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Atovaquone

KEY POINTS

  • Atovaquone (Mepron) is an antiprotozoal drug that works by inhibiting electron transport in mitochondria of susceptible microorganisms, which inhibits key metabolic enzymes needed for synthesis of nucleic acids and ATP
  • Active against Toxoplasma gonidii, Pneumocystis jirovecci pneumonia (PCP) and Babesia microti
    • Common to consider atovaquone for PCP or toxoplasmosis when sulfamethoxazole-trimethoprim (Bactrim, Septra) is not an option
  • In adults, dosed as 1,500mg oral daily for PCP or toxoplasmosis prophylaxis and 750mg oral twice daily for PCP treatment
    • Prophylaxis versus PCP indicated when CD4 < 200 cells/mm^3
    • Common to combine atovaquone with pyrimethamine plus leucovorin or with sulfadiazine for the treatment or prophylaxis against toxoplasmosis
    • See guidelines from AIDSinfo.nih.gov for dosing and regimen recommendations
      • No dose adjustment required for hepatic or renal dysfunction, per the package insert
  • Should be taken with food
    • Absorption may be less in patients with diarrhea or vomiting
  • Many adverse events are possible, but some of the more common ones are: headache, insomnia, skin rash, itching, diarrhea, nausea, vomiting, abdominal pain, weakness, cough, rhinitis, dyspnea, sinusitis and fever
  • Pregnancy category: C
  • Is expensive and only comes oral as a solution
  • Atovaquone/proguanil (Malarone) is a different medication not covered here, which is used for malaria treatment or prophylaxis

RESOURCES

    • Atovaquone (Mepron) Package Insert
    • Opportunistic Infection Guidelines (AIDSinfo.nih.gov)




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