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Atovaquone / proguanil Disease Interactions

There are 4 disease interactions with atovaquone / proguanil:

Major

Proguanil (applies to atovaquone/proguanil) severe renal impairment

Major Potential Hazard, Moderate plausibility. Applicable conditions: Renal Dysfunction

Atovaquone and Proguanil tablets are contraindicated for prophylaxis of P. falciparum malaria in patients with severe renal impairment (creatinine clearance <30 mL/min) because of pancytopenia in patients with severe renal impairment treated with proguanil. Use with caution for the treatment of malaria in patients with severe renal impairment, only if the benefits of the 3-day treatment regimen outweigh the potential risks associated with increased drug exposure. No dosage adjustments are needed in patients with mild (creatinine clearance 50 to 80 mL/min) or moderate (creatinine clearance 30 to 50 mL/min) renal impairment.

Moderate

Atovaquone (applies to atovaquone/proguanil) gastrointestinal absorption

Moderate Potential Hazard, High plausibility. Applicable conditions: Anorexia/Feeding Problems, Malabsorption Syndrome, Diarrhea

Oral bioavailability of atovaquone is limited under fasting conditions, but is increased approximately two-fold when administered with food. Patients with gastrointestinal disorders or eating difficulties may be more likely to have impaired absorption and, consequently, subtherapeutic levels of the drug. Alternative parenteral treatment should be considered for patients unable to achieve adequate plasma concentrations of atovaquone with oral administration.

References

  1. Rolan PE, Mercer AJ, Weatherley BC, Holdich T, Ridout G, Meire H "Investigation of the factors responsible for a food-induced increase in absorption of a novel antiprotozoal drug 566C80." Br J Clin Pharmacol 33 (1992): p534-5
  2. "Product Information. Mepron (atovaquone)." Glaxo Wellcome, Research Triangle Park, NC.
Moderate

Atovaquone (applies to atovaquone/proguanil) liver disease

Moderate Potential Hazard, Moderate plausibility.

Atovaquone may cause elevated liver function tests. In clinical trials, elevated serum alkaline phosphatase concentrations (> 2.5 times the upper limit of normal, or ULN) were reported in approximately 8% of patients, and elevations in serum ALT and AST (> 5 times ULN) were reported in 6% and 4% of patients, respectively. Increases in serum bilirubin has occurred rarely. Atovaquone also may undergo limited metabolism by the liver. Therapy with atovaquone should be administered cautiously in patients with severe hepatic impairment. Liver function tests should be performed periodically, and therapy withdrawn if significant elevations develop.

References

  1. "Product Information. Mepron (atovaquone)." Glaxo Wellcome, Research Triangle Park, NC.
Moderate

Proguanil (applies to atovaquone/proguanil) hepatic impairment

Moderate Potential Hazard, Moderate plausibility. Applicable conditions: Liver Disease

No proguanil dosage adjustments are needed in patients with mild or moderate hepatic impairment, however, no trials have been conducted in patients with severe hepatic impairment. Caution is advised, as elevated liver laboratory tests and cases of hepatitis and hepatic failure requiring liver transplantation have been reported with prophylactic use of atovaquone and proguanil hydrochloride tablets.

Atovaquone / proguanil drug interactions

There are 74 drug interactions with atovaquone / proguanil

Atovaquone / proguanil alcohol/food interactions

There is 1 alcohol/food interaction with atovaquone / proguanil

Drug Interaction Classification

These classifications are only a guideline. The relevance of a particular drug interaction to a specific individual is difficult to determine. Always consult your healthcare provider before starting or stopping any medication.
Major Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.
Moderate Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.
Minor Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan.
Unknown No interaction information available.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.