atovaquone

REMS

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

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

Therapeutic Effects:

Active against P. jirovecii.

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.

Contraindicated in:

Hypersensitivity
Lactation: Avoid breast feeding in patients infected with HIV.

Use Cautiously in:

↓hepatic, renal, or cardiac function (dose modification may be necessary)
GI disorders (absorption may be limited)
OB: Use only if potential maternal benefit justifies potential fetal risk
Pedi: Safety not established.

Derm: rash.

GI: diarrhea, nausea, vomiting.

Neuro: headache, insomnia.

Resp: cough.

Misc: fever.

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.
May ↓ indinavir levels and efficacy; use caution when using concurrently.

Drug-Food:

Food↑ absorption.

Treatment

PO (Adults): 750 mg twice daily for 21 days.
PO (Children): 40 mg/kg/day (unlabeled).

Prevention

PO (Adults and Adolescents 13–16 yr): 1500 mg once daily.

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

Therapeutic Classification: anti-infectives

(Generic available)

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

(blood levels)

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

†Two peaks are due to enterohepatic recycling.

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.

Risk for infection (Indications, Side Effects).
Deficient knowledge, Relate med (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.
Advise female patient to notify health care professional if pregnancy is planned or suspected and to avoid breast feeding.

Resolution of the signs and symptoms of infection.

NDC Code^*

0173- GlaxoSmithKline LLC
0173-0547- MEPRON 0173-0547-00- 42 POUCH in 1 DOSE PACK (0173-0547-00) > 5 mL in 1 POUCH

0173- GlaxoSmithKline LLC
0173-0665- MEPRON 0173-0665-18- 210 mL in 1 BOTTLE (0173-0665-18)

10702- KVK-Tech, Inc.
10702-223- Atovaquone Oral Suspension 10702-223-21- 1 BOTTLE, PLASTIC in 1 CARTON (10702-223-21) > 210 mL in 1 BOTTLE, PLASTIC

16714- Northstar Rx LLC
16714-900- atovaquone 16714-900-01- 210 mL in 1 BOTTLE (16714-900-01)

31722- Camber Pharmaceuticals, Inc.
31722-629- Atovaquone 31722-629-21- 1 BOTTLE in 1 CARTON (31722-629-21) > 210 mL in 1 BOTTLE

65162- Amneal Pharmaceuticals LLC
65162-693- ATOVAQUONE 65162-693-88- 1 BOTTLE in 1 CARTON (65162-693-88) > 210 mL in 1 BOTTLE

66689- VistaPharm, Inc.
66689-062- Atovaquone 66689-062-18- 18 POUCH in 1 CASE (66689-062-18) > 1 mL in 1 POUCH (66689-062-01)

66689- VistaPharm, Inc.
66689-062- Atovaquone 66689-062-42- 42 POUCH in 1 CASE (66689-062-42) > 1 mL in 1 POUCH (66689-062-01)

66993- Prasco Laboratories
66993-062- Atovaquone 66993-062-42- 42 POUCH in 1 CARTON (66993-062-42) > 5 mL in 1 POUCH

66993- Prasco Laboratories
66993-062- Atovaquone 66993-062-72- 1 BOTTLE in 1 CARTON (66993-062-72) > 210 mL in 1 BOTTLE

68180- Lupin Pharmaceuticals, Inc.
68180-282- Atovaquone 68180-282-01- 1 BOTTLE in 1 CARTON (68180-282-01) > 210 mL in 1 BOTTLE

68462- Glenmark Pharmaceuticals Inc., USA
68462-421- atovaquone 68462-421-21- 210 mL in 1 BOTTLE (68462-421-21)

68462- Glenmark Pharmaceuticals Inc., USA
68462-421- atovaquone 68462-421-69- 42 POUCH in 1 CARTON (68462-421-69) > 5 mL in 1 POUCH

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Indications ⬆ ⬇

Action ⬆ ⬇

Pharmacokinetics ⬆ ⬇

Contraind./Precautions ⬆ ⬇

Adv. Reactions/Side Effects ⬆ ⬇

Interactions ⬆ ⬇

Route/Dosage ⬆ ⬇

Implementation ⬆ ⬇

US Brand Names ⬆ ⬇

Classifications ⬆ ⬇

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Time/Action Profile ⬆ ⬇

Assessment ⬆ ⬇

Pot. Nursing Diagnoses ⬆ ⬇

Patient/Family Teaching ⬆ ⬇

Evaluation/Desired Outcomes ⬆ ⬇

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