From the Guidelines
Atovaquone is a recommended treatment for uncomplicated Plasmodium falciparum malaria, particularly in chloroquine-resistant areas, with a dosing regimen of 100-500 mg orally twice daily for 3 days, depending on the patient's weight 1. The medication is often prescribed as Malarone, a combination of atovaquone and proguanil, for malaria prevention and treatment. Key points to consider when prescribing atovaquone include:
- The importance of taking the medication with food to enhance absorption, as fatty meals can increase bioavailability by 2-3 times 1.
- The potential side effects, such as rash, nausea, diarrhea, headache, and elevated liver enzymes, which are generally well-tolerated compared to other antimalarials and PCP treatments.
- The value of atovaquone as an alternative treatment for patients with sulfa allergies or G6PD deficiency who cannot take standard therapies. In terms of specific dosing regimens, atovaquone-proguanil is recommended for the treatment of uncomplicated Plasmodium falciparum malaria, with a treatment duration of 3 days 1. It's also important to note that atovaquone can be used as an alternative treatment for PCP, particularly for patients who cannot tolerate trimethoprim-sulfamethoxazole, with a dosing regimen of 750mg twice daily with food for 21 days 1. Overall, atovaquone is a valuable treatment option for various protozoal infections, including malaria and PCP, and its use should be guided by the most recent and highest-quality evidence, such as the guidelines provided by the CDC and the Infectious Diseases Society of America 1.
From the FDA Drug Label
Atovaquone oral suspension USP is a quinone antimicrobial drug. The chemical name of atovaquone is trans-2-[4-(4-chlorophenyl)cyclohexyl]-3-hydroxy-1,4-naphthalenedione. Atovaquone is a yellow crystalline solid that is practically insoluble in water.
The main ingredient in Atovaquone is atovaquone, a quinone antimicrobial drug.
- The chemical name is trans-2-[4-(4-chlorophenyl)cyclohexyl]-3-hydroxy-1,4-naphthalenedione.
- It has a molecular weight of 366.84 and the molecular formula C 22H 19ClO 3 2.
From the Research
Atovaquone Overview
- Atovaquone is an antimalarial agent often used in combination with proguanil for the prophylaxis and treatment of Plasmodium falciparum malaria 3, 4, 5, 6, 7.
- The combination of atovaquone and proguanil is highly effective against drug-resistant strains of P. falciparum, with a prophylactic efficacy rating of 95-100% in semi-immune individuals 3.
Mechanism of Action
- Atovaquone inhibits parasitic mitochondrial electron transport, which is enhanced when used in combination with proguanil 3.
- The protective mechanism of atovaquone/proguanil is likely to act via the mitochondrial cytochrome bc complex, which is different from other malaria drugs, reducing the risk of cross-resistance 5.
Efficacy and Safety
- Atovaquone/proguanil is highly effective for the prevention of P. falciparum malaria, with an estimated efficacy of 100% in nonimmune adults, adolescents, and children 3.
- The combination is generally well tolerated, with fewer gastrointestinal adverse events compared to chloroquine plus proguanil, and fewer neuropsychiatric adverse events compared to mefloquine 3, 6.
- Atovaquone-proguanil is effective against uncomplicated P. falciparum malaria, although treatment failure rates may be between 5% and 10% in some instances 4.
Comparison to Other Antimalarial Agents
- Atovaquone/proguanil has been compared to other antimalarial agents, including artemether-lumefantrine, artesunate-amodiaquine, and artesunate-mefloquine, with similar or improved efficacy and safety profiles 4.
- The addition of artesunate to atovaquone-proguanil may reduce treatment failure rates, although further research is needed to fully understand the benefits and risks of this combination 4.