Infectious Disease Compendium

Atovaquone (Mepron®)

Dosing

CrCl Formula

CrCl > 80: 750 mg po bid of the suspension (5 ml). Only use the suspension with a high-fat meal. Better absorption.

PJP: 750 mg PO BID x 21 days.

PJP prophylaxis: 1500 mg/day po qd or bid with food.

CrCl 80-50:

CrCl 50-10:

CrCl < 10:

Hemodialysis:

Peritoneal dialysis:

Important side effects

Cholestatic hepatitis.

Important drug interactions

Combination of atovaquone with metoclopramide may result in decreased bioavailability of atovaquone; a Combination of rifabutin and atovaquone may result in reduced serum concentrations of atovaquone by 34%.

Combination of rifampin reduces atovaquone levels by approximately 50%; a Combination of ritonavir and atovaquone may result in decreased serum concentrations of atovaquone.

Combination of tetracycline and atovaquone is associated with reduced serum concentrations of atovaquone by 40%.

Pearls

Atovaquone resistance in PJP can occur when used as prophylaxis and has led to an outbreak in heart transplant patients (PubMed).

Absorption significantly increased with a high-fat meal.

Use for

PJP, Malaria (part of Malarone), Toxoplasmosis, Babesia.

Class

Naphthoquinones.

Last Update: 04/11/19.