Pharm

Atovaquone

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Atovaquone, Mepron, Malarone

  • 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. Third line agent (Mefloquine preferred)
  3. Babesiosis
  • Contraindications
  1. Creatinine Clearance <30 ml/minute/1.73m2
  2. Pregnancy Category C
  3. Breast Feeding of infants under 11 klb (5 kg)
  1. Prophylaxis: 1500 mg PO qd with food
  2. Treatment: 750 mg PO bid with food for 21 days
  • Dosing
  • Malaria (Atovaquone/Proguanil or Malarone)
  1. Adults
    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)
    1. Weight 5-8 kg
      1. Prophylaxis: 1/2 tablet (62.5 mg /25 mg) orally daily
    2. Weight 9-10 kg
      1. Prophylaxis: 3/4 tablet (62.5 mg /25 mg) orally daily
    3. Weight: 11-20 kg
      1. Prophylaxis: 1 tablet (62.5 mg /25 mg) orally daily
      2. Treatment: 1 tablet (250 mg/100 mg) orally daily
    4. Weight: 21-30 kg
      1. Prophylaxis: 1 tablet (125 mg /50 mg) orally daily
      2. Treatment: 2 tablet (250 mg/100 mg) orally daily
    5. Weight: 31-40 kg
      1. Prophylaxis: 1 tablet (187.5 mg /75 mg) orally daily
      2. Treatment: 3 tablet (250 mg/100 mg) orally daily
    6. Weight: >40 kg (Adult dose)
      1. Prophylaxis: 1 tablet (250 mg /100 mg) orally daily
      2. Treatment: 4 tablet (250 mg/100 mg) orally daily
  • Precautions
  • Poor absorption
  1. Take with food (fatty meal) to ensure absorption
  2. Up to 10% of patients still may not absorb Mepron
  • Efficacy
  • HIV
  1. Not as clinically active as Bactrim
  2. Pneumocystis Pneumonia treatment Failure rate: 17%
    1. Contrast with 6% for Bactrim
  • 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
  • Drug Interactions
  • Reduced plasma levels of Atovaquone
  1. Tetracycline
  2. Metoclopramide (Reglan)
  3. Rifampin