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 |