Malaria Medicine Names in Nigeria: A Guide to What's in the Pack

When you stand at the pharmacy counter, having been handed a malaria drug with an unfamiliar name, it can be confusing, but it is quite common. However, this doesn't mean that you have been given the wrong medication. If you are not sure about the medicine or its name, do not hesitate to ask the pharmacist to explain it and to help you check that it matches what was prescribed.  

Medicines can be identified in several ways: by their active ingredients, drug class or brand name. Understanding the difference makes it easier for you to know what exactly is inside a pack. For instance, antimalarial medicines can be classified by the way they act against the malaria parasite, including the stage of the parasite’s life cycle that they target. 

This is why it is important to test for malaria, understand what medicine you have been given and check that the product is registered with NAFDAC before purchasing any antimalarial.

Why do malaria medicines have different names?

Most medicines are identified by different names, and antimalarial medications are no exception. They can be identified by their generic names, which refer to the active ingredients that produce the drug’s medicinal effect. Antimalarials can also be identified by a trademarked brand name given to the product by its manufacturer. This is the name that appears on the pack. What this means is that a category of antimalarials may contain the same active ingredients meant to fight malaria, but the packaging, brand name and manufacturer may be different. For example, NAFDAC’s registered product database [1] lists antimalarials with different product names, manufacturers and registration numbers that are different from each other, but they all serve the purpose of treating malaria at different stages.

What does ACT mean?

ACT stands for artemisinin-based combination therapy. It refers to a group of antimalarial medicines that is usually a combination of artemisinin derivatives with another antimalarial medicine, otherwise known as a partner medicine. The artemisinin component acts rapidly [2] by clearing the parasites in the blood, while the partner medicine helps clear the remaining parasites and provides protection against the development of resistance to the artemisinin derivative.

ACT is therefore not the name of a particular antimalarial or brand. It is only a group of combination treatments. For example, artemether-lumefantrine is one ACT. 

Other ACT combinations contain different artemisinin derivatives and partner medicines. For example:

•  Artemether-lumefantrine.
• Artesunate-amodiaquine.
• Artesunate-mefloquine.
• Dihydroartemisinin-piperaquine.
• Artesunate + sulfadoxine-pyrimethamine.
• Artesunate-pyronaridine.

These are the types of artemisinin derivatives and their partner medicines recommended by the World Health Organization (WHO).

What is sulfadoxine-pyrimethamine (SP) and Fansidar?

Sulfadoxine-pyrimethamine (SP) is a fixed combination containing two active ingredients, sulfadoxine and pyrimethamine.  

SP is the antimalarial active ingredient, while Fansidar is the brand name associated with the combination. However, seeing ‘SP’ or ‘Fansidar’ on a malaria pack does not mean that it should be used to treat malaria.

The function of sulfadoxine-pyrimethamine in malaria care has evolved. NAFDAC states that sulfadoxine-pyrimethamine (SP) is no longer recommended [5] for the treatment of malaria, but is currently recommended for intermittent preventive treatment of malaria in pregnancy [5]. In other words, it is a preventive measure against malaria for pregnant women, mostly during the second and third trimesters.

Older antimalarials and how their uses have changed. 

An example of antimalarial medicines widely used in the past is chloroquine. Its usage was dependent on the type of malaria parasite and whether the parasite retained its sensitivity to the medicine.

Quinine is another old antimalarial medicine that has been used for a long time. Although no longer a first-line malaria treatment, it is still an option for severe cases. 

The current WHO guidance recommends chloroquine only for cases where P.vivax is sensitive to it, rather than as a general malaria treatment. [3]

P. vivax refers to the protozoan parasite that is a frequent and widely distributed cause of malaria.

So, the fact that chloroquine and quinine were used in the past doesn't make them standard treatment for malaria today.

Prophylactic and preventive malaria medicines.

Not all antimalarial medicines are used for treatment. Some are used to prevent malaria in high-risk individuals. This is known as chemoprevention [2] or chemoprophylaxis. They are used as intermittent preventive treatment (IPTp) for pregnant women in malaria-endemic areas. 

Chemoprevention is given at a scheduled time to treat existing infections and prevent new malaria infections. 

The World Health Organization (WHO) recommends chemoprevention for specific populations, including seasonal malaria prevention for children and pregnant women in high-risk areas. 

The medicine and the schedule used often depend on the population and the malaria transmission setting.

How to check if your antimalarial medication is NAFDAC registered

NAFDAC has a greenbook, Nigeria's registered product database, where medicines can be searched using information like the product name, active ingredients or NAFDAC registration number. 

If a medicine is offered to you and you are not sure about it, you can check the following important details and make sure the details correspond. They are:

• The product name.
• The active ingredient.
• The NAFDAC registration number.
• The manufacturer details.

Conclusion.

The next time you come across an unfamiliar antimalarial at the pharmacy, you now know what to look for. Here are a few things to keep in mind:

• You should know what the name means. Look beyond the brand name. Check the active ingredient (for instance, ACTs), the manufacturer, and the NAFDAC registration number. Artemisinin-based combination therapy (ACT) refers to a group of antimalarial combinations, while artemether-lumefantrine is one example.
• Testing before treating malaria helps distinguish suspected malaria from other possible causes with similar symptoms. A malaria test, such as a rapid diagnostic test (RDT), helps confirm whether malaria is present before commencing treatment.
• Remember that antimalarials have different purposes. Some are meant to treat malaria, while others are used to prevent it in specific situations, such as pregnancy.
• A medicine may have a generic name, brand name or drug-class name, and these names describe different aspects of the product.
• NAFDAC's Registered Product Database provides a way to verify the registration details of medicines available in Nigeria.