Dosing
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.