BMA Concise Guide to Medicine & Drugs

Proguanil with Atovaquone

Brand name Malarone

Used in the following combined preparations Not applicable

QUICK REFERENCE

Drug group Antimalarial drug

Overdose danger rating Medium

Dependence rating Low

Prescription needed Yes

Available as generic No

GENERAL INFORMATION

Proguanil is an antimalarial drug given to prevent the development of malaria. Microbial resistance to its effects can occur and this has led to it being used in combination with other drugs.

Atovaquone is an antiprotozoal drug that is also active against the fungus Pneumocystis jirovecii (a cause of pneumonia in people with poor immunity). Atovaquone is less useful on its own for malaria, but when it is combined with proguanil it rapidly treats the infection. The combination is also used for prevention of malaria, especially in areas where resistance to other drugs is present. Used for prevention, you should start taking proguanil with atovaquone a day or two before travelling. Continue taking the tablets during your stay, and for 7 days after your return. It is important to take other precautions, such as using an insect repellent at all times and a mosquito net at night. If you develop an illness or fever in the year after your return from a malarial zone, and especially in the first 3 months, go to your doctor immediately and tell him or her where you have been.

INFORMATION FOR USERS

Your drug prescription is tailored for you. Do not alter dosage without checking with your doctor.

How taken/used Tablets.

Frequency and timing of doses Prevention Once daily with food or a milky drink, at the same time each day. Start 1–2 days before travel and continue for period of stay (which should not exceed 28 days) and for 7 days after return. Treatment Once daily for 3 days, with food or a milk drink.

Adult dosage range Prevention 1 tablet. Treatment 4 tablets.

Onset of effect After 24 hours.

Duration of action 24–48 hours.

Diet advice None.

Storage Keep in original container at room temperature out of the reach of children.

Missed dose Take as soon as you remember. If your next dose is due at this time, take both doses together.

Stopping the drug Do not stop taking the drug for 1 week after leaving a malaria-infected area, otherwise there is a risk that you may develop the disease.

Exceeding the dose An occasional unintentional extra dose is unlikely to cause problems. Large overdoses may cause abdominal pain and vomiting. Notify your doctor.

POSSIBLE ADVERSE EFFECTS

Adverse effects are generally fairly mild. The most frequent are diarrhoea, nausea, vomiting, abdominal pain, and headache; discuss with your doctor if these become severe. More rarely, the drug may cause mouth ulcers, hair loss, jaundice, or a rash. Consult your doctor if mouth ulcers are severe or if any of these other symptoms occur. If you develop a sore throat or fever, you should contact your doctor urgently.

INTERACTIONS

Warfarin The effects of warfarin may be enhanced by proguanil with atovaquone.

Antacids The absorption of proguanil with atovaquone may be reduced by antacids.

Rifampicin, metoclopramide, and tetracycline antibiotics These drugs reduce the effect of proguanil with atovaquone.

SPECIAL PRECAUTIONS

Be sure to tell your doctor if:

· You have a long-term kidney problem.

· You have a liver problem.

· You are suffering from diarrhoea and vomiting.

· You are taking other medicines.

Pregnancy Safety in pregnancy not established, although benefits are generally considered to outweigh risks. Folic acid supplements must be taken. Discuss with your doctor.

Breast-feeding The drug passes into breast milk and may affect the baby. Breast-feeding is not recommended while you are taking the drug; it will not protect your baby from malaria. Discuss with your doctor.

Infants and children Reduced dose necessary.

Over 60 No known problems.

Driving and hazardous work Avoid until you know how the drug affects you because it may cause dizziness.

Alcohol No special problems.

PROLONGED USE

No known problems.