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 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 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
- 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
- Atovaquone
- Excretion: feces and urine
- Mechanism of Action:
- Atovaquone
- bacteriostatic or bactericidal
- Proguanil
- Inhibits parasite dihydofolate
- Atovaquone
Administration
- Give with food or milk
- If vomiting occurs within 1 hour repeat dose
See Also
References
- Epocrates