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Fansidar

Fansidar is a fixed-dose combination of pyrimethamine and sulfadoxine, paired in a single oral preparation for the management of malaria. Combinations of this kind are long-established in antimalarial therapy: the two ingredients act on different steps of the same parasitic pathway, and pairing them in one product formalises a co-administration that has been part of malaria treatment protocols for decades.

Pyrimethamine and sulfadoxine together fall within the antimalarial sulfonamide combination category, classified more broadly as antiprotozoal and antimalarial agents. Pyrimethamine contributes one mechanism of parasite inhibition while sulfadoxine, a long-acting sulfonamide, contributes another — at the category level, the rationale is complementary action against the malaria parasite rather than reliance on a single point of attack. Registered indications include malaria treatment and, in some markets, malaria prevention in defined contexts.

Fansidar is registered in 12 countries, with a footprint that reaches across malaria-endemic regions and several non-endemic markets that hold the product for travellers. Examples include Thailand, Brazil, South Africa, Indonesia, and France. Outside these markets the brand may be unfamiliar, but pyrimethamine–sulfadoxine is available internationally under other brand names, particularly in countries with active malaria control programmes.

Combination antimalarials vary considerably between countries — both in regulatory status and in how they fit into national malaria treatment guidelines, which evolve with local resistance patterns. Travellers should treat antimalarial choice as a travel-medicine decision made in advance of departure, and any patient considering Fansidar or an equivalent should do so through consultation with a qualified healthcare provider.

Countries
Brazil France Georgia Indonesia Oman Pakistan Philippines Russia South Africa Thailand United Arab Emirates USA
Diseases
Malaria Malaria prevention
Ingredients
Pyrimethamine Sulfadoxine
Drug Actions
Antiprotozoal Antimalarial Antimalarial sulfonamide combination

Drugs with the same active ingredients

Daraprim Falcistat Artesunate, sulphadoxine & pyrimethamine Daraprim (oral) Fansidar (oral) Pyrimethamine leucovorin Rebalance Rebalance (pyrimethamine,sulfadiazine) Amalar Amalar forte Anitmala Antifocinc Croydoxin-fm Falcistat (pyrimethamine,sulfadoxine) Laridox Laridox forte Malacide Malason Malex Malocide

Overdose

Acute intoxication may be manifested by headache, nausea, anorexia, vomiting and central nervous system stimulation (including convulsions), followed by megaloblastic anemia, leukopenia, thrombocytopenia, glossitis and crystalluria. In acute intoxication, emesis and gastric lavage followed by purges may be of benefit. The patient should be adequately hydrated to prevent renal damage. The renal, hepatic, and hematopoietic systems should be monitored for at least 1 month after an overdosage. If the patient is having convulsions, the use of parenteral diazepam or a barbiturate is indicated. For depressed platelet or white blood cell counts, folinic acid (leucovorin) should be administered in a dosage of 5 mg to 15 mg intramuscularly daily for 3 days or longer.

Contraindications

  • Repeated prophylactic (prolonged) use of Fansidar (sulfadoxine and pyrimethamine) is contraindicated in patients with renal or hepatic failure or with blood dyscrasias;
  • Hypersensitivity to pyrimethamine, sulfonamides, or any other ingredient of Fansidar (sulfadoxine and pyrimethamine) ;
  • Patients with documented megaloblastic anemia due to folate deficiency;
  • Infants less than 2 months of age;
  • Prophylactic use of Fansidar (sulfadoxine and pyrimethamine) in pregnancy at term and during the nursing period.

Undesirable effects

For completeness, all major reactions to sulfonamides and to pyrimethamine are included below, even though they may not have been reported with Fansidar (see WARNINGS and PRECAUTIONS: Information For The Patient).

Hematological Changes

Agranulocytosis, aplastic anemia, megaloblastic anemia, thrombocytopenia, leukopenia, hemolytic anemia, purpura, hypoprothrombinemia, methemoglobinemia, and eosinophilia.

