# Artemether-Lumefantrine vs Dihydroartemisinin-Piperaquine in Nigeria: Coartem-style or P-Alaxin-style — which ACT for malaria?

**The short answer:** Both are WHO-recommended ACTs that cure uncomplicated malaria reliably when taken properly. Artemether-lumefantrine (Coartem, Lonart) is Nigeria's workhorse — twice daily for three days, taken with milk or food. Dihydroartemisinin-piperaquine (P-Alaxin, Duo-Cotecxin) is once daily for three days and shields you a few weeks longer afterwards. Pick either genuine product over any 'stronger' non-ACT alternative.

Nigeria's pharmacy shelves carry both of these artemisinin combinations under dozens of brand names, and people argue passionately about which 'works better'. The evidence says both cure over 95% of uncomplicated falciparum malaria when the tablets are genuine and the course is completed. The real-world differences are practical: dosing schedule, food requirements, and how long each protects you after treatment.
Artemether-lumefantrine must be taken with fatty food or milk — on an empty stomach much of the lumefantrine simply isn't absorbed, which is a common hidden cause of 'treatment failure'. Dihydroartemisinin-piperaquine is once daily and its piperaquine lingers for weeks, giving longer post-treatment protection — useful where reinfection is quick. Counterfeits are the biggest danger with both: verify the NAFDAC number on any pack before you swallow the first dose.

## Side by side

| | Artemether-Lumefantrine | Dihydroartemisinin-Piperaquine |
|---|---|---|
| Dosing | Twice daily × 3 days (6 doses) | Once daily × 3 days (3 doses) |
| Food requirement | Must take with fatty food or milk | Best on an empty stomach |
| Protection after cure | Shorter tail | Longer — piperaquine lingers for weeks |
| Familiar brands | Coartem, Lonart, Amatem | P-Alaxin, Duo-Cotecxin |
| Drug class | Antimalarial (Artemisinin combination) | Antimalarial (Artemisinin combination) |
| Typical price | ~₦3,370 online (tablets) (September 2026) | varies by brand and pack |
| NAFDAC registrations | 298 active Greenbook listings | 24 active Greenbook listings |
| Common brands | [Coartem](https://ogbogwu.com/brands/coartem/), [Coartem Dispersible](https://ogbogwu.com/brands/coartem-dispersible/) | [P-Alaxin](https://ogbogwu.com/brands/p-alaxin/), [Duo-Cotexcin](https://ogbogwu.com/brands/duo-cotexcin/) |

## Reach for Artemether-Lumefantrine when…

- You want the most widely stocked, most familiar option
- Food with doses is not a problem
- Your clinician or pharmacist recommends the national first-line

## Reach for Dihydroartemisinin-Piperaquine when…

- Sticking to a twice-daily schedule is unrealistic for you
- You're in a high-reinfection area and want the longer protective tail
- Taking tablets with fatty food is difficult

## My malaria 'didn't clear' with one of these — is it resistance?

Usually not. The common culprits in Nigeria are counterfeit or substandard tablets, missed doses, artemether-lumefantrine taken without food, or a fever that was never malaria in the first place. Confirm with a test, verify the pack's NAFDAC number, and see a clinician rather than stacking different antimalarials.

## Are injections stronger than these tablets?

For uncomplicated malaria, no — oral ACTs are the recommended treatment, and routine artesunate injections for walking-in patients are unnecessary. Injectable artesunate is for severe malaria, in a health facility.

Full guides: https://ogbogwu.com/drugs/artemether-lumefantrine/ · https://ogbogwu.com/drugs/dihydroartemisinin-piperaquine/
Source: https://ogbogwu.com/compare/artemether-lumefantrine-vs-dihydroartemisinin-piperaquine/ — educational comparison, not a prescription.