View source for Atovaquone-proguanil

==General==
*Type: Antimalarial
*Dosage Forms: tablet
*Dosage Strengths: 62.5mg/25mg, 250mg/100mg
*Routes of Administration: PO
*Common Trade Names: Malarone

==Adult Dosing==
===Malaria prophylaxis===
*250mg/100mg PO QD
**Start 1-2 days prior to possible exposure
**Continue 7 days after possible exposure

===Malaria treatment===
*1000mg/400mg PO QD x 3 days
*Not for severe, complicated or cerebral malaria
*See [http://www.cdc.gov/malaria/resources/pdf/treatmenttable.pdf CDC Recommendations] for complete dosing/recommendations

==Pediatric Dosing==
===Malaria prophylaxis===
*For all dosing regimins 
**Start 1-2 days prior to possible exposure
**Continue 7 days after possible exposure

====5-8 kg====
*31.25mg/12.5mg PO QD

====9-10 kg====
*46.9mg/18.7mg PO QD

====11-20 kg====
*62.5mg/25mg PO QD

====21-30 kg====
*125mg/50mg PO QD

====31-40 kg====
*187.5mg/75mg PO QD

====>40 kg====
*See adult dosing

===Malaria treatment===
*Not for severe, complicated or cerebral malaria
*See [http://www.cdc.gov/malaria/resources/pdf/treatmenttable.pdf CDC Recommendations] for complete dosing/recommendations

====5-8 kg====
*125mg/50mg PO QD x 3 days

====9-10 kg====
*187.5mg/75mg PO QD x 3 days

====11-20 kg====
*250mg/100mg QD x 3 days

====21-30 kg====
*500mg/200mg PO QD x 3 days

====31-40 kg====
*750mg/300mg PO QD x 3 days

====>40 kg====
*See adult dosing

==Special Populations==
*[[Drug Ratings in Pregnancy|Pregnancy Rating]]: C
*Lactation:  Safety unknown; caution advised
*Renal Dosing: Adult and Pediatric
**CrCl>30: No adjustment
**CrCl<30
***Contraindicated for malaria prophylaxis
***Risk/benefit analysis for malaria treatment
*Hepatic Dosing: Adult and Pediatric
**Undefined for severe impairment otherwise no adjustment

==Contraindications==
*Allergy to class/drug
*CrCl <30
*Caution
**CrCl<30 for treatment
**Persistent severe diarrhea/vomiting

==Adverse Reactions==
===Serious===
*Hypersensitivity reaction
*[[Stevens-Johnson Syndrome]]
*[[Erythema multiforme]]
*Photosensitivity
*Hepatotoxicity
*Neutropenia
*Anemia
*Pancytopenia

===Common===
*Elevated LFTs
*Abdominal pain
*Headache
*Nausea/Vomiting
*Cough
*[[Diarrhea]]
*Asthenia
*Vivid dreams
*Oral ulcers
*Anorexia
*Dizziness
*Gastritis
*Pruritus
*Insomnia

==Pharmacology==
*Half-life: 12-21 hours
*Metabolism: 
**Atovaquone
***CYP450
**Proguanil
***liver; CYP450
*Excretion: feces and urine
*Mechanism of Action:
**Atovaquone
***bacteriostatic or bactericidal 
**Proguanil
***Inhibits parasite dihydofolate

==Administration==
*Give with food or milk
*If vomiting occurs within 1 hour repeat dose

==See Also==
[[Malaria]]

==References==
*Epocrates

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[[Category:Pharmacology]] [[Category:ID]]