Atovaquone

Question 1

Atovaquone

Answer 1

Activity against several important protozoans

Activity against malaria parasite enhanced when given with proguanil (Malarone)

Tends to be better tolerated than comparator drugs but limited by lack of IV form (for severe disease), high cost, and somewhat lower efficacy (for Pneumocystis)

Question 2

Atovaquone MOA

Answer 2

Appears to interfere with electron transport in the parasitic mitochondria

Question 3

Atovaquone Spectrum

Answer 3

Like a parasite but technically a fungus
P. jirovecii

Protozoa
Plasmodium species
T. gondii
Babesia species

Question 4

Atovaquone Adverse Effects

Answer 4

Very well tolerated

Most common GI (N/V/D, abdominal pain)

Question 5

Atovaquone Important Facts

Answer 5

Atovaquone available as suspension
Malarone as tablet
Bioavailability low for both, but enhanced substantially with food (especially high fat meals)
Both should be taken with food

Clinical trials in treating mild to moderate Pneumocystis pneumonia in patients intolerant of T/S- atovaquone slightly less effective than its comparators (dapsone or pentamidine) but better tolerated (leading to similar overall success rates); do not use in severe disease or in patients whose GI absorption is thought to be poor

Malarone favorable for malaria prophylaxis for travelers; but cost is high
Highly effective, well tolerated, active against chloroquine resistant Plasmodium, requires administration only 1-2 days prior to travel, while in malaria endemic area, and for 7 days after return
Many other agents require beginning 2 weeks before travel and continuing for 4 weeks afterward

Make sure to take with food (at very least a glass of milk)
Bioavailability increased approximately 5-fold

Question 6

Atovaquone Good For

Answer 6

Atovaquone:
Treatment mild moderate Pneumocystis pneumonia
Prophylaxis against Pneumocystis in patients intolerant of 1st line therapy

Atovaquone/proguanil:
Treatment of uncomplicated malaria and prophylaxis against malaria