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Drug Interactions between Malarone Pediatric and Toposar

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

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Interactions between your drugs

Moderate

etoposide atovaquone

Applies to: Toposar (etoposide) and Malarone Pediatric (atovaquone / proguanil)

MONITOR: The coadministration with atovaquone may modestly increase the plasma concentrations of etoposide and its catechol metabolite. The mechanism of interaction is unknown. In nine children treated with etoposide (300 mg/m2 intravenous infusion), atovaquone (45 mg/kg/day in 2 divided doses) increased the area under the plasma concentration-time curve (AUC) of etoposide and its catechol metabolite by a median of 8.6% and 28.4%, respectively, compared to administration following daily sulfamethoxazole-trimethoprim.

MANAGEMENT: Given the risk of etoposide-related secondary acute myeloid leukemia associated with minor changes in schedule and concurrent therapy, caution is advised during the simultaneous administration of atovaquone and etoposide. Patients should be monitored for etoposide toxicity such as myelosuppression.

References

  1. van de Poll ME, Relling MV, Schuetz EG, Harrison PL, Hughes W, Flynn PM "The effect of atovaquone on etoposide pharmacokinetics in children with acute lymphoblastic leukemia." Cancer Chemother Pharmacol 47 (2001): 467-72

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Drug and food interactions

Moderate

atovaquone food

Applies to: Malarone Pediatric (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

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

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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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