Atovaquone

Aka: Atovaquone, Mepron, Malarone

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II. Indications

  1. Human Immunodeficiency Virus (HIV)
    1. Pneumocystis carinii Pneumonia prophylaxis
    2. Pneumocystis carinii Pneumonia treatment
    3. Patients unable to tolerate Bactrim
  2. Malaria Prophylaxis and Treatment (Malarone)
    1. Uncomplicated Plasmodium FalciparumMalaria infection from countries with artemisinin resistance
  3. Babesiosis

III. Contraindications

  1. Creatinine Clearance <30 ml/minute/1.73m2
  2. Pregnancy Category C
  3. Breast Feeding of infants under 11 klb (5 kg)

IV. Dosing: Pneumocystis carinii Pneumonia

  1. Prophylaxis: 1500 mg orally daily with food
  2. Treatment: 750 mg orally twice daily with food for 21 days

V. Dosing: Malaria (Atovaquone/Proguanil or Malarone)

  1. Adults (one tablet: 250/100 mg)
    1. Prophylaxis: 1 tablet (250 mg/100 mg) orally daily
      1. Start 1-2 days before travel
      2. Stop 7 days after return
    2. Treatment: 4 tablets (1000 mg/400 mg) orally daily for 3 days
  2. Children (over age 1 month; one childrens tablet: 62.5/25 mg, one adult tablet: 250/100 mg)
    1. Weight 5-8 kg
      1. Prophylaxis: 1/2 children's tablet orally daily
      2. Treatment: 2 childrens tablets orally daily
    2. Weight 9-10 kg
      1. Prophylaxis: 3/4 tablet orally daily
      2. Treatment: 3 childrens tablets orally daily
    3. Weight: 11-20 kg
      1. Prophylaxis: 1 childrens tablet (62.5/25 mg) orally daily
      2. Treatment: 1 adult tablet (250 mg/100 mg) orally daily
    4. Weight: 21-30 kg
      1. Prophylaxis: 2 childrens tablets orally daily
      2. Treatment: 2 adult tablets orally daily
    5. Weight: 31-40 kg
      1. Prophylaxis: 3 childrens tablets orally daily
      2. Treatment: 3 adult tablet orally daily
    6. Weight: >40 kg (Adult dose)
      1. Prophylaxis: 1 adult tablet (250 mg /100 mg) orally daily
      2. Treatment: 4 adult tablet orally daily

VI. Precautions: Poor absorption

  1. Take with food (fatty meal) to ensure absorption
  2. Up to 10% of patients still may not absorb Mepron
  3. Repeat dose if Vomiting occurs within one hour of treatment in adults (within 30 minutes for children)
  4. Tablets may be crushed and mixed with 10 ml water if unable to swallow tablets

VII. Efficacy: HIV

  1. Not as clinically active as Bactrim
  2. Pneumocystis Pneumonia treatment Failure rate: 17%
    1. Contrast with 6% for Bactrim

VIII. Adverse effects

  1. Less dose-limiting adverse reactions than Bactrim
    1. Atovaquone: 7%
    2. Bactrim: 20%
  2. Rash
  3. Abdominal Pain
  4. Nausea or Vomiting
  5. Diarrhea
  6. Headache
  7. Mild Liver Function Test abnormalities

IX. Drug Interactions: Reduced plasma levels of Atovaquone

  1. Tetracycline
  2. Metoclopramide (Reglan)
  3. Rifampin

X. References

  1. (2000) Med Lett Drugs Ther 42(1093):109-12 [PubMed]

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Related Studies

Cost: Medications

atovaquone (on 12/21/2022 at Medicaid.Gov Survey of pharmacy drug pricing)
ATOVAQUONE 750 MG/5 ML SUSP Generic $1.22 per ml
ATOVAQUONE-PROGUANIL 250-100 MG TABLET Generic $2.03 each
ATOVAQUONE-PROGUANIL 62.5-25 Generic $0.63 each
FPNotebook does not benefit financially from showing this medication data or their pharmacy links. This information is provided only to help medical providers and their patients see relative costs. Insurance plans negotiate lower medication prices with suppliers. Prices shown here are out of pocket, non-negotiated rates. See Needy Meds for financial assistance information. GoodRx is another tool for finding lower drug prices.

Related Topics in Pharmacology

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