Atovaquone

These indications are based on manufacturer information for both originator and generic products. For product specific registered indications, please refer to product specific manufacturer information

Registered South African indications:

• Pneumocystis jirovecii (carinii) pneumonia (PCP)  in patients who are intolerant of co-trimoxazole therapy

Contraindications

• Hypersensitivity to the active ingredient or any of its excipients

Cautions

• Pregnancy
• Breastfeeding
• Renal impairment
• Hepatic impairment
• Elderly
• Diarrhoea
• Severe P. jiroveci pneumonia
• Prophylactic treatment of P. jiroveci pneumonia
• Non-HIV infected patients 
• Patients failing other P. jiroveci pneumonia therapy
• Fungal, bacterial, mycobacterial or viral diseases
• Coadministration with efavirenz
• Coadministration with protease-inhibitors
• Coadministration with tetracycline
• Coadministration with rifampicin or rifabutin
• Coadministration with metoclopramide

Forms avail. in SA and covered in this monograph: sus

Infections caused by Pneumocystis jiroveci 

Specific doses based on individual indications

Please note that the dosages below should be used in combination with regional guidelines, taking into account local antibiotic sensitivities

• Oral (sus): 750mg, 12hrly; Treatment duration: 21 days

OR

• Oral (sus): 1500mg, dly; Treatment duration: 21 days

Take with food

Not established for use in children  

Pregnancy

• Caution
• There is no information on the effects of atovaquone administration during human pregnancy. Atovaquone should not be used during pregnancy unless the benefit of treatment to the mother outweighs any possible risk to the developing foetus
• Insufficient data are available from animal experiments to assess the possible risk to reproductive potential or performance

Breastfeeding

• Caution, not recommended 
• It is not known whether atovaquone is excreted in human milk, and therefore breastfeeding is not recommended

Renal Impairment

• Caution; no information available

Hepatic Impairment

• Caution; no information available

Elderly

• Caution; no information available

Porphyria Information

• Probably not porphyrinogenic (PNP)

Drugs in Sport

• Permitted - No warnings

Central Nervous System Disorders

• Insomnia
• Headache

Gastrointestinal Disorders

• Nausea and vomiting
• Diarrhoea

Hepatobiliary Disorders

• Elevated hepatic enzymes 

Endocrine and Metabolic Disorders

• Hyponatraemia

Immune, Blood and Lymphatic System Disorders

• Anaemia
• Neutropenia
• Hypersensitivity reactions 

Skin and Subcutaneous Tissue Disorders

• Rash
• Pruritus
• Urticaria
• Erythema multiforme 
• Stevens-Johnson syndrome

• Rifampicin
• Rifabutin
• Metoclopramide
• Efavirenz
• Protease inhibitors
• Tetracycline
• Etoposide
• Paracetamol
• Benzodiazepines
• Acyclovir
• Opiates
• Cephalosporins
• Antidiarrhoeal agents
• Laxatives
• Zidovudine
• Didanosine
• Highly protein bound agents
• Indinavir

Hepatic function

The presence of food, particularly high-fat food, increases the bioavailability of atovaquone two to three-fold

Atovaquone is a selective and potent inhibitor of the eukaryotic mitochondrial electron transport chain in a number of parasitic protozoa and the parasitic fungus P. jiroveci. The site of action appears to be the cytochrome bc1 complex (complex III). The ultimate metabolic effect of such blockade is likely to be inhibition of nucleic acid and ATP synthesis.

Spectrum of activity: Pneumocystis jiroveci

Suspension (per 5ml) 750mg

• Wellvone (GSK) originator