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# **Atovaquone** ## Overview Atovaquone is an antiprotozoal agent that inhibits mitochondrial electron transport. ## Primary Indications * **Pneumocystis jirovecii pneumonia (PCP) prophylaxis:** In patients intolerant to trimethoprim-sulfamethoxazole. * **PCP treatment:** As an alternative agent in mild to moderate cases in patients intolerant to other agents. * **Babesiosis treatment:** In combination with azithromycin. * **Malaria treatment and prophylaxis:** (Often in combination with proguanil) ## Adult Dosing * **PCP Prophylaxis:** 1600 mg (20 mL) orally once daily. * **PCP Treatment (mild to moderate):** 1600 mg (20 mL) orally twice daily for 21 days. * **Babesiosis (with azithromycin):** 1000 mg orally once daily for 7 to 10 days. * **Malaria (treatment and prophylaxis, with proguanil):** Refer to specific malaria treatment guidelines. ## Pediatric Dosing Dosing varies significantly by indication and age. Consult specific pediatric guidelines. * **PCP Prophylaxis (children 13 months to < 20 kg):** 45 mg/kg orally once daily, not to exceed 1600 mg/day. * **PCP Prophylaxis (children 13 months to 20-40 kg):** 30 mg/kg orally once daily, not to exceed 1600 mg/day. * **PCP Prophylaxis (children 13 months to > 40 kg):** 1600 mg orally once daily. * **PCP Treatment:** Consult specific pediatric guidelines. Dosing is typically higher than for prophylaxis. * **Babesiosis:** Not established. ## Dose Adjustments No dose adjustment is typically required for renal or hepatic impairment, though caution is advised. ## Contraindications Known hypersensitivity to atovaquone or any component of the formulation. ## Adverse Effects Common: Diarrhea, nausea, vomiting, headache, rash, insomnia, abdominal pain. Less common: Anemia, neutropenia, hyponatremia, elevated liver enzymes. ## Key Drug Interactions * **Rifampin and Rifabutin:** Can significantly decrease atovaquone plasma concentrations. Avoid coadministration. * **Didanosine:** May increase didanosine levels. ## Monitoring * **PCP treatment/prophylaxis:** Monitor for clinical improvement and adverse effects. Consider laboratory monitoring (e.g., CBC, electrolytes) as clinically indicated. * **Babesiosis:** Monitor for clinical improvement and adverse effects. ## Clinical Pearls * Administer with a high-fat meal to enhance absorption. * Absorption is significantly reduced in patients with impaired absorption (e.g., malabsorption syndromes, gastric surgery). * For PCP prophylaxis in children, dose adjustments are based on weight. *** **Disclaimer:** This information is intended for healthcare professionals. Always consult the official prescribing information and institutional guidelines for the most current and comprehensive drug information before making prescribing decisions.