Atovaquone and proguanil (Malarone) for prophylaxis and treatment of P.falciparum malaria.
Use Malarone® (Atovaquone/proguanil) can be used for prophylaxis in areas with resistance to any other malaria drug. Malarone is probably less efficient against P.vivax and should be used primarily for prophylaxis against P.falciparum malaria.
Malarone should be taken at the same time of the day every day. Atovaquone is soluble in fat and should be taken with a meal containing fat like butter, cheese or milk.
Prevention Malarone is taken once a day from the day before departure until 7 days after departure from the area with malaria. Malarone is only registered for travels of up to 28 days.
Adults and children > 40 kg body weight: 1 tablet 1/1 once a day.
Children 30 – 40 kg: 3 tablets ¼ strength once a day.
Children 20 – 29 kg: 2 tablets ¼ strength once a day.
Children 10 – 19 kg: 1 tablet ¼ strength once a day.
Self treatment of suspected malaria
Adults and children > 40 kg body weight: 4 tablet 1/1 once a day.
Children 30 – 40 kg: 3 tablets 1/1 strength once a day for three days.
Children 20 – 29 kg: 2 tablets 1/1 strength once a day for three days.
Children 10 – 19 kg: 1 tablet 1/1 strength once a day for three days. Even as taken for self-treatment medical assistance should be consulted.
Pregnancy Malaria during pregnancy is a risk for both mother and child. Travelling to a high-risk area when pregnant should only be considered if absolutely necessary. Animal studies have not shown any untoward effects of Malarone on the foