I. Aralen fact file
Aralen is manufactured by Sanofi-Synthelabo.
Sanofi-Synthelabo Inc. is the U.S. affiliate of the global pharmaceutical company Sanofi-Aventis.
Sanofi-Aventis group is Number 1 in Europe and Number 3 worldwide in the pharmaceutical industry. This group is present in more than 100 countries throughout the 5 continents.
Sanofi-Synthelabo's principal area of business is ethical pharmaceuticals. The core therapeutic areas of Sanofi-Synthelabo are cardiovascular disease and thrombosis; diseases of the central nervous system; oncology; and internal medicine.
II. Aralen Medication
Aralen (Chloroquine) is an antimalarial agent. Aralen prevents and treats attacks of malaria.
Aralen also treats amebiasis. Aralen is also used to treat certain infections of the intestinal tract and certain types of skin problems.
Aralen (Chloroquine) is a commonly used form of medication against malaria. As it also mildly suppresses the immune system, it is used in some autoimmune disorders, such as rheumatoid arthritis.
Inside the red blood cells, the parasite must degrade the hemoglobin for the acquisition of all the nutrients the parasite needs to survive and multiply inside the cell.
During this process, the parasite produces the toxic and soluble molecule heme. To avoid destruction by this molecule, the parasite aggregates heme to form hemozoin, an insoluble and non-toxic molecule.
Aralen (Chloroquine) interferes with this process and prevents the formation of hemazoine. This allows the toxic effect of heme on the parasite, which is killed by this molecule.
Against rheumatoid arthritis, it operates by inhibiting lymphocyte proliferation, phospholipase A, release of enzymes from lysosomes, release of reactive oxygen species from macrophages, and production of IL-1.
Antimalarial drugs: Information
Antimalarial drugs are designed to prevent or treat malaria.
Antimalarial drugs currently used for treatment
- mefloquine (Larium ®)
- chloroquine (Aralen)
- fansidar (pyrimethamine, sulfadoxine
- amodiaquine
- quinine/quinidine
- artemether/artesunate
- atovaquone
Antimalarial drugs currently used for prophylaxis
- mefloquine
- chloroquine (Aralen)
- proguanil
- pyrimethamine (daraprim)
- doxycycline
Malaria: Information
Malaria is a life-threatening parasitic disease transmitted by mosquitoes. It was once thought that the disease came from fetid marshes, hence the name malaria, ((bad air). In 1880, scientists discovered the real cause of malaria a one-cell parasite called plasmodium. Later they discovered that the parasite is transmitted from person to person through the bite of a female Anopheles mosquito, which requires blood to nurture her eggs.
Today approximately 40% of the world's population mostly those living in the world's poorest countries are at risk of malaria.
There are four types of human malaria Plasmodium vivax, P. malariae, P. ovale and P. falciparum. P. vivax and P. falciparum are the most common and falciparum the most deadly type of malaria infection.
Plasmodium falciparum malaria is most common in Africa, south of the Sahara, accounting in large part for the extremely high mortality in this region. There are also worrying indications of the spread of P. falciparum malaria into new regions of the world and its reappearance in areas where it had been eliminated.
Causes of Malaria
The malaria parasite, Plasmodium, is a small, single-cell organism (protozoan), which lives as a parasite in man and a specific species of mosquito (Anopheles).
There are four different types of malaria parasite: Plasmodium falciparum is the cause of malignant malaria, while Plasmodium vivax, Plasmodium ovale and Plasmodium malariae cause more benign types of malaria. Malignant malaria can kill, but the other forms are much less likely to prove fatal.
There are several stages in the life cycle of the parasite and by and large these are the same for all four types.
The malarial parasite, Plasmodium, is a very small, single-cell blood organism, or 'protozoan'. It lives as a parasite in other organisms, namely man and mosquito. The parasite is the cause of the tropical disease malaria.
The Plasmodium parasite is dependent on a single species of mosquito, Anopheles, which is the only species capable of serving as host for it.
This small single-cell organism has three to four different forms. Each form is specialized in living in a certain place.
- The gametocyte is the form that infects the mosquito and reproduces itself, as if it were both sexes. When the mosquito has sucked blood-containing gametocytes, these pass into the salivary glands of the mosquito, where they develop into a new form, the sporozoite. The infection can then move on.
- The sporozoite can be passed on to man when the mosquito bites, injecting its saliva into the tiny blood vessels. The sporozoite travels with the blood to the liver and enters the liver cells. In the liver some of the sporozoites divide (tachysporozoites) and become thousands of merozoites.
- The merozoites are released from the liver to the blood where they are taken up by the red blood corpuscles. Some of these turn into ring-formed trophozoites, which split again to form schizonts.
- Schizonts burst the red blood corpuscles at a certain moment, releasing the merozoites. This release coincides with the violent rises in temperature during the attacks seen in malaria.
The trophozoites that are left over during division can, in the course of the next day, develop into the sexual form, the gametocyte, which can be taken up by a blood-sucking mosquito and start another cycle.
The incubation period (time from infection to development of the disease) is usually about 10 to 15 days. This period can be much longer depending on whether any antimalarial medication has been taken.
Plasmodium ovale and Plasmodium vivax can produce a dormant form, a hypnozoite, which can cause relapses of the disease months and even years after the original disease (relapsing malaria), because it is dormant in the liver cells. This is why it is very important after these infections to be treated with primaquine to kill the liver stages. (Primaquine cannot be used by people with a condition called G6PD-deficiency.)
Diagram 1: Man and Mosquito play complementary roles in the malaria cycle
[Explanation for Diagram: The malaria parasite enters the human host when an infected Anopheles mosquito takes a blood meal. Inside the human host, the parasite undergoes a series of changes as part of its complex life cycle. Its various stages allow plasmodia to evade the immune system, infect the liver and red blood cells, and finally develop into a form that is able to infect a mosquito again when it bites an infected person. Inside the mosquito, the parasite matures until it reaches the sexual stage where it can again infect a human host when the mosquito takes her next blood meal, 10 to 14 or more days later.
Malaria symptoms appear about 9 to 14 days after the infectious mosquito bite, although this varies with different plasmodium species. Typically, malaria produces fever, headache, vomiting and other flu-like symptoms. If drugs are not available for treatment or the parasites are resistant to them, the infection can progress rapidly to become life threatening. Malaria can kill by infecting and destroying red blood cells (anaemia) and by clogging the capillaries that carry blood to the brain (cerebral malaria) or other vital organs.]
Signs and Symptoms of Malaria
Symptoms of malaria include fever and flu-like illness, including shaking chills, headache, muscle aches, and tiredness. Nausea, vomiting, and diarrhea may also occur. Malaria may cause anemia and jaundice (yellow coloring of the skin and eyes) because of the loss of red blood cells. Infection with one type of malaria, Plasmodium falciparum, if not promptly treated, may cause kidney failure, seizures, mental confusion, coma, and death.
Preventing Malaria
You and your family can prevent malaria by
- keeping mosquitoes from biting you, especially at night
- taking antimalarial drugs to kill the parasites
- eliminating places around your home where mosquitoes breed
- spraying insecticides on your home's walls to kill adult mosquitoes that come inside
- sleeping under bed nets - especially effective if they have been treated with insecticide, and
- wearing insect repellent and long-sleeved clothing if out of doors at night
Diagnosis of Malaria
The symptoms of malaria are similar to those of many other feverish diseases and infections, which can upset the stomach. Therefore you should always tell your doctor if you have been abroad, especially if you have been to the tropics in the last 12 months.
The actual diagnosis is made by detecting the parasite in the blood. This is done using a special product mixed with one to two drops of the patient's blood and spreading it on a microscope slide. This is then stained and examined carefully under a microscope.
The examination may have to be repeated if the fever has only just begun and/or preventive medication is to some extent keeping the numbers of the malaria parasite low.
Treatment of Malaria
The treatment of malaria normally calls for admission to hospital, because it may be malignant malaria, which can have a fatal outcome in only a few days.
In addition, there is an increasing level of resistance of the malaria parasite, particularly P. falciparum, to several of the known antimalarial products.
Outpatient treatment, or worse still, self-treatment of malaria is something only to be undertaken when no qualified medical help is available, i.e. if you develop malaria in a remote area.
Side effects of Antimalarial Drugs
The most feared side effect is that of losing vision. On the doses of Aralen, which are used, today the risk of eye damage is very small. When antimalarials were first used for arthritis they were used in much higher doses than at present. Furthermore patients were not regularly checked. Despite the very slight chance of eye damage, most rheumatologists send their patients to an ophthalmologist every six months for a check. The problem is that our eyes do change with age, and often these changes are not easy to separate from those due to Aralen.
Nevertheless if changes do occur, they occur slowly and can be picked up on routine screening. Even if they may be due to age most doctors would stop the drug to ensure that no unnecessary damage occurs.
Some people do find difficulty on focusing when first starting Aralen this does not indicate that the eyes are being damaged. It is more a sign of the eye muscles adjusting to the presence of the drug.
Other side effects are those of nausea and occasionally vomiting. This can be counteracted by taking the tablets with food. Rarely the skin can become hyperpigmented and skin may become scaly and thick. But this is rare, and will disappear when the drug is stopped.
Very rarely there may be weakness, headaches or "singing in the ears" If you have any symptoms which you feel may be due to the drug it is best to consult your doctor.
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III. Useful links
Government http://www.cdc.gov/
http://www.fda.gov/
http://www.fda.gov/cder/ogd/
http://www.nih.gov/
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi
http://www.health.gov.on.ca/
National Library of Medicine
World Health Organization
Health Sites
http://www.mayoclinic.com/index.cfm
MedicineNet.com
Drugdigest.org
Healthsquare.com
www.drugs.com/PDR/Aralen_Tablets.html
www.sanofi-synthelabous.com
http://en.sanofi-aventis.com/index.asp
http://www.drugdigest.org/DD/DVH/Uses/0,3915,6056%7CAralen,00.html
http://en.wikipedia.org/wiki/Chloroquine
http://en.wikipedia.org/wiki/Category:Antimalarial_agents
http://mosquito.who.int/cmc_upload/0/000/015/372/RBMInfosheet_1.htm
http://www.netdoctor.co.uk/travel/diseases/malaria_disease.htm
http://www.rheumatologysa.com/saraaantimalarial.htm
Pharmacy sites
http://www.roche.com/home/company/com_hist.htm
http://www.healthdigest.org/Bactrim-DS(Oral)_2006_PRO.php
http://www.hsforum.com/stories/storyReader$1509
http://www.hsforum.com/stories/storyReader$1504
http://www.people.vcu.edu/~urdesai/atc.htm#Process%20of%20clotting
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