Skin and Miscellaneous Sites Allergic Reactions

Erythema multiforme, Stevens-Johnson syndrome, generalized skin eruptions, toxic epidermal necrolysis, urticaria, serum sickness, pruritus, exfoliative dermatitis, anaphylactoid reactions, periorbital edema, conjunctival and scleral injection, photosensitization, arthralgia, allergic myocarditis, slight hair loss, Lyell's syndrome,

Gastrointestinal Reactions

Glossitis, stomatitis, nausea, emesis, abdominal pains, hepatitis, hepatocellular necrosis, diarrhea, pancreatitis, feeling of fullness, and transient rise of liver enzymes.

Central Nervous System Reactions

Headache, peripheral neuritis, mental depression, convulsions, ataxia, hallucinations, tinnitus, vertigo, insomnia, apathy, fatigue, muscle weakness, nervousness, and polyneuritis.

Respiratory Reactions

Pulmonary infiltrates resembling eosinophilic or allergic alveolitis.

Genitourinary

Renal failure, interstitial nephritis, BUN and serum creatinine elevation, toxic nephrosis with oliguria and anuria, and crystalluria.

Miscellaneous Reactions

Drug fever, chills, periarteritis nodosa and LE phenomenon have occurred.

The sulfonamides bear certain chemical similarities to some goitrogens, diuretics (acetazolamide and the thiazides), and oral hypoglycemic agents. Diuresis and hypoglycemia have occurred rarely in patients receiving sulfonamides. Cross-sensitivity may exist with these agents. Rats appear to be especially susceptible to the goitrogenic effects of sulfonamides, and long-term administration has produced thyroid malignancies in the species.

Therapeutic indications

Treatment of Acute Malaria

Fansidar (sulfadoxine and pyrimethamine) is indicated for the treatment of acute, uncomplicated P. falciparum malaria for those patients in whom chloroquine resistance is suspected. However, strains of P. falciparum (see CLINICAL PHARMACOLOGY: Microbiology) may be encountered which have developed resistance to Fansidar (sulfadoxine and pyrimethamine) , in which case alternative treatment should be administered.

Prevention of Malaria

Malaria prophylaxis with Fansidar (sulfadoxine and pyrimethamine) is not routinely recommended and should only be considered for travelers to areas where chloroquine-resistant P. falciparum malaria is endemic and sensitive to Fansidar (sulfadoxine and pyrimethamine) , and when alternative drugs are not available or are contraindicated (see CONTRAINDICATIONS). However, strains of P. falciparum may be encountered which have developed resistance to Fansidar (sulfadoxine and pyrimethamine).

Date of revision of the text

August 2004. FDA revision date: 2/26/2004

Fertility, pregnancy and lactation

Teratogenic Effects: Pregnancy Category C

Fansidar (sulfadoxine and pyrimethamine) has been shown to be teratogenic in rats when given in weekly doses approximately 12 times the weekly human prophylactic dose. Teratology studies with pyrimethamine plus sulfadoxine (1:20) in rats showed the minimum oral teratogenic dose to be approximately 0.9 mg/kg pyrimethamine plus 18 mg/kg sulfadoxine. In rabbits, no teratogenic effects were noted at oral doses as high as 20 mg/kg pyrimethamine plus 400 mg/kg sulfadoxine.

There are no adequate and well-controlled studies in pregnant women. However, due to the teratogenic effect shown in animals and because pyrimethamine plus sulfadoxine may interfere with folic acid metabolism, Fansidar (sulfadoxine and pyrimethamine) therapy should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. Women of childbearing potential who are traveling to areas where malaria is endemic should be warned against becoming pregnant, and should be advised to practice contraception during prophylaxis with Fansidar (sulfadoxine and pyrimethamine) and for three months after the last dose.

Nonteratogenic Effects

See CONTRAINDICATIONS.

Qualitative and quantitative composition

Scored tablets, containing 500 mg sulfadoxine and 25 mg pyrimethamine — unit dose packages of 25 (NDC-0004-0161-03). Imprint on tablets: FANSIDAR (sulfadoxine and pyrimethamine) ((ROCHE LOGO)) ROCHE.

