atovaquone

REMS

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

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

Drug-Food:

Food↑ absorption.

Availability ⬆ ⬇

(Generic available)

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

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.

US Brand Names ⬆ ⬇

Action ⬆ ⬇

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

Therapeutic effects:

Active against P. jirovecii.

Classifications ⬆ ⬇

Therapeutic Classification: anti-infectives

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.

Patient/Family Teaching ⬆ ⬇

Explain the purpose and side effects of atovaquone. 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 read Patient Information before starting and with each Rx refill in case of changes.
Advise patient to notify health care professional if rash occurs.
Inform the patient to report signs and symptoms of liver toxicity (fatigue, nausea, vomiting, upper abdominal pain, yellowing of skin or eyes, dark urine, light-colored stools).
Advise patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and to consult with health care professional before taking other medications.
Rep: Advise women of reproductive potential to notify health care professional if pregnancy is planned or suspected or if breastfeeding.

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Indications ⬇