atovaquone (Rx)

Brand and Other Names:Mepron
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Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

oral suspension

  • 750mg/5mL

Pneumocystis Carinii Pneumonia

Treatment: 750 mg PO BID x21 days

Prophylaxis: 1500 mg/day PO, qDay or divided BID, with food

Malaria (P. falciparum)

1000 mg (with proguanil 400 mg) PO qDay x3 days

Dosage Forms & Strengths

oral suspension

  • 750mg/5mL

Prevention of Pneumocystis jirovecii Pneumonia

<13 years: Not established

>13 years: 1,500 mg (10 mL) once daily administered with food

Mild-to-Moderate Pneumocystis jirovecii Pneumonia

<13 years: Not established

>13 years: 750 mg (5 mL) twice daily (1,500 mg total daily dose) administered with food for 21 days

Malaria (P. Falciparum)

11-20 kg: 250 mg (with proguanil 100 mg)

21-30 kg: 500 mg (with proguanil 200 mg)

31-40 kg: 750 mg (with proguanil 300 mg)

All PO qDay x3 days

Dosing Considerations

  • Administer oral suspension with food to avoid low plasma atovaquone concentrations that may limit response to therapy
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Interactions

Interaction Checker

and atovaquone

No Results

     activity indicator 
    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

            All Interactions Sort By:
             activity indicator 

            Contraindicated (0)

              Serious - Use Alternative (2)

              • dapsone topical

                atovaquone, dapsone topical. unspecified interaction mechanism. Avoid or Use Alternate Drug. Avoid coadministration of dapsone topical with oral dapsone or antimalarial medications because of the potential for hemolytic reactions.

              • efavirenz

                efavirenz decreases levels of atovaquone by unspecified interaction mechanism. Avoid or Use Alternate Drug.

              Monitor Closely (5)

              • bupivacaine implant

                atovaquone, bupivacaine implant. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: Local anesthetics may increase the risk of developing methemoglobinemia when concurrently exposed to drugs that also cause methemoglobinemia.

              • indinavir

                indinavir will decrease the level or effect of atovaquone by unknown mechanism. Modify Therapy/Monitor Closely.

              • metoclopramide intranasal

                metoclopramide intranasal will increase the level or effect of atovaquone by Other (see comment). Use Caution/Monitor. Metoclopramide may decrease the absorption of atovaquone. Monitor for reduced therapeutic effect of atovaquone.

              • rifabutin

                rifabutin decreases levels of atovaquone by increasing metabolism. Use Caution/Monitor.

              • rifampin

                rifampin decreases levels of atovaquone by increasing metabolism. Use Caution/Monitor.

              Minor (2)

              • metoclopramide

                metoclopramide decreases levels of atovaquone by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

              • tetracycline

                tetracycline decreases levels of atovaquone by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown. Effect may be minor, due to pharmacodynamic synergism.

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              Adverse Effects

              >10%

              Abdominal pain (4-21%)

              Cough (14-25%)

              Depression (undefined)

              Diarrhea (19-42%)

              Dyspnea (15-21%)

              Fever (14-40%)

              Headache (16-31%)

              Infection (18-22%)

              Insomnia (10-19%)

              Myalgia (undefined)

              Nausea (21-32%)

              Rash (22-46%)

              Rhinitis (5-24%)

              Vomiting (14-22%)

              Weakness (8-31%)

              1-10%

              Amylase increased (7-8%)

              Anemia (4-6%)

              Anorexia (<7%)

              Anxiety (<7%)

              BUN/creatinine increased (<1%)

              Constipation (<3%)

              Dyspepsia (<5%)

              Dizziness (3-8%)

              Hyperglycemia (<9%)

              Hypoglycemia (<1%)

              Hyponatremia (7-10%)

              Liver enzymes elevated (4-8%)

              Neutropenia (3-5%)

              Pruritus (5-10%)

              Oral moniliasis (5-10%)

              Taste perversion (<3%)

              Postmarketing Reports

              Blood and lymphatic system disorders: Methemoglobinemia, thrombocytopenia

              Immune system disorders: Hypersensitivity reactions including angioedema, bronchospasm, throat tightness, and urticaria

              Eye disorders: Vortex keratopathy

              Gastrointestinal disorders: Pancreatitis

              Hepatobiliary disorders: Hepatitis, fatal liver failure

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              Warnings

              Contraindications

              History of hypersensitivity reactions (e.g., angioedema, bronchospasm, throat tightness, urticaria) to drug or components

              Cautions

              Oral absorption is limited but can be significantly increased when drug is taken with food; failure to administer with food may result in lower plasma concentrations and may limit response to therapy; consider therapy with other agents in patients who have difficulty taking oral suspension with food or in patients who have gastrointestinal disorders that may limit absorption of oral medications

              Cases of cholestatic hepatitis, elevated liver enzymes, and fatal liver failure reported; if treating patients with severe hepatic impairment, closely monitor patients

              Hypersensitivity reactions reported, including bronchospasm, angioedema, urticaria and throat tightness

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              Pregnancy & Lactation

              Pregnancy Category: C

              Lactation: excretion in milk unknown; use with caution

              Pregnancy Categories

              A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

              B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

              C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

              D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

              X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

              NA: Information not available.

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              Pharmacology

              Absorption: significantly increased with a high-fat meal

              Distribution: 3.5 L/kg

              Protein Bound: >99%

              Metabolism: undergoes enterohepatic recirculation

              Bioavailability: tablet: 23%; suspension: 47%

              Half-life, elimination: 2-3 d

              Excretion: feces (94% as unchanged drug)

              Mechanism of Action

              Inhibits electron transport chain in Plasmodium

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              Administration

              Foil pouch

              Open each 5-mL pouch by folding along dotted line and tearing open at horizontal slit as directed by arrow on pouch

              For a 5-mL dose, take entire contents either by placing directly into mouth or by dispensing into a dosing spoon (5 mL) or cup prior to administration by mouth

              For a 10-mL dose, take the entire contents of 2 pouches

              Bottle

              Shake bottle gently before administering the recommended dosage

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              Images

              BRAND FORM. UNIT PRICE PILL IMAGE
              atovaquone oral
              -
              750 mg/5 mL suspension
              atovaquone oral
              -
              750 mg/5 mL suspension
              atovaquone oral
              -
              750 mg/5 mL suspension
              atovaquone oral
              -
              750 mg/5 mL suspension
              atovaquone oral
              -
              750 mg/5 mL suspension
              atovaquone oral
              -
              750 mg/5 mL suspension
              atovaquone oral
              -
              750 mg/5 mL suspension
              Mepron oral
              -
              750 mg/5 mL suspension
              Mepron oral
              -
              750 mg/5 mL suspension

              Copyright © 2010 First DataBank, Inc.

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              Patient Handout

              Patient Education
              atovaquone oral

              ATOVAQUONE SUSPENSION - ORAL

              (a-TOE-va-kwone)

              COMMON BRAND NAME(S): Mepron

              USES: Atovaquone is used to prevent or treat a serious lung infection called Pneumocystis pneumonia (PCP). This medication helps to stop infection symptoms such as fever, cough, tiredness, and shortness of breath.

              HOW TO USE: Shake the bottle gently but well before each dose. Carefully measure the dose using a special measuring device/spoon. Do not use a household spoon because you may not get the correct dose.To treat PCP, take this medication by mouth with food as directed by your doctor, usually twice daily for 21 days. To prevent PCP, take this medication with food usually once a day as directed. Atovaquone must be taken with food so your body can absorb as much of the medication as possible so it can work well.For children, the dosage is also based on age and weight.This medication works best when the amount of medicine in your body is kept at a constant level. If you take this drug twice a day, take it at evenly spaced intervals about 12 hours apart. If you take this medication once a day, take it at the same time each day.Continue to take this medication for the full time prescribed, even if symptoms disappear after a few days. Stopping the medication too early may result in a return of the infection.Tell your doctor if you develop symptoms of PCP, or if your condition lasts or gets worse.

              SIDE EFFECTS: Nausea, vomiting, diarrhea, headache, dizziness, trouble sleeping, or runny nose may occur. If any of these effects last or get worse, tell your doctor or pharmacist promptly.Remember that this medication has been prescribed because your doctor has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.Tell your doctor right away if you have any serious side effects, including: depression, symptoms of liver disease (such as nausea/vomiting that doesn't stop, loss of appetite, stomach/abdominal pain, yellowing eyes/skin, dark urine).Atovaquone can commonly cause a mild rash that is usually not serious. However, you may not be able to tell it apart from a rare rash that could be a sign of a severe reaction. Get medical help right away if you develop any rash.A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

              PRECAUTIONS: Before taking atovaquone, tell your doctor or pharmacist if you are allergic to it; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.Before using this medication, tell your doctor or pharmacist your medical history, especially of: liver disease, kidney disease, stomach/intestinal problems that may affect absorption of atovaquone (such as long-term diarrhea, malabsorption syndrome).This drug may make you dizzy. Alcohol or marijuana (cannabis) can make you more dizzy. Do not drive, use machinery, or do anything that needs alertness until you can do it safely. Limit alcoholic beverages. Talk to your doctor if you are using marijuana (cannabis).Before having surgery, tell your doctor or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).During pregnancy, this medication should be used only when clearly needed. Discuss the risks and benefits with your doctor.It is unknown if this drug passes into breast milk. Consult your doctor before breast-feeding.

              DRUG INTERACTIONS: Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval.Other medications can decrease the level of atovaquone in your body, which may affect how atovaquone works. Examples include efavirenz, metoclopramide, rifampin, rifabutin, tetracycline, among others.

              OVERDOSE: If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center.

              NOTES: Do not share this medication with others.This medication has been prescribed for your current condition only. Do not use it later for another infection unless your doctor tells you to.

              MISSED DOSE: If you miss a dose, take it as soon as you remember. If it is near the time of the next dose, skip the missed dose. Take your next dose at the regular time. Do not double the dose to catch up.

              STORAGE: Store at room temperature away from light and moisture. Do not store in the bathroom. Do not freeze this product. Freezing decreases the amount of atovaquone your body can absorb and may cause it to not work well. Keep all medications away from children and pets.Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company.

              Information last revised August 2021. Copyright(c) 2021 First Databank, Inc.

              IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.

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              Formulary

              FormularyPatient Discounts

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              The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

              Tier Description
              1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
              2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
              3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
              4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
              5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
              6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
              NC NOT COVERED – Drugs that are not covered by the plan.
              Code Definition
              PA Prior Authorization
              Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
              QL Quantity Limits
              Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
              ST Step Therapy
              Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
              OR Other Restrictions
              Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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              Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.