The effect of Verapamil in Malaria - A Prospective Randomized Double Blind Control Clinical Study

Context: To reduce the drug resistance produced by malarial parasites to chloroquine and Verapamil, a chemosensitiser which has been tried in vivo. Objectives: To find out whether verapamil facilitates the action of chloroquine in malaria and to find out the safety of using verapamil in malaria. Study Design: A double blind randomized control study Description of the Subjects: Sixty patients who were positive for malaria by the QBC test (vivax, falciparum) without any associated illness (hypertension, diabetes, anaemia, cardiac, renal diseases) were included. Informed consent was obtained from each patient. Interventions: After thorough clinical examination, the patients were randomly allocated for two different treatments. Group A received standard chloroquine therapy (600 mg loading dose, 300 mg after 8 hrs, 2 4 hrs and 4 8 hrs). Group B received in addition to chloroquine therapy, verapamil 4 0 mg orally two hours after the administration of chloroquine. All the patients were evaluated, based on the time taken for the temperature to become normal, disappearance of rigor and chills (patients were evaluated at every 4 th hour) and the QBC test to become negative (test done at every 12 th hour) Results: It was observed that patients in group B had earlier relief of symptoms and signs and QBC became negative early as compared to group A. Fever (Mean-18.53 hours for group A and 9.33 hours for group B, SD for group A is 7.68 hours and for group B is 3.53 hours) and rigor and chills (Mean for group A is 18.8 hours and group B is 9.7 hours, SD for group A is 7.9 4 hours and for group B is 3.53 hours) were reduced to normal within 2 4 hours in group B, whereas in group A, it became normal only in 36 hours. Parasitaemia was cleared in 36 hours in group B, but in group A, it was cleared only in 4 8 hours (Mean for group A is 28. 4 hours and for group B is 19.7 hours, SD for group A is 7.68 hours and for group B is 6.81 hours). No one had hypotension or any other significant adverse effects. The results were analyzed by the Student's t test and they was considered to be significant (p<0.001). Conclusion: Verapamil facilitates the action of chloroquine in malaria and it is safe.