Atovaquone Brand Name– Mepron
What is Atovaquone
Atovaquone is an oral antiprotozoal agent. It is active against both Toxoplasma gondii and Pneumocystis jiroveci (formerly Pneumocystis carinii).
Atovaquone is structurally and pharmacologically related to lapinone and parvaquone, which were used as antimalarials; in combination with proguanil, atovaquone is effective for malaria.
Atovaquone has been shown less effective than oral TMP-SMX and roughly equivalent to IV pentamidine in the treatment of Pneumocystis pneumonia (PCP) in patients with AIDS.
Both of these studies, however, found that atovaquone had fewer treatment-limiting adverse effects.
These studies were conducted with atovaquone tablets.
Atovaquone was originally approved by the FDA in November 1992 for use in the treatment of PCP in patients who do not tolerate TMP-SMX. An oral suspension with improved bioavailability relative to the tablets was later approved in February 1995, and the tablets were subsequently removed from the market.
In January 1999, the FDA approved use of atovaquone for the prevention of PCP in HIV-infected patients intolerant of TMP-SMX, after two clinical trials reported equivalence of atovaquone to dapsone or aerosolized pentamidine for this purpose.
Atovaquone remains designated as an orphan drug for the prophylaxis, treatment, and suppression of Toxoplasma gondii encephalitis.
Atovaquone has not been proven to decrease the risk of T. gondii encephalitis relapse, and thus is considered an alternative to standard therapy (e.g., pyrimethamine plus sulfadiazine or clindamycin).
Indications
- babesiosis
- Plasmodium falciparum
- Plasmodium sp.
- Pneumocystis jirovecii (formerly Pneumocystis carinii)
- Pneumocystis pneumonia (PCP)
- Pneumocystis pneumonia (PCP) prophylaxis
- Toxoplasma gondii
- toxoplasmic encephalitis
- toxoplasmosis
- toxoplasmosis prophylaxis
Side Effects
- abdominal pain
- anemia
- angioedema
- anorexia
- anxiety
- asthenia
- bronchospasm
- candidiasis
- constipation
- cough
- diarrhea
- dizziness
- dysgeusia
- dyspepsia
- dyspnea
- elevated hepatic enzymes
- erythema multiforme
- fever
- headache
- hepatic failure
- hepatitis
- hyperamylasemia
- hyperglycemia
- hyperhidrosis
- hypoglycemia
- hyponatremia
- hypotension
- infection
- influenza
- insomnia
- keratopathy
- maculopapular rash
- methemoglobinemia
- myalgia
- nausea
- neutropenia
- pancreatitis
- pruritus
- rash
- rhinitis
- sinusitis
- Stevens-Johnson syndrome
- thrombocytopenia
- urticaria
- vomiting
Monitoring Parameters
- CBC
- LFTs
- serum amylase
- serum sodium
Contraindications
- benzyl alcohol hypersensitivity
- breast-feeding
- GI disease
- hepatic disease
- infection
- neonates
- pregnancy
- respiratory insufficiency
Interactions
- Abacavir; Lamivudine, 3TC; Zidovudine, ZDV
- Atazanavir
- Atazanavir; Cobicistat
- Bismuth Subcitrate Potassium; Metronidazole; Tetracycline
- Bismuth Subsalicylate; Metronidazole; Tetracycline
- Dasabuvir; Ombitasvir; Paritaprevir; Ritonavir
- Efavirenz
- Efavirenz; Emtricitabine; Tenofovir
- Efavirenz; Lamivudine; Tenofovir Disoproxil Fumarate
- Indinavir
- Isoniazid, INH; Pyrazinamide, PZA; Rifampin
- Isoniazid, INH; Rifampin
- Lamivudine, 3TC; Zidovudine, ZDV
- Lopinavir; Ritonavir
- Metoclopramide
- Ombitasvir; Paritaprevir; Ritonavir
- Omeprazole; Amoxicillin; Rifabutin
- Penicillamine
- Rabies Vaccine
- Rifabutin
- Rifampin
- Rifapentine
- Ritonavir
- Sulfamethoxazole; Trimethoprim, SMX-TMP, Cotrimoxazole
- Tetracycline
- Trimethoprim
- Zidovudine, ZDV