Manufactured by: F. Hoffmann-La Roche Ltd. Basel, Switzerland. Distributed by: Roche Laboratories Inc., 340 Kingsland Street, Nutley, New Jersey, NJ 07110-1199. Revised: August 2004. FDA revision date: 2/26/2004

Special warnings and precautions for use

WARNINGS

FATALITIES ASSOCIATED WITH THE ADMINISTRATION OF FANSIDAR (sulfadoxine and pyrimethamine) HAVE OCCURRED DUE TO SEVERE REACTIONS, INCLUDING STEVENS-JOHNSON SYNDROME AND TOXIC EPIDERMAL NECROLYSIS. FANSIDAR (sulfadoxine and pyrimethamine) PROPHYLAXIS MUST BE DISCONTINUED AT THE FIRST APPEARANCE OF SKIN RASH, IF A SIGNIFICANT REDUCTION IN THE COUNT OF ANY FORMED BLOOD ELEMENTS IS NOTED, OR UPON THE OCCURRENCE OF ACTIVE BACTERIAL OR FUNGAL INFECTIONS.

Fatalities associated with the administration of sulfonamides, although rare, have occurred due to severe reactions, including fulminant hepatic necrosis, agranulocytosis, aplastic anemia and other blood dyscrasias. Fansidar (sulfadoxine and pyrimethamine) prophylactic regimen has been reported to cause leukopenia during a treatment of 2 months or longer. This leukopenia is generally mild and reversible.

PRECAUTIONS General

Oral Fansidar (sulfadoxine and pyrimethamine) has not been evaluated for the treatment of cerebral malaria or other severe manifestations of complicated malaria, including hyperparasitemia, pulmonary edema or renal failure. Patients with severe malaria are not candidates for oral therapy. In the event of recrudescent P. falciparum infections after treatment with Fansidar (sulfadoxine and pyrimethamine) or failure of chemoprophylaxis with Fansidar (sulfadoxine and pyrimethamine) , patients should be treated with a different blood schizonticide.

Fansidar (sulfadoxine and pyrimethamine) should be given with caution to patients with impaired renal or hepatic function, to those with possible folate deficiency and to those with severe allergy or bronchial asthma. As with some sulfonamide drugs, in glucose-6-phosphate dehydrogenase-deficient individuals, hemolysis may occur. Urinalysis with microscopic examination and renal function tests should be performed during therapy of those patients who have impaired renal function. Excessive sun exposure should be avoided.

Laboratory Tests

Regularly scheduled complete blood counts, liver enzyme tests and analysis of urine for crystalluria should be performed whenever Fansidar (sulfadoxine and pyrimethamine) is administered for more than three months.

Carcinogenesis, Mutagenesis, Impairment of Fertility

Pyrimethamine was not found carcinogenic in female mice or in male and female rats. The carcinogenic potential of pyrimethamine in male mice could not be assessed from the study because of markedly reduced life-span. Pyrimethamine was found to be mutagenic in laboratory animals and also in human bone marrow following 3 or 4 consecutive daily doses totaling 200 mg to 300 mg. Pyrimethamine was not found mutagenic in the Ames test. Testicular changes have been observed in rats treated with 105 mg/kg/day of Fansidar (sulfadoxine and pyrimethamine) and with 15 mg/kg/day of pyrimethamine alone. Fertility of male rats and the ability of male or female rats to mate were not adversely affected at dosages of up to 210 mg/kg/day of Fansidar (sulfadoxine and pyrimethamine). The pregnancy rate of female rats was not affected following their treatment with 10.5 mg/kg/day, but was significantly reduced at dosages of 31.5 mg/kg/day or higher, a dosage approximately 30 times the weekly human prophylactic dose or higher.

Pregnancy Teratogenic Effects: Pregnancy Category C

Fansidar (sulfadoxine and pyrimethamine) has been shown to be teratogenic in rats when given in weekly doses approximately 12 times the weekly human prophylactic dose. Teratology studies with pyrimethamine plus sulfadoxine (1:20) in rats showed the minimum oral teratogenic dose to be approximately 0.9 mg/kg pyrimethamine plus 18 mg/kg sulfadoxine. In rabbits, no teratogenic effects were noted at oral doses as high as 20 mg/kg pyrimethamine plus 400 mg/kg sulfadoxine.

There are no adequate and well-controlled studies in pregnant women. However, due to the teratogenic effect shown in animals and because pyrimethamine plus sulfadoxine may interfere with folic acid metabolism, Fansidar (sulfadoxine and pyrimethamine) therapy should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. Women of childbearing potential who are traveling to areas where malaria is endemic should be warned against becoming pregnant, and should be advised to practice contraception during prophylaxis with Fansidar (sulfadoxine and pyrimethamine) and for three months after the last dose.

Nonteratogenic Effects

See CONTRAINDICATIONS.

Nursing Mothers

See CONTRAINDICATIONS.

Pediatric Use

Fansidar (sulfadoxine and pyrimethamine) should not be given to infants less than 2 months of age because of inadequate development of the glucuronide-forming enzyme system.

Geriatric Use

Clinical studies of Fansidar (sulfadoxine and pyrimethamine) did not include sufficient numbers of subjects aged 65 and over to determine whether they respond differently from younger subjects. Other reported clinical experience has not identified differences in responses between the elderly and younger patients. In general, dose selection for an elderly patient should be cautious, usually starting at the low end of the dosing range, reflecting the greater frequency of decreased hepatic, renal or cardiac function, and of concomitant disease or other drug therapy. This drug is known to be substantially excreted by the kidney, and the risk of toxic reactions to this drug may be greater in patients with impaired renal function. Because elderly patients are more likely to have decreased renal function, care should be taken in dose selection, and it may be useful to monitor renal function.

Dosage (Posology) and method of administration

(See INDICATIONS AND USAGE)

The dosage should be swallowed whole, and not chewed, with plenty of fluids after a meal.

Treatment of Acute Malaria

Adults 2 to 3 tablets taken as a single dose.
Pediatric patients
(>2 months to 18 years)		 The dosage for treatment of malaria in children is based upon body weight:
Weight (kg) Number of Tablets Taken as a Single Dose
>45 3
31 to 45 2
21 to 30 1 ½
11 to 20 1
5 to 10 ½
Prevention of Malaria

The malaria risk must be carefully weighed against the risk of serious adverse drug reactions (see INDICATIONS AND USAGE). If Fansidar (sulfadoxine and pyrimethamine) is prescribed for prophylaxis, it is important that the physician inquires about sulfonamide intolerance and points out the risk and the need for immediate drug withdrawal if skin reactions do occur.

The first dose of Fansidar (sulfadoxine and pyrimethamine) should be taken 1 or 2 days before arrival in an endemic area; administration should be continued during the stay and for 4 to 6 weeks after return.

  Once Weekly Once Every 2 Weeks
Adults 1 tablet 2 tablets
Pediatric patients
(>2 months to 18 years)		 The dosage for prevention of malaria in children is based upon body weight:
Weight (kg) Number of Tablets Taken Once Weekly
>45 1½
31 to 45 1
21 to 30 ¾
11 to 20 ½
5 to 10 ¼

Prophylaxis with Fansidar (sulfadoxine and pyrimethamine) should not be continued for more than two years, since no experience of more prolonged administration is available to date.

Interaction with other medicinal products and other forms of interaction

SIDE EFFECTS

For completeness, all major reactions to sulfonamides and to pyrimethamine are included below, even though they may not have been reported with Fansidar (see WARNINGS and PRECAUTIONS: Information For The Patient).

Hematological Changes

Agranulocytosis, aplastic anemia, megaloblastic anemia, thrombocytopenia, leukopenia, hemolytic anemia, purpura, hypoprothrombinemia, methemoglobinemia, and eosinophilia.

Skin and Miscellaneous Sites Allergic Reactions

Erythema multiforme, Stevens-Johnson syndrome, generalized skin eruptions, toxic epidermal necrolysis, urticaria, serum sickness, pruritus, exfoliative dermatitis, anaphylactoid reactions, periorbital edema, conjunctival and scleral injection, photosensitization, arthralgia, allergic myocarditis, slight hair loss, Lyell's syndrome,

Gastrointestinal Reactions

Glossitis, stomatitis, nausea, emesis, abdominal pains, hepatitis, hepatocellular necrosis, diarrhea, pancreatitis, feeling of fullness, and transient rise of liver enzymes.

Central Nervous System Reactions

Headache, peripheral neuritis, mental depression, convulsions, ataxia, hallucinations, tinnitus, vertigo, insomnia, apathy, fatigue, muscle weakness, nervousness, and polyneuritis.

Respiratory Reactions

Pulmonary infiltrates resembling eosinophilic or allergic alveolitis.

Genitourinary

Renal failure, interstitial nephritis, BUN and serum creatinine elevation, toxic nephrosis with oliguria and anuria, and crystalluria.

Miscellaneous Reactions

Drug fever, chills, periarteritis nodosa and LE phenomenon have occurred.

The sulfonamides bear certain chemical similarities to some goitrogens, diuretics (acetazolamide and the thiazides), and oral hypoglycemic agents. Diuresis and hypoglycemia have occurred rarely in patients receiving sulfonamides. Cross-sensitivity may exist with these agents. Rats appear to be especially susceptible to the goitrogenic effects of sulfonamides, and long-term administration has produced thyroid malignancies in the species.

DRUG INTERACTIONS

There have been reports which may indicate an increase in incidence and severity of adverse reactions when chloroquine is used with Fansidar (sulfadoxine and pyrimethamine) as compared to the use of Fansidar (sulfadoxine and pyrimethamine) alone. Fansidar (sulfadoxine and pyrimethamine) is compatible with quinine and with antibiotics. However, antifolic drugs such as sulfonamides, trimethoprim, or trimethoprim-sulfamethoxazole combinations should not be used while the patient is receiving Fansidar (sulfadoxine and pyrimethamine) for antimalarial prophylaxis. Fansidar (sulfadoxine and pyrimethamine) has not been reported to interfere with antidiabetic agents.

If signs of folic acid deficiency develop, Fansidar (sulfadoxine and pyrimethamine) should be discontinued. When recovery of depressed platelets or white blood cell counts in patients with drug-induced folic acid deficiency is too slow, folinic acid (leucovorin) may be administered in doses of 5 to 15 mg intramuscularly daily for 3 days or longer.

Frequently asked questions

What is Fansidar used for?

Fansidar is used in the treatment of malaria and, in certain settings, for malaria prevention. It belongs to the antimalarial sulfonamide combination category, pairing two ingredients that act on the malaria parasite through complementary pathways. The exact registered indications differ between countries — some markets authorise it for treatment only, others for prevention in specific traveller or residency contexts. The structured indication block below this introduction lists each registered use.

Which active substances are in Fansidar?

Fansidar contains two active ingredients: pyrimethamine and sulfadoxine. Together they form an antimalarial sulfonamide combination, classified within the broader antiprotozoal and antimalarial categories. The same pyrimethamine–sulfadoxine pairing circulates internationally under several brand names, particularly in malaria-endemic regions where fixed-dose antimalarial combinations are part of standard public health formularies.

In how many countries is Fansidar available?

Fansidar is registered in 12 countries, with a footprint that spans malaria-endemic regions and several non-endemic markets that stock it for travellers. Examples include Thailand, Brazil, South Africa, Indonesia, Pakistan, France, and the United Arab Emirates. If your country is not on this list, a local pharmacist or travel-medicine clinic can confirm whether pyrimethamine–sulfadoxine is available locally under a different brand name.

Are there other medications with the same active ingredients as Fansidar?

Pyrimethamine–sulfadoxine combinations are sold under several brand names worldwide, particularly across sub-Saharan Africa and parts of Asia where malaria control programmes use fixed-dose antimalarials. Other medications within the broader antimalarial category also exist, although they are not freely interchangeable — antimalarials differ meaningfully in their indications, parasite coverage, and travel-medicine positioning. A pharmacist or travel-medicine specialist can identify locally available options.

Should I consult a doctor before taking Fansidar?

Yes. Antimalarial therapy is calibrated to the destination, the malaria species circulating there, the patient's history, and concurrent medications, and combination products in this category vary across countries in their regulatory status and prescribing patterns. Travellers in particular should plan antimalarial choices through a travel-medicine consultation well before departure rather than at a pharmacy counter on arrival. Any decision to start, stop, or substitute should involve a healthcare provider.

Fansidar

Available in 12 countries