II. Indications
-
Human Immunodeficiency Virus (HIV)
- Pneumocystis carinii Pneumonia prophylaxis
- Pneumocystis carinii Pneumonia treatment
- Patients unable to tolerate Bactrim
- Babesiosis (off-label)
- Toxoplasmosis in HIV Infection (off-label)
III. Contraindications
- Creatinine Clearance <30 ml/minute/1.73m2
- Breast Feeding of infants under 11 lb (5 kg)
IV. Mechanism
- Synthetic hydroxynaphthoquinone with Antiprotozoal activity
- Blocks mitochondrial electron transport at complex 3 of the respiratory chain of Protozoa
- Inhibits Pyrimidine synthesis (and therefore Protozoal DNA synthesis)
V. Dosing: Pneumocystis carinii Pneumonia
- Adults (and children age >13 years)
- Prophylaxis: 1500 mg orally daily with food
- Treatment: 750 mg orally twice daily with food for 21 days
VI. Dosing: Toxoplasmosis in comorbid HIV Infection
- Atovaquone is taken in combination with either Sulfadiazine or pyrimethanine-leucovorin
- Adults (off-label)
- Acute: 1500 mg orally twice daily with food for 6 weeks or more
- Chronic: 750 to 1500 mg orally with food twice daily
VII. Dosing: Babesiosis (Mild to Moderate Disease, Off-Label Use)
- Taken in combination with Azithromycin (high dose Azithromycin if Immunocompromised)
- Adult: 750 mg orally every 12 hours with food
- Child: 20 mg/kg (up to 750 mg) orally every 12 hours with food for 7 to 10 days
VIII. Dosing: Malaria
- See Atovaquone/Proguanil (Malarone)
IX. Precautions: Poor absorption
- Take with food (fatty meal) to ensure absorption
- Up to 10% of patients still may not absorb Mepron
- Repeat dose if Vomiting occurs within one hour of treatment in adults (within 30 minutes for children)
- Tablets may be crushed and mixed with 10 ml water if unable to swallow tablets
X. Efficacy: HIV
XI. Adverse Effects
- Less dose-limiting adverse reactions than Bactrim
- Atovaquone: 7%
- Bactrim: 20%
- Rash
- Abdominal Pain
- Nausea or Vomiting
- Diarrhea
- Headache
- Mild Liver Function Test abnormalities
XII. Safety
- Pregnancy Category C
- Unknown safety in Lactation
- Contraindicated in Breast Feeding of infants under 11 lb (5 kg)
XIII. Drug Interactions
- Reduced plasma levels of Atovaquone (and decreased efficacy)
- Efavirenz (avoid)
- Rifampin (avoid)
- Rifabutin
- Rifapentine
- Tetracycline
- Metoclopramide (Reglan)
XIV. Resources
- Atovaquone Suspension (DailyMed)
XV. References
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Related Studies
| 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 |