Indications:

  • Prophylaxis and treatment of malaria, particularly Plasmodium falciparum, including strains resistant to chloroquine and mefloquine.

Dosage:

  • For Malaria Prophylaxis:
  • Adults: 250 mg atovaquone / 100 mg proguanil once daily, starting 1–2 days before entering the malaria-endemic area and continuing daily during the stay and for 7 days after leaving.

For Treatment of Acute Malaria:

  • Adults: 1000 mg atovaquone / 400 mg proguanil OD*3/7.
  • Pediatric dosing is weight-based and should follow specific pediatric guidelines.
  • Adult tablet: 250 mg atovaquone / 100 mg proguanil
  • Pediatric tablet: 62.5 mg atovaquone / 25 mg proguanil
  • Take with food or a milky drink to improve absorption.
  • If vomiting occurs within 1 hour of dosing, repeat the dose.
  • Adhere strictly to daily dosing schedule for full effectiveness.
  • Store in a cool, dry place.

Mechanism of Action:

  • Atovaquone: Inhibits mitochondrial electron transport in parasites, disrupting ATP and pyrimidine synthesis.
  • Proguanil: A prodrug converted to cycloguanil, which inhibits Plasmodium dihydrofolate reductase, impairing DNA synthesis.
  • Synergy: The two drugs work synergistically for better efficacy and to reduce resistance.

Common:

  • Abdominal pain
  • Nausea, vomiting, diarrhea
  • Headache
  • Dizziness
  • Elevated liver enzymes
  • Rash

Rare but serious:

  • Stevens-Johnson syndrome
  • Hepatitis
  • Severe allergic reactions
  • Hypersensitivity to atovaquone, proguanil, or any components of the formulation.
  • Severe renal impairment (CrCl < 30 mL/min) – particularly avoid for prophylaxis.
  • Rifampin and rifabutin: Decrease atovaquone levels.
  • Tetracycline: May reduce atovaquone levels.
  • Metoclopramide: Reduces absorption of atovaquone.
  • Warfarin: Proguanil may enhance the anticoagulant effect – monitor INR closely.
  • Antiretrovirals (some): May alter drug levels; monitor for interactions.

                                   Drug Status

Availability
Pregnancy
Breastfeeding
Schedule
BRAND NAME STRENGTH FORMULATION PACK SIZE MANUFACTURER DISTRIBUTOR
Malaglen 250mg/100mg Tablet 12’s Glenmark Pharma Glenmark Pharma
Malanil Adult 250mg/100mg Tablet 12’s GSK Ltd GSK Ltd
Malanil Paediatric 62.5mg/25mg Tablet 12’s GSK Ltd GSK Ltd