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Heme alkylation in *Plasmodium* refers to the covalent modification of free heme molecules within the malaria parasite, primarily by antimalarial drugs containing peroxide groups such as artemisinin derivatives and ozonides. This process is a key mechanism underlying the efficacy of these drugs against *Plasmodium falciparum*. Peroxide-based antimalarials are activated by intraparasitic iron—most likely from free heme—leading to generation of highly reactive carbon-centered radicals that alkylate the porphyrin ring of free heme at various meso positions, forming stable adducts and disrupting normal detoxification pathways.
Iron-mediated activation of peroxide antimalarials leads to radical formation and subsequent covalent modification (alkylation) of free heme, disrupting its detoxification and leading to parasite death.
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