Discard if solution appears cloudy or a precipitate is present.
  • Stable 1 hour after reconstitution. Administer as soon as possible following reconstitution or further dilution. Discard unused solution.
  • For IM administration: Add 4 mL 0.9% NaCl (provided vial) to the reconstituted solution to get 20 mg/mL

-  Solutions Compatible:  D5W, 0.9% NaCl

-  Incompatible:  Water for injection (no data)


(For approved routes of administration by nursing personnel, refer to Policy for the Administration of Intravenous Medications.)


YES  -if IV access cannot be obtained - into anterior thigh

- may need to divide dose and inject in several sites

US product - 10 mg/mL

Chinese product - 20 mg/mL

IV Direct YES - preferred
Usual dilution:  with 5 mL D5W or 0.9% NaCl prior to injection
Infusion time:  over 1 - 2 minutes
IV Intermittent Infusion NO
IV Continuous Infusion NO

(For neonatal dosages, refer to Neonatal IV Drug Manual.)


  • 2.4 mg/kg IV at 0, 12, 24 and 48 hours (total of 4 doses = 9.6 mg/kg)
  • First dose should be admininistered STAT
  • Obese patients should be dosed based on actual body weight (no maximum dose)
  • Dose adjustment not required in renal or liver dysfunction
  • An oral agent is required as follow-on therapy within 4 hours after last dose of IV artesunate ie. Malarone (atovaquone /proguanil)
Potential hazards of parenteral administration: 
  • Very well tolerated in adults and children.  Observe patient for 30 minutes following administration for signs of an allergic reaction
  • Hypersensitivity :  allergic reactions (rash, urticaria, swelling, watery eyes, shortness of breath, chest pain, anaphylaxis)
  • Cardiovascular:  bradycardia, heart block
  • Gastrointestinal:  anorexia, taste alteration, nausea, vomiting, diarrhea
  • Central nervous system:  dizziness, lightheadedness, headache
  • Reversible decrease in reticulocyte count
  • Increased liver enzymes
  • Artesunate is not marketed in Canada & falls under the jurisdiction of the Special Access Program (SAP) therefore requires a verbal consent from a parent  which must be documented in the patient's medical chart before administration
  • No known drug interactions at this time but note that it is a derivative of artemisinin which is metabolized via cytochrome P450 2B6
  • Pregnancy -IV quinine preferred in the first trimester& IV artesunate is the drug of choice in the second and third trimester  (Canadian Malaria Network July 2009)
  • Artesunate is converted in the body to its active metabolite, dihydroartemisinin
  • US product (Walter Reed supply): vials have the date manufactured and do not have a specified expiry date, as testing of the product is ongoing
  • Chinese product (Artesun): expiration date as per package

The information contained on this website is provided for informational purposes only, as a guide to assist physicians, nurses and other healthcare providers in deciding on the appropriate care required for a particular patient. At all times, physicians, nurses and other healthcare providers must exercise their independent clinical judgment, based on their knowledge, training and experience, taking into account the specific facts and circumstances of each patient, when deciding on the appropriate course of investigation and/or treatment to recommend in a particular clinical situation.

CHEO has made every effort to ensure that the information contained on this website is as current and accurate as possible. However, changes can occur due to ongoing research and the constant influx of new information. Where possible, hospitals and healthcare practitioners should verify the information before acting on it.

Reliance on any information in this website is at the user's own risk. CHEO is not responsible or liable for any harm, loss or other consequences from the use or misuse of the information on this website.