atovaquone

REMS

Treatment of mild to moderate
Pneumocystis jirovecii
pneumonia (PJP) in patients who are unable to tolerate trimethoprim/sulfamethoxazole.
Prophylaxis of
PJP
.

Action ⬆ ⬇

Inhibits the action of enzymes necessary to nucleic acid and ATP synthesis.

Therapeutic effects:

Active against P. jirovecii.

Pharmacokinetics ⬆ ⬇

Absorption: Absorption is poor but is increased by food, particularly fat.

Distribution: Enters CSF in very low concentrations (<1% of plasma levels).

Protein Binding: >99.9%.

Metabolism/Excretion: Undergoes enterohepatic recycling; elimination occurs in feces.

Half-Life: 2.2–2.9 days.

Time/Action Profile ⬆ ⬇

(plasma concentrations)

ROUTE	ONSET	PEAK	DURATION
PO	unknown	1–8 hr; 24–96 hr‡	12 hr

‡Two peaks are due to enterohepatic recycling.

Contraind./Precautions ⬆ ⬇

Contraindicated in:

Hypersensitivity;
Lactation: Breastfeeding not recommended for women with HIV.

Use Cautiously in:

↓hepatic, renal, or cardiac function (dose modification may be necessary);
GI disorders (absorption may be limited);
OB: Use during pregnancy only if potential maternal benefit justifies potential fetal risk;
Pedi: Children 13 yr (safety and effectiveness not established).

Adv. Reactions/Side Effects ⬆ ⬇

Derm: rash

GI: diarrhea, nausea, vomiting

Neuro: headache, insomnia

Resp: cough

Misc: fever

Interactions ⬆ ⬇

Drug-drug:

Rifampin or rifabutin may ↓ levels and efficacy; concurrent use not recommended.
Tetracycline may ↓ levels and efficacy; use caution when using concurrently.
Metoclopramide may ↓ levels and efficacy; use only if no other alternative available.

Food↑ absorption.

Route/Dosage ⬆ ⬇

Treatment of Mild to Moderate Pneumocystis jirovecii Pneumonia

PO (Adults and Children ≥13 yr): 750 mg twice daily for 21 days.

Prevention of Pneumocystis jirovecii Pneumonia

PO (Adults and Children ≥13 yr): 1500 mg once daily.

Availability ⬆ ⬇

(Generic available)

Suspensioncitrus flavor: 750 mg/5 mL
In combination with: proguanil (Malarone). See Appendix [not included in this PDA edition].

Assessment ⬆ ⬇

Assess patient for signs of infection (vital signs, lung sounds, sputum, WBCs) at beginning of and throughout therapy.
Obtain specimens prior to initiating therapy. First dose may be given before receiving results.

Lab Test Considerations:

Monitor hematologic and hepatic functions. May cause mild, transient anemia and neutropenia. May also cause ↑ serum amylase, AST, ALT, and alkaline phosphatase.
- Monitor electrolytes. May cause hyponatremia.

Implementation ⬆ ⬇

PO: Administer with food twice daily for 21 days for treatment and once daily for prevention.
- Shake suspension gently prior to administration.

Patient/Family Teaching ⬆ ⬇

Instruct patient to take atovaquone as directed around the clock for full course of therapy, even if feeling better. Emphasize the importance of taking atovaquone with food, especially foods high in fat; taking without food may decrease plasma concentrations and effectiveness.
Advise patient to notify health care professional if rash occurs.
Rep: Advise females of reproductive potential to notify health care professional if pregnancy is planned or suspected or if breastfeeding.

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Pronunciation ⬇

Classifications ⬆ ⬇

Indications ⬆ ⬇