A combination of chloroquine and amlodipine, a derivative of 1,4-dihydropyridine calcium channel blocker, was tested against Plasmodium falciparum in vitro and P. yoelii in mice. The dextrorotary enantiomer of amlodipine, practically devoid of calcium channel blocking action, increased chloroquine accumulation inside the infected mouse erythrocytes and potentiated chloroquine action against the resistant strains of P. falciparum in vitro and P. yoelii in mice. Unlike the racemate, the dextrorotary amlodipine was not toxic to the host animal, even at the highest dose of 250 mg/kg. No potentiating effect was noted in the chloroquine-susceptible strains of P. falciparum. The results of this study indicate that chloroquine potentiation of amlodipine is probably independent of calcium channels and that a combination therapy of the dextrorotary enantiomer of amlodipine and chloroquine might be a potentially useful therapeutic strategy against chloroquine-resistant falciparum malaria.Chloroquine has been the drug of choice for treating Plasmodium falciparum malaria for more than 40 years. However, the prophylactic and therapeutic utility of chloroquine is largely limited today because of the spread of the chloroquine-resistant strains of P. falciparum in most malaria-endemic regions (5). Therefore, new therapeutic approaches are urgently needed.The mechanism of chloroquine resistance is thought to involve an enhanced drug efflux from the drug-resistant malaria parasites (17). This efflux process is supposed to be responsible for the failure of chloroquine to accumulate inside erythrocytes parasitized by resistant parasites to the extent that has been observed with susceptible parasites (7,21,32). This efflux process can be inhibited by several calcium channel blockers (22,29). Similar observations were reported with tricyclic antidepressants (4) and tricyclic antihistaminics (25). The latter agents possess an indirect calcium antagonist action on either calmodulin, a calciumbinding protein (27), or other calcium-dependent enzymes (20).The use of combination therapy with chloroquine and calcium antagonists is probably unsuitable in cases of human malaria because of the high doses of calcium antagonists necessary to reverse chloroquine resistance (4). One of the possible means to circumvent this problem of host toxicity may be the use of stereospecific drugs (2, 16), since the dextrorotatory (+)-enantiomer of verapamil has been shown to reverse chloroquine resistance in vitro (37). Amlodipine, a 1,4-dihydropyridine derivative of nifedipine, has a highly stereospecific property on the calcium channels. The affinity of its levorotary (-)-enantiomer to the calcium channels is 1,000 times superior to that of its dextrorotary (+)-enantiomer (1). On the basis of this stereospecificity, the chloroquine potentiating actions of the racemic mixture and the (+)-enantiomer of amlodipine were compared in this study. We report that (+)-amlodipine potentiated chloroquine in vitro and in vivo, without lethal effects, and led to a * Corr...