Generic Name and Formulations:
Atovaquone 250mg, proguanil HCl 100mg; tabs.
Indications for MALARONE:
Prophylaxis of P. falciparum malaria (including chloroquine-resistant strains). Treatment of acute uncomplicated P. falciparum malaria.
Adults and Children:
Take at the same time each day with food or a milky drink. Children: may crush and mix with condensed milk if unable to swallow tabs. Repeat dose if vomiting occurs within 1 hour. Prophylaxis (once daily starting 1–2 days before entering endemic area, during stay, and for 7 days after return): <11kg: not recommended (see Treatment); 11–20kg: 62.5mg atovaquone/25mg proguanil; 21–30kg: 125mg/50mg; 31–40kg: 187.5mg/75mg. >40kg: 250mg/100mg. Treatment (give as single daily dose for 3 consecutive days): <5kg: not recommended; 5–8kg: 125mg/50mg; 9–10kg: 187.5mg/75mg; 11–20kg: 250mg/100mg; 21–30kg: 500mg/200mg; 31–40kg: 750mg/300mg. >40kg: 1g/400mg.
Prophylaxis in severe renal impairment (CrCl <30mL/min).
Use other therapy in severe malaria, recrudescence, or prophylaxis failure. Monitor parasitemia closely and consider other therapy in severe or persistent diarrhea or vomiting (may use antiemetics). Hepatic or renal impairment (CrCl <30mL/min): consider alternate therapy for treatment. Elderly. Pregnancy (Cat.C; may continue folate supplements). Nursing mothers.
Naphthoquinone + dihydrofolate reductase inhibitor.
Concomitant rifampin, rifabutin: not recommended. Atovaquone antagonized by tetracycline, metoclopramide. Proguanil may potentiate warfarin or other coumarin-based anticoagulants (monitor). Caution with indinavir, CYP2C19 substrates or inhibitors.
GI upset/pain, headache, asthenia, anorexia, dizziness, elevated liver function tests; rare: anaphylaxis, vasculitis, hepatitis, cholestasis. Children: vomiting, pruritus.
Tabs—24, 100; Ped tabs—100