Drug Interactions between Malarone and tafenoquine

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.

ADJUST DOSING INTERVAL: Food enhances the oral bioavailability of tafenoquine. According to the manufacturer, tafenoquine peak plasma concentration (Cmax) and systemic exposure (AUC) increased by 31% and 41%, respectively, when administered as an investigational capsule formulation with a high-calorie, high-fat meal (approximately 1000 calories; 15% protein, 25% carbohydrate, 60% fat) relative to the fasted state.

MANAGEMENT: Tafenoquine should be administered with food.

The recommended maximum number of medicines in the 'antimalarials' category to be taken concurrently is usually one. Your list includes two medicines belonging to the 'antimalarials' category:

• Malarone (atovaquone/proguanil)
• tafenoquine

Note: In certain circumstances, the benefits of taking this combination of drugs may outweigh any risks. Always consult your healthcare provider before making changes to your medications or dosage.