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Drug Interactions between atovaquone / proguanil and typhoid vaccine, live

This report displays the potential drug interactions for the following 2 drugs:

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Interactions between your drugs

Major

typhoid vaccine, live proguanil

Applies to: typhoid vaccine, live and atovaquone / proguanil

ADJUST DOSING INTERVAL: The coadministration of single agent proguanil and live attenuated typhoid vaccine has been associated with diminished immunologic response to the vaccine. Proguanil possesses antibacterial activity and may be active against the vaccine strain of Salmonella typhi (Ty21a), thereby preventing a sufficient degree of multiplication to occur in order to induce a protective immune response. A significant decrease in the immune response rate was noted in a study of 30 healthy adults who received proguanil 200 mg daily with the Ty21a vaccine strain. However, in a study of 330 subjects between the ages of 4 to 16 years of age, the combination product atovaquone-proguanil (62.5-187.5 mg/day atovaquone and 25-75 mg/day proguanil depending on the body weight of the patient) did not have a significant effect on the vaccinees' immune response. Likewise, the antimalarial agents mefloquine and chloroquine, also possess antibacterial activity but have not been shown to interfere with the immunogenicity of the vaccine.

MANAGEMENT: Single agent proguanil should not be administered until at least 10 days after the last dose of live attenuated typhoid vaccine. However, the commercially available fixed combination atovaquone and proguanil can be given concurrently with this vaccine.

References (5)
  1. (2001) "Product Information. Vivotif Berna (typhoid vaccine, live)." Crucell Vaccine Inc
  2. Youngster I, Barnett E (2023) Interactions between travel vaccines & drugs CDC yellow book 2024 https://wwwnc.cdc.gov/travel/yellowbook/2024/preparing/interactions-travel-vaccines-drugs#travel
  3. Crucell Vaccines Inc. (2023) Vivotif typhoid vaccine live oral ty21a. https://www.fda.gov/media/75988/download
  4. Emergent Travel Health Inc. (2023) Product monograph vivotif typhoid vaccine live oral attenuated ty21a activeimmunizing agent. https://pdf.hres.ca/dpd_pm/00058906.PDF
  5. Biocelect Pty Ltd (2023) Australian product information - vivotif oral (salmonella typhi) capsule. https://www.ebs.tga.gov.au/ebs/picmi/picmirepository.nsf/pdf?OpenAgent=&id=CP-2020-PI-01717-1&d=20230530172310101

Drug and food interactions

Moderate

atovaquone food

Applies to: atovaquone / proguanil

ADJUST DOSING INTERVAL: Food, particularly high-fat food, significantly enhances the oral absorption and bioavailability of atovaquone. In 16 healthy volunteers, administration of a single 750 mg dose of atovaquone suspension following a standard breakfast (23 g fat: 610 kCal) resulted in an approximately 3.4-fold increase in the mean peak plasma concentration (Cmax) and a 2.5-fold increase in the mean area under the plasma concentration-time curve (AUC) of atovaquone compared to administration following an overnight fast. In a study consisting of 19 HIV-infected volunteers receiving atovaquone suspension 500 mg/day, Cmax and AUC of atovaquone increased by 72% and 66%, respectively, in the fed state relative to the fasting state.

MANAGEMENT: To ensure maximal oral absorption, atovaquone products (suspension, tablet, or in combination with proguanil) should be administered with a meal or milky drink, or enteral nutrition at the same time(s) each day. Because plasma atovaquone concentrations have been shown to correlate with the likelihood of successful treatment and in some cases, survival, alternative therapies may be appropriate for patients who have difficulty taking atovaquone with food.

References (3)
  1. (2001) "Product Information. Mepron (atovaquone)." Glaxo Wellcome
  2. (2001) "Product Information. Malarone (atovaquone-proguanil)." Glaxo Wellcome
  3. Wohlt PD, Zheng L, Gunderson S, Balzar SA, Johnson BD, Fish JT (2009) "Recommendations for the use of medications with continuous enteral nutrition." Am J Health Syst Pharm, 66, p. 1438-67

Therapeutic duplication warnings

No warnings were found for your selected drugs.

Therapeutic duplication warnings are only returned when drugs within the same group exceed the recommended therapeutic duplication maximum.

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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.

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