Artesunate suppositories work with artemisinin suppositories in severe malaria was conducted in Viet Nam in the early 1990s, and clinical trials of rectal artesunate followed by mefloquine treatment in moderately severe malaria were conducted in the mid-1990s in Thailand. A major placebo-controlled clinical trial published in 2009 found that "if patients with severe malaria cannot be treated orally and access to injections will take several hours, a single inexpensive artesunate [rectal] suppository at the time of referral substantially reduces the risk of death or permanent disability." Artesunate suppositories Artesunate suppositories are used for the treatment of malaria. Artesunate is an antimalarial water-soluble
Mefloquine with an increased risk of birth defects or miscarriages. The drug may be used during breastfeeding, though it appears in breast milk in low concentrations. The World Health Organization gives approval for the use of mefloquine in the second and third trimesters of pregnancy and use in the first trimester does not mandate termination of pregnancy. Mefloquine is metabolized primarily through the liver. Its elimination in persons with impaired liver function may be prolonged, resulting in higher plasma levels and an increased risk of adverse reactions. The mean elimination plasma half-life of mefloquine is between two and four weeks. Total