Atovaquone/Proguanil

Dosing

Uncomplicated P. falciparum malariaP. falciparum prophylaxisAtovaquone/proguanil 1,000/400 mg PO q24h x3dAtovaquone/proguanil 250/100 mg PO q24h from 1-2d before entering endemic area to 7 days after returnMalarone (TN) 1 adult tab = Atovaquone 250 mg + Proguanil hydrochloride 100 mg

  • BW 5-8 kg: 125/50 mg PO q24h x3d

  • BW 9-10 kg: 187.5/75 mg PO q24h x3d

  • BW 11-20 kg: 250/100 mg PO q24h x3d

  • BW 21-30 kg: 500/200 mg PO q24h x3d

  • BW 31-40 kg: 750/300 mg PO q24h x3d

  • BW >40 kg: 1,000/400 mg PO q24h x3d

  • BW 11-20 kg: 1 pediatric tab PO q24h

  • BW 21-30 kg: 125/50 mg PO q24h

  • BW 31-40 kg: 187.5/75 mg PO q24h

  • BW >40 kg : 250/100 mg PO q24hMalarone (TN) 1 pediatric tab = Atovaquone 62.5 mg + Proguanil hydrochloride 25 mg

Mild or moderate hepatic impairmentSevere hepatic impairmentNo dose adjustmentNo data

CrCl ≥30CrCl <30No dose adjustmentAvoid

General Information

  • Malaria, P. falciparum; Prophylaxis

  • Malaria, Uncomplicated, P. falciparum

Resolution in the signs and symptoms of acute, uncomplicated Plasmodium falciparum malaria is indicative of efficacy.

Monitor closely for parasitemia in patients who are vomiting.

Common

  • Pruritus

  • Nausea

  • Vomiting

  • Diarrhea

  • Dizziness

  • Abdominal pain

  • Loss of appetite

  • Increased liver function test

  • Asthenia

  • Dizziness

  • Headache

Serious

  • Neutropenia

  • Pancytopenia

  • Hepatitis

  • Liver failure

Major drug-drug interactions:

  • Efavirenz

  • Warfarin

  • Rifamycins

  • Dicumarol

  • Ritonavir

  • Sapropterin

  • Methotrexate

  • Carbamazepine

  • Cholera vaccine, live

Antimicrobial class: Quinone, Biguanide

Pregnancy category: C

Average serum half life: 2-3 days (adults), 1-2 days (pediatrics)

Precautions:

  • Relapse of Plasmodium vivax infection has commonly occurred in patients with mixed P. falciparum and Plasmodium vivax infections who were treated with monotherapy.

  • Use with caution for the treatment of malaria in patients with severe renal impairment (CrCl <30 mL/min) only if benefits outweigh potential risks.

  • Monitoring recommended in patients with vomiting or diarrhea; alternative therapy may be required.

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