By Oluwatise Osinaike
You must have heard it time and time again when you go to the pharmacy to get an antimalarial drug. There is always this instruction, don’t use it with vitamin C oh!
Have you stopped to ask why?
During my time working in a community pharmacy, I encountered a patient with malaria like symptoms who needed antimalarial drugs based on doctors prescription. I gave her an artemisinin combo, prescribed only for her to come back after three days saying we sold fake drugs to her.
She complained that she still had those symptoms and she wasn’t getting any better.
What could be wrong? We asked her, are you using vitamin C? Of course she said yes and right there we suspected Vitamin C could slow down the healing process.. We guessed correctly. When she stopped using vitamin C along with the malaria drug.she became.well.
That may not be the case for many other people because there are many other factors that could make a drug ineffective. It could be that the patient is not following the prescribed dosage, not eating well or that there was poor diagnosis. So many other factors could also be responsible which I may not be able to discuss here.
While some patients may not have issues with combining Vitamin C with malarial drugs some findings tend to discourage use of vitamin C along with malaria drugs. Some medical experts however have different views
What malaria is
Before we go further, let’s quickly do a backdrop of what malaria really is and its symptoms.
Malaria is caused by plasmodium parasites and it is transmitted by infected mosquito bites (Female Anopheles Mosquito).
There are actually different plasmodium parasites; there is the plasmodium falciparum, the plasmodium vivax, plasmodium malariae and the likes.
Resistance acquired by the mosquito to insecticides, and by the parasites to drugs has led to new therapeutic challenges.
Symptoms of malaria
There are diverse symptoms of malaria. Patients may present with headache, fever, body pains, vomiting, stomach pains and so many others. It’s funny how that these symptoms differ from one body type to the other.
For me, I normally have a bad sore throat and also severe cold that would cause me to cough and sneeze. For others it could just be body pain and severe headache.
Regardless, it is important you get conversant with your body, so that you are able to decipher which is which before getting to the hospital. Or better still, go to the hospital and get a proper diagnosis.
How antimalarial drugs work
One important mechanism of action of most antimalarial drugs is that they work by an oxidation process. What this means is that they work by generating reactive oxygen species within the malaria parasite, damaging the parasites proteins and DNA and by so doing killing the parasites.
Now, the way all these happen is that the malarial parasite on entry and feeding on the host produces heme. (Heme is gotten from the parasites digestion of hemoglobin. It is a molecule that contains iron and it plays a crucial role in various biological processes) but this heme the parasite produces is toxic to the parasite, so as a way of protecting itself, it metabolizes the heme to hemozoin. Hemozoin isn’t toxic.
Once this heme is released, the iron from it activates the antimalarial drugs especially the artemisinin combo, which then leads to oxidative stress of the parasites.
These reactive oxygen species can also affect heme synthesis potentially influencing heme accumulation.
What would vitamin C do?
Aside the many other mechanisms of action of Vitamin C, one important thing to note is that, vitamin C is an antioxidant, protecting cells from oxidative damage.
The antimalarial medications that are trying to kill the malaria parasite could be rendered ineffective once you take vitamin C.. Vitamin C may counter the harm the parasite has sustained.
Well, not only vitamin C should be avoided during the treatment of malaria, even fruits that have vitamin C like Oranges, lemons should also be avoided.
Multivitamins, Blood tonic, Zinc and even supplements that have Vitamin E (because Vitamin E also protects cells from oxidative damage) should also be avoided. But as noted earlier, this may not apply to all patients
Possible solutions to reoccurring malaria symptoms
Another thing I’d advise is to always complete your antimalarial medications. Even when you get better from the first day, try to finish the dose prescribed by your doctor.
Also follow prescriptions correctly. Most antimalarial medications are given for three days, especially the artemisinin combination therapy. The first dose is usually 8 hourly for many of the malaria drugs and then the second and third dose is 24 hours from the initial dose.
One last thing, make sure you eat well during your treatment. Your mouth could be bitter but push yourself to eat good food. Emphasis on good food and not junks. The drugs you take would need food to work better and faster
Oluwatise Osinaike is a Pharmacologist based in Ota, Ogun State
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