Atovaquone and Proguanil use while Breastfeeding

Summary of Use during Lactation

No information is available on the use of atovaquone and proguanil during breastfeeding. The Centers for Disease Control and Prevention does not currently recommend it for the prevention of malaria in women breastfeeding infants weighing less than 5 kg (11 pounds). However, it can be used for treatment of women who are breastfeeding infants of any weight when the potential benefit outweighs the potential risk to the infant (e.g., treating a breastfeeding woman who has acquired P. falciparum malaria in an area of multidrug-resistant strains and who cannot tolerate other treatment options).[1]

In general, very small amounts of antimalarial drugs are excreted in the breastmilk of lactating women. Because the quantity of antimalarial drugs transferred in breastmilk is insufficient to provide adequate protection against malaria, infants who require chemoprophylaxis must also receive the recommended dosages of antimalarial drugs.[1]

Drug Levels

Maternal Levels. A physiologically based pharmacokinetic model predicted that the RID of proguanil is between 0.25% and 0.5%.[2]

Infant Levels. Relevant published information was not found as of the revision date.

Effects in Breastfed Infants

Relevant published information was not found as of the revision date.

Effects on Lactation and Breastmilk

Relevant published information was not found as of the revision date.

References

1.

Malaria. In: Centers for Disease Control and Prevention. CDC Yellow Book 2024: Health Information for International Travel. 2024. https://wwwnc​.cdc.gov​/travel/yellowbook/2024​/infections-diseases​/malaria#treatment

2.

Almond LM, Abduljalil K, Pansari A, et al. PBPK-led assessment of antimalarial drug concentrations in breastmilk: A strategy for optimal use of prediction methods to guide decision making in an understudied population. CPT Pharmacometrics Syst Pharmacol 2025. [PubMed: 39930940]

Substance Name

Atovaquone and Proguanil

CAS Registry Number

156879-69-5

Drug Class

Breast Feeding

Lactation

Milk, Human

Anti-infective Agents

Antiparasitic Agents

Antimalarials

Antiprotozoal Agents