Pharm
Atovaquone
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Atovaquone
, Mepron, Malarone
Indications
Human Immunodeficiency Virus
(HIV)
Pneumocystis carinii Pneumonia
prophylaxis
Pneumocystis carinii Pneumonia
treatment
Patients unable to tolerate
Bactrim
Malaria Prophylaxis
and Treatment (Malarone)
Third line agent (
Mefloquine
preferred)
Babesiosis
Contraindications
Creatinine Clearance
<30 ml/minute/1.73m2
Pregnancy Category C
Breast Feeding
of infants under 11 klb (5 kg)
Dosing
Pneumocystis carinii Pneumonia
Prophylaxis: 1500 mg PO qd with food
Treatment: 750 mg PO bid with food for 21 days
Dosing
Malaria
(Atovaquone/Proguanil or Malarone)
Adults
Prophylaxis: 1 tablet (250 mg/100 mg) orally daily
Start 1-2 days before travel
Stop 7 days after return
Treatment: 4 tablets (1000 mg/400 mg) orally daily for 3 days
Children (over age 1 month)
Weight 5-8 kg
Prophylaxis: 1/2 tablet (62.5 mg /25 mg) orally daily
Weight 9-10 kg
Prophylaxis: 3/4 tablet (62.5 mg /25 mg) orally daily
Weight: 11-20 kg
Prophylaxis: 1 tablet (62.5 mg /25 mg) orally daily
Treatment: 1 tablet (250 mg/100 mg) orally daily
Weight: 21-30 kg
Prophylaxis: 1 tablet (125 mg /50 mg) orally daily
Treatment: 2 tablet (250 mg/100 mg) orally daily
Weight: 31-40 kg
Prophylaxis: 1 tablet (187.5 mg /75 mg) orally daily
Treatment: 3 tablet (250 mg/100 mg) orally daily
Weight: >40 kg (Adult dose)
Prophylaxis: 1 tablet (250 mg /100 mg) orally daily
Treatment: 4 tablet (250 mg/100 mg) orally daily
Precautions
Poor absorption
Take with food (fatty meal) to ensure absorption
Up to 10% of patients still may not absorb Mepron
Efficacy
HIV
Not as clinically active as
Bactrim
Pneumocystis
Pneumonia
treatment Failure rate: 17%
Contrast with 6% for
Bactrim
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
Drug Interactions
Reduced plasma levels of Atovaquone
Tetracycline
Metoclopramide (Reglan)
Rifampin
References
(2000) Med Lett Drugs Ther 42(1093):109-12 [PubMed]
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