Atovaquone

Trade name: Wellvoneâ„¢ Suspension with 750 mg/5 ml Drug class: antibiotic Manufacturer: GlaxoSmithKline

Indications: PCP prophylaxis in cases of hypersensitivity to cotrimoxazole; also reserve drug for treatment of mild to moderate cases of PCP and for cerebral toxoplasmosis.

Dose: for treatment 750-1500 mg bid (i.e. 1-2 measuring spoons of 5 ml bid) for 21 days. For prophylaxis 750 mg bid (i.e. 1 measuring spoon of 5 ml bid) or 1500 mg qd.

Side effects: gastrointestinal complaints such as nausea, vomiting and diarrhea are frequent (but often mild), as are rashes, which occur in approx. 20 %. More rarely headache, insomnia. Elevated liver enzymes, amylase. Anemia (rare).

Comments/Warnings: atovaquone should be taken with meals, ideally with fatty dishes, as this improves absorption. Atovaquone is considerably more expensive than other drugs for PCP prophylaxis (costs approx. 1,000 Euro/month)!! Rifampin and possibly also rifabutin lower plasma levels of atovaquone by approx. 50 %. The combination with these two drugs is therefore not recommended. Fluco-nazole probably increases levels.

Lopinavir seems to lower the plasma concentration of atovaquone. Dose adjustment may be necessary.

Internet sources:

UK: http://hiv.net/link.php?id=174 References:

1. Chan C, Montaner J, Lefebvre EA, et al. Atovaquone suspension compared with aero-solized pent-amidine for prevention of Pneumocystis carinii pneumonia in HIV-infected subjects intolerant of trimethoprim or sulfonamides. J Infect Dis 1999, 180:369-76. http://amedeo.com/lit.php?id=10395851

2. Chirgwin K, Hafner R, Leport C, et al. Randomized phase II trial of atovaquone with pyrimethamine or sulfadiazine for treatment of toxoplasmic encephalitis in patients with AIDS: ACTG 237/ANRS 039 Study. Clin Infect Dis 2002, 34:1243-50. http://amedeo.com/lit.php?id=11941551

3. El-Sadr WM, Murphy RL, Yurik TM, et al. Atovaquone compared with dapsone for the prevention of Pneumocystis carinii pneumonia in patients with HIV infection who cannot tolerate trimethoprim, sulfonamides, or both. N Engl J Med 1998, 339:1889-95. http://amedeo.com/lit.php?id=9862944

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4. Rosenberg DM, McCarthy W, Slavinsky J, et al. Atovaquone suspension for treatment of Pneumo-cystis carinii pneumonia in HIV-infected patients. AIDS 2001, 15:211-4. http://amedeo.com/lit.php?id=11216929

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