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# Atovaquone
## Overview
Atovaquone is an antiprotozoal agent. It is a hydroxynaphthoquinone that inhibits mitochondrial electron transport.
## Primary Indications
* Treatment and prophylaxis of *Pneumocystis jirovecii* pneumonia (PCP) in patients unable to tolerate trimethoprim-sulfamethoxazole.
* Treatment of mild to moderate PCP.
* Prophylaxis of PCP.
* Treatment of toxoplasmosis in patients unable to tolerate trimethoprim-sulfamethoxazole.
* Treatment and prophylaxis of babesiosis.
* Treatment and prophylaxis of malaria (in combination with azithromycin or proguanil).
## Adult Dosing
**Pneumocystis jirovecii Pneumonia (PCP):**
* **Treatment:** 750 mg orally twice daily for 21 days.
* **Prophylaxis:** 750 mg orally once daily.
**Toxoplasmosis:**
* **Treatment:** 750 mg orally twice daily in combination with pyrimethamine and leucovorin.
**Babesiosis:**
* **Treatment:** 750 mg orally twice daily for 7 days.
**Malaria (Prophylaxis, in combination with azithromycin):**
* 250 mg orally once daily.
**Malaria (Treatment, in combination with proguanil):**
* 250 mg orally once daily for 7 days.
## Pediatric Dosing
Dosing for pediatric patients is often weight-based and depends on the specific indication. Refer to specific pediatric guidelines or product labeling for precise dosing.
## Dose Adjustments
* No dose adjustment is necessary for patients with renal or hepatic impairment, although caution is advised.
## Contraindications
* Known hypersensitivity to atovaquone.
## Adverse Effects
* Rash
* Nausea
* Diarrhea
* Headache
* Insomnia
* Fever
* Abdominal pain
* Vomiting
* Anorexia
* Maculopapular rash
## Key Drug Interactions
* **Probenecid and Rifampin:** Concurrent use is contraindicated as it can lead to increased atovaquone plasma concentrations.
* **Warfarin:** Atovaquone may increase the INR of warfarin. Monitor INR closely and adjust warfarin dose as needed.
* **Tetracyclines:** May increase atovaquone levels and potentially increase adverse effects.
* **Erythromycin, Ketoconazole, Itraconazole:** May increase atovaquone plasma concentrations.
## Monitoring
* **PCP:** Clinical response, resolution of symptoms.
* **Toxoplasmosis:** Clinical response, resolution of symptoms.
* **Babesiosis:** Clinical response, resolution of symptoms.
* **Malaria:** Clinical response, symptom resolution.
* **Warfarin therapy:** Regular INR monitoring.
## Clinical Pearls
* Atovaquone is poorly absorbed; absorption is significantly increased when taken with a high-fat meal.
* For PCP treatment, clinical efficacy is lower than trimethoprim-sulfamethoxazole, especially in severe cases.
* The suspension form is preferable for children and patients who cannot swallow tablets.
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*Disclaimer: This information is intended for healthcare professionals. Always consult the most current prescribing information and relevant guidelines for complete details and to verify accuracy before making any treatment decisions.*
