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Atovaquone/Proguanil

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Atovaquone/Proguanil, Malarone

  • See Also
  1. Atovaquone
  • Indications
  1. Malaria Prophylaxis and Treatment (Malarone)
    1. Uncomplicated Plasmodium FalciparumMalaria infection
    2. Regions with artemisinin resistance (Chloroquine or Mefloquine resistance)
  • Contraindications
  1. Creatinine Clearance <30 ml/min
    1. Avoid for Malaria Prophylaxis (and Exercise caution in Malaria treatment)
  • Mechanism
  1. See Atovaquone
  2. Proguanil is a Biguanide compound that is metabolized to cycloguanil (anti-Malaria agent)
  • Medications
  1. Adult Tablet: Atovaquone 250 mg Proguanil 100 mg
  2. Child Tablet: Atovaquone 62.5 mg Proguanil 25 mg
  3. Administration
    1. Take with food or milk at same time daily
    2. Repeat dose if Vomiting within 1 hour of dose
  1. General
    1. Start 1-2 days before travel
    2. Stop 7 days after return
  2. Adult
    1. Take 1 tablet (250 mg/100 mg) orally daily
  3. Children (over age 1 month; weight >5 kg)
    1. Weight 5-8 kg: 1/2 children's tablet orally daily
    2. Weight 9-10 kg: 3/4 tablet orally daily
    3. Weight: 11-20 kg: 1 childrens tablet (62.5/25 mg) orally daily
    4. Weight: 21-30 kg: 2 childrens tablets orally daily
    5. Weight: 31-40 kg: 3 childrens tablets orally daily
    6. Weight: >40 kg (Adult dose): 1 adult tablet (250 mg /100 mg) orally daily
  1. Adults
    1. Take 4 tablets (1000 mg/400 mg) orally daily for 3 days
  2. Children (over age 1 month; weight >5 kg)
    1. Weight 5-8 kg: 2 childrens tablets orally daily
    2. Weight 9-10 kg: 3 childrens tablets orally daily
    3. Weight: 11-20 kg: 1 adult tablet (250 mg/100 mg) orally daily
    4. Weight: 21-30 kg: 2 adult tablets orally daily
    5. Weight: 31-40 kg: 3 adult tablets orally daily
    6. Weight: >40 kg (Adult dose): 4 adult tablets orally daily
  • Adverse Effects
  1. Common
    1. Headache
    2. Abdominal Pain
    3. Nausea and Vomiting
      1. Consider Antiemetic before dose
  2. Other adverse effects
    1. Nightmares
    2. Insomnia
    3. Oral Ulcers
  • Safety
  1. Considered safe in Lactation
    1. Avoid in Breast Feeding infants <5 kg
  2. Pregnancy Category C
    1. Lack of safety data (but no reported major birth defects)
    2. Not recommended for Malaria Prophylaxis by CDC
  • Drug Interactions
  1. Atovaquone levels are decreased by other drugs
    1. Efavirenz
    2. Tetracycline
    3. Metoclopramide
  2. Warfarin
    1. INR increased
  • Resources
  1. Atovaquone Proguanil (DailyMed)
    1. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=57d74d71-8cf8-4b10-9420-22954fae623c
  • References
  1. (2000) Med Lett Drugs Ther 42(1093):109-12 [PubMed]
  2. (2019) Drugs for Malaria Prophylaxis, Med Lett Drugs Ther, p. e104-5
  3. (2023) Presc Lett, Malaria Prophylaxis, Resource #350806