Names and pronunciation
(a-toe′va-kwon) Malarone, Malarone Pediatric
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Drug reference
(a-toe′va-kwon) Malarone, Malarone Pediatric
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Func. class.: Antimalarial
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Chem. class.: Aromatic diamide derivative
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ACTION: The constituents of Malarone, atovaquone, and proguanil hydrochloride interfere with 2 different pathways involved in DNA/RNA synthesis in protozoa
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USES: Malaria, malaria prophylaxis
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CONTRAINDICATIONS: Hyper- sensitivity to this product, malaria pro- phylaxis in patients with severe renal impairment Precautions: Pregnancy, breastfeeding, children, hepatic/GI/renal disease
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SIDE EFFECTS CNS: Dizziness, headache, anxiety, insomnia, asthenia, fever CV: Hypotension GI: Nausea, vomiting, diarrhea, anorexia, increased AST/ALT, acute pan- creatitis, constipation, abdominal pain INTEG: Pruritus OTHER: Cough, dyspnea
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INTERACTIONS Increase: level of warfarin; monitor INR Decrease: effect of atovaquone— rifAMPin, rifabutin, tetracycline, meto- clopramide; avoid using concurrently Drug/Lab Increase: AST, ALT, alkaline phosphatase Decrease: glucose, neutrophils, HB
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DOSAGE AND ROUTES Treatment of acute, uncomplicated Plasmodium falciparum malaria Malarone adult-strength tablets • Adult/adolescent/child >40 kg: PO 4 adult-strength tablets every day as a sin- gle dose × 3 consecutive days • Child 31-40 kg: PO 3 adult-strength tablets every day as a single dose × 3 consecutive days • Child 21-30 kg: PO 2 adult-strength tablets every day as a single dose × 3 consecutive days • Infant/child 11-20 kg: PO 1 adult-strength tablet every day × 3 consecutive days Malarone Pediatric tablets • Infant/child 11-20 kg: PO 4 pediatric tablets every day × 3 consecutive days • Infant/child 9-10 kg: PO 3 pediatric tablets every day × 3 consecutive days • Infant/child 5-8 kg: PO 2 pediatric tablets every day × 3 consecutive days P. falciparum malaria prophylaxis, including chloroquine resistance areas Malarone adult-strength tablets • Adult/adolescent/child >40 kg: PO 1 adult-strength tablet every day; begin prophylaxis 1-2 days before entering the endemic area; continue daily during the stay and for 7 days after leaving the area Malarone Pediatric tablets • Child 31-40 kg: PO 3 pediatric tablets every day; begin prophylaxis 1-2 days before entering the endemic area; con- tinue daily during the stay and for 7 days after leaving the area • Child 21-30 kg: PO 2 pediatric tablets every day; begin prophylaxis 1-2 days before entering the endemic area; con- tinue daily during the stay and for 7 days after leaving the area • Infant/child 11-20 kg: PO 1 pediatric tablet every day; begin prophylaxis 1-2 days before entering the endemic area; continue daily during the stay and for 7 days after leaving the area Renal dose • Adult: PO CCr <30 mL/min, do not use for prophylaxis
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Available forms: Tablets (adult) 250 mg atovaquone/proguanil 100 mg; tab- lets (pediatric) 62.5 atovaquone/progua- nil 25 mg
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Administer: • Give with food or with milk or milk- based drink (nutritional supplement shake) to enhance oral absorption of atova- quone; food with high fat content is desired • Give dose at the same time each day; administer a repeat dose if vomiting oc- curs within 1 hr after dosing • Tablets may be crushed and mixed with condensed milk for children unable to swallow whole tablets
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Assess: • Malaria: identify when the patient will be entering an area with malaria • Bowel pattern before, during treatment • Respiratory status: rate, character, wheez- ing, dyspnea; risk for respiratory infection • Allergies before treatment, reaction to each medication • CBC, LFTs, serum amylase, creatinine/ BUN, sodium; increases in LFTs can persist for 4 wk after discontinuation of treatment • Pregnancy/breastfeeding: identify if pregnancy is planned or suspected; avoid in breastfeeding if possible
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Evaluate: • Therapeutic response: resolution/pre- vention of malaria
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CLINICAL CONSIDERATIONS
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Patient and caregiver information: • To take with food to increase plasma concentrations, at same time of day • To take whole course of treatment • That product may be crushed and mixed with fluid if unable to swallow HIGH ALERT
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PHARMACOKINETICS Atovaquone excreted unchanged in feces (94%), highly protein-bound (99%), proguanil 75% protein-bound, 40%-60% excreted in urine, hepatic metabolism; half-life 2-3 days
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• Adult/adolescent/child >40 kg: PO 4 adult-strength tablets every day as a sin- gle dose × 3 consecutive days
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• Child 31-40 kg: PO 3 adult-strength tablets every day as a single dose × 3 consecutive days
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• Child 21-30 kg: PO 2 adult-strength tablets every day as a single dose × 3 consecutive days
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• Infant/child 11-20 kg: PO 1 adult-strength tablet every day × 3 consecutive days Malarone Pediatric tablets
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• Infant/child 11-20 kg: PO 4 pediatric tablets every day × 3 consecutive days
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• Infant/child 9-10 kg: PO 3 pediatric tablets every day × 3 consecutive days
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• Infant/child 5-8 kg: PO 2 pediatric tablets every day × 3 consecutive days P. falciparum malaria prophylaxis, including chloroquine resistance areas Malarone adult-strength tablets
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• Adult/adolescent/child >40 kg: PO 1 adult-strength tablet every day; begin prophylaxis 1-2 days before entering the endemic area; continue daily during the stay and for 7 days after leaving the area Malarone Pediatric tablets
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• Child 31-40 kg: PO 3 pediatric tablets every day; begin prophylaxis 1-2 days before entering the endemic area; con- tinue daily during the stay and for 7 days after leaving the area
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• Child 21-30 kg: PO 2 pediatric tablets every day; begin prophylaxis 1-2 days before entering the endemic area; con- tinue daily during the stay and for 7 days after leaving the area
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• Infant/child 11-20 kg: PO 1 pediatric tablet every day; begin prophylaxis 1-2 days before entering the endemic area; continue daily during the stay and for 7 days after leaving the area Renal dose
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• Adult: PO CCr <30 mL/min, do not use for prophylaxis
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