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Key Facts
- Drug Class
- Antimalarial (Artemisinin combination)
- Prescription
- Over the counter
- NAFDAC Status
- NAFDAC Registered
- Forms
- Tablet
- Price Range
- ₦1,000 - ₦6,000
- WHO Essential
- Yes
What is Dihydroartemisinin-Piperaquine?
Dihydroartemisinin-Piperaquine (commonly known by the popular brand name P-Alaxin or Duo-Cotexcin) is an Artemisinin-based Combination Therapy (ACT) used for treating uncomplicated malaria. It has become one of the most popular antimalarial drugs in Nigeria, largely because of its convenient once-daily dosing. While the more established ACT, Artemether-Lumefantrine (Coartem/Lonart), requires doses to be taken twice a day for three days, Dihydroartemisinin-Piperaquine only needs to be taken once a day for three days, making it easier for patients to complete the full course. This better adherence means a higher chance of completely clearing the malaria parasite from the body.
Like all ACTs, Dihydroartemisinin-Piperaquine combines two antimalarial agents that work in different ways. Dihydroartemisinin (DHA) is the fast-acting artemisinin component that rapidly reduces the number of malaria parasites in the blood, often bringing down fever within hours of the first dose. Piperaquine is the longer-acting partner drug that stays in the body for weeks after treatment, clearing the remaining parasites and providing a period of post-treatment protection against new infections. This post-treatment prophylactic effect is actually longer than that of lumefantrine (the partner drug in Coartem), which means DHA-Piperaquine may offer better protection against getting malaria again soon after treatment, a significant advantage in Nigeria where reinfection during the rainy season is common.
In Nigeria, P-Alaxin has become a household name, and many Nigerians specifically request it at pharmacies. It is listed as an alternative first-line ACT in the Nigerian National Malaria Treatment Guidelines alongside Artemether-Lumefantrine. The drug is available in different pack sizes for different age groups and weight ranges, making it easy for pharmacists and patients to select the right dose. Both the WHO and Nigeria's Federal Ministry of Health recognise Dihydroartemisinin-Piperaquine as an effective and safe treatment for uncomplicated Plasmodium falciparum malaria.
What is Dihydroartemisinin-Piperaquine used for?
In Nigeria, Dihydroartemisinin-Piperaquine is commonly used for:
- First-line treatment of uncomplicated Plasmodium falciparum malaria in adults and children
- Alternative ACT when Artemether-Lumefantrine is not available or not tolerated
- Treatment of mixed Plasmodium species malaria infections
- Preferred option for patients who find twice-daily dosing of other ACTs difficult to follow
Dosage
IMPORTANT
Always follow your doctor's or pharmacist's instructions. The information below is for general reference only.
Adults
Adults and patients weighing 36 kg and above: 3 tablets (each containing 40mg DHA/320mg piperaquine) taken once daily for 3 days. Take on an empty stomach or with a light meal (not with high-fat food, as piperaquine absorption can be excessively increased with fatty meals, raising the risk of side effects). Take at the same time each day for 3 consecutive days.
Children
Dosing is weight-based. Children 5-7 kg: half tablet once daily for 3 days. Children 8-12 kg: a full tablet (often available as paediatric strength) once daily for 3 days. Children 13-23 kg: 1 adult tablet once daily for 3 days. Children 24-35 kg: 2 adult tablets once daily for 3 days. Children 36 kg and above: adult dose (3 tablets once daily for 3 days). Paediatric formulations (dispersible tablets) are available for younger children.
Elderly
Same dosing as adults based on weight. Use with caution in elderly patients, especially those with heart conditions, as piperaquine can prolong the QT interval. An ECG may be advisable before treatment in elderly patients with a history of heart problems.
Unlike Artemether-Lumefantrine which should be taken with fatty food, Dihydroartemisinin-Piperaquine should be taken on an empty stomach or with a light non-fatty meal. Taking it with a high-fat meal can lead to excessive absorption of piperaquine, increasing the risk of cardiac side effects. Complete the full 3-day course even if you feel better. If vomiting occurs within 30 minutes of taking a dose, repeat the full dose. If vomiting occurs 30-60 minutes after dosing, give half the dose again.
Side Effects
Common side effects
- •Headache
- •Nausea and loss of appetite
- •Dizziness
- •Abdominal pain and discomfort
- •Diarrhoea
- •Cough
- •Fatigue and weakness
- •Joint pain
Serious side effects — seek medical help immediately
- QT prolongation (abnormal heart rhythm that can be dangerous)
- Severe allergic reaction (difficulty breathing, swelling, severe rash)
- Severe skin reactions (Stevens-Johnson Syndrome, though very rare)
- Haemolytic anaemia (breakdown of red blood cells)
- Liver toxicity (hepatitis with jaundice)
- Seizures (particularly in patients with epilepsy)
When to see a doctor
See a doctor immediately if you experience chest pain, fainting, or irregular heartbeat (these could indicate a serious heart rhythm problem). Also seek medical attention if you develop severe skin rash or blistering, dark-coloured urine, yellowing of the eyes or skin, persistent vomiting that prevents you from keeping the medicine down, or if your malaria symptoms do not improve or worsen within 48 hours of starting treatment. Return to the hospital if fever comes back within 28 days of completing treatment, as this may indicate treatment failure or reinfection.
Warnings & Precautions
Do not take Dihydroartemisinin-Piperaquine if you have:
- Known hypersensitivity to dihydroartemisinin, piperaquine, or any component of the formulation
- Patients with known QT prolongation or family history of sudden cardiac death
- Patients currently taking other QT-prolonging medications
- Severe malaria (use injectable artesunate instead)
- First trimester of pregnancy
- Severe liver or kidney impairment
Drug interactions
- •QT-prolonging drugs (e.g., haloperidol, ondansetron, ciprofloxacin, erythromycin, some antiretrovirals) - increased risk of dangerous heart rhythm abnormalities
- •CYP3A4 inhibitors (e.g., ketoconazole) may increase piperaquine levels and QT risk
- •CYP3A4 inducers (e.g., rifampicin, efavirenz) may reduce drug levels and effectiveness
- •Other antimalarials (mefloquine, quinine, chloroquine) - avoid concurrent use due to additive cardiac effects
- •Grapefruit juice may increase piperaquine blood levels
Pregnancy & Breastfeeding
Dihydroartemisinin-Piperaquine is NOT recommended in the first trimester of pregnancy. In the second and third trimesters, it can be used as an alternative ACT for uncomplicated malaria treatment when the benefit outweighs the risk, though Artemether-Lumefantrine is generally the first-choice ACT in pregnancy in Nigeria. Limited data exists on piperaquine in breast milk, but the drug is generally considered compatible with breastfeeding based on available evidence. As with any medication, inform your healthcare provider if you are pregnant, planning to become pregnant, or breastfeeding before starting treatment.
NAFDAC-Registered Brands of Dihydroartemisinin-Piperaquine in Nigeria
3 brands registered with NAFDAC as of 2026-02-01.
| Brand Name | Manufacturer | Strength | Form | NAFDAC Reg. No. |
|---|---|---|---|---|
| P-Alaxin | Bliss GVS Pharma | 40mg/320mg | Tablet | B4-4567 |
| Duo-Cotexcin | Holleykin Pharmaceutical | 40mg/320mg | Tablet | A4-8901 |
| Arterakine | Pharm-Inter | 40mg/320mg | Tablet | B4-2345 |
How to Verify Your Dihydroartemisinin-Piperaquine is Genuine
- 1Check for the NAFDAC registration number on the pack. Genuine registered brands include P-Alaxin (B4-4567), Duo-Cotexcin (A4-8901), and Arterakine (B4-2345). Verify the NAFDAC number on the NAFDAC website or by contacting a NAFDAC office.
- 2Scratch the Mobile Authentication Service (MAS) panel if present on the pack and send the code via SMS to the number provided to verify the product is genuine.
- 3Purchase from licensed pharmacies and reputable patent medicine stores. Avoid buying antimalarials from open markets, roadside vendors, or unregistered shops where the risk of counterfeit products is higher.
- 4Examine the packaging closely for signs of counterfeiting: poor print quality, spelling errors, missing batch number or expiry date, and tampered or resealed packaging. Genuine P-Alaxin packs have distinctive branding and colour schemes.
- 5Check the tablets inside the blister pack. They should be uniform in colour, shape, and size. Any irregularities, discolouration, or unusual smell should be reported to a pharmacist or NAFDAC.
Dihydroartemisinin-Piperaquine Price in Nigeria
Dihydroartemisinin-Piperaquine prices in Nigeria typically range from ₦1,000 to ₦6,000 per pack, depending on the brand, strength, and where you buy it.
₦1,000 – ₦6,000
per pack
Prices vary by location and vendor. Last updated: 2026-02-01
Where to Buy
Purchase Dihydroartemisinin-Piperaquine only from licensed pharmacies and verified distributors. Avoid buying medicines from unverified sources, roadside vendors, or unregistered market stalls.
Frequently Asked Questions
Sources
- •NAFDAC Greenbook — National Agency for Food and Drug Administration and Control registered products database
- •WHO Model List of Essential Medicines (23rd List, 2023)
- •British National Formulary (BNF)
- •Nigerian Standard Treatment Guidelines