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