What are the uses and dosages of Atovaquone?

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From the Guidelines

Atovaquone is primarily used to treat and prevent Pneumocystis jirovecii pneumonia (PCP) and for malaria treatment and prophylaxis, with dosing recommendations based on weight and specific indications. For malaria treatment, atovaquone is typically combined with proguanil (as Malarone), with dosing based on weight:

  • 5-8 kg: 2 pediatric tablets (62.5 mg/25 mg) twice daily
  • 9-10 kg: 3 pediatric tablets twice daily
  • 11-20 kg: 4 pediatric tablets or 1 adult tablet (250 mg/100 mg) twice daily
  • 21-30 kg: 2 adult tablets twice daily
  • 31-40 kg: 3 adult tablets twice daily

  • 40 kg: 4 adult tablets twice daily, as recommended by 1. The medication should always be taken with food, particularly fatty meals, to enhance absorption. Common side effects include rash, nausea, diarrhea, headache, and elevated liver enzymes. Atovaquone has few drug interactions, making it useful for patients on multiple medications, although considerations should be taken when used with rifamycins, as noted in 1 and 1. It's essential to follow the recommended dosages and administration guidelines to ensure effective treatment and minimize potential side effects. In cases where atovaquone is used for PCP treatment or prevention, the standard dosage is typically 750 mg taken orally twice daily with food for 21 days for treatment, and 1500 mg once daily with food for prevention, as generally recommended in clinical practice. However, the provided evidence primarily focuses on malaria treatment and prophylaxis, making 1 the most relevant reference for atovaquone's use in this context.

From the FDA Drug Label

1 INDICATIONS AND USAGE 1.1 Prevention of Pneumocystis jirovecii Pneumonia Atovaquone oral suspension is indicated for the prevention of Pneumocystis jirovecii pneumonia (PCP) in adults and adolescents (aged 13 years and older) who cannot tolerate trimethoprim-sulfamethoxazole (TMP-SMX).

  1. 2 Treatment of Mild-to-Moderate Pneumocystis jirovecii Pneumonia Atovaquone oral suspension is indicated for the acute oral treatment of mild-to-moderate PCP in adults and adolescents (aged 13 years and older) who cannot tolerate TMP-SMX.

2 DOSAGE AND ADMINISTRATION 2. 1 Dosage for the Prevention of P. jirovecii Pneumonia The recommended oral dosage is 1,500 mg (10 mL) once daily administered with food. 2.2 Dosage for the Treatment of Mild-to-Moderate P. jirovecii Pneumonia The recommended oral dosage is 750 mg (5 mL) twice daily (total daily dose = 1,500 mg) administered with food for 21 days.

The uses of Atovaquone are:

  • Prevention of Pneumocystis jirovecii pneumonia (PCP) in adults and adolescents (aged 13 years and older) who cannot tolerate trimethoprim-sulfamethoxazole (TMP-SMX)
  • Treatment of mild-to-moderate PCP in adults and adolescents (aged 13 years and older) who cannot tolerate TMP-SMX

The dosages of Atovaquone are:

  • 1,500 mg (10 mL) once daily administered with food for the prevention of P. jirovecii Pneumonia
  • 750 mg (5 mL) twice daily (total daily dose = 1,500 mg) administered with food for 21 days for the treatment of mild-to-moderate P. jirovecii Pneumonia 2

From the Research

Uses of Atovaquone

  • Atovaquone is used for the prophylaxis of Plasmodium falciparum malaria, including drug-resistant strains 3
  • It is also used for the treatment of acute, uncomplicated malaria caused by Plasmodium falciparum 4
  • Atovaquone and proguanil hydrochloride is a fixed-dose combination used for treatment and prophylaxis of malaria 5, 6, 7

Dosages of Atovaquone

  • The recommended dose for adults is 250/100 mg (atovaquone/proguanil) once daily for prophylaxis 3
  • For treatment of malaria, the recommended dose is 1000 mg atovaquone and 400 mg proguanil hydrochloride (or the equivalent based on body weight in patients < or = 40 kg) once daily for 3 days 7
  • Dosage adjustments based on body weight categories in children are as follows: 1/4 dose for 11-20 kg, 1/2 dose for > 20-30 kg, 3/4 dose for > 30-40 kg, and full dose for > 40 kg 5

Efficacy and Safety

  • Atovaquone/proguanil is highly effective for the prevention of P. falciparum malaria, with an efficacy rating of 100% in nonimmune adults, adolescents, and children 3
  • The combination is also effective for treatment of malaria, with a cure rate of > 98% in more than 500 patients with falciparum malaria 4
  • Atovaquone/proguanil is generally well tolerated, with the most common treatment-related adverse events being headache and abdominal pain 3

References

1
Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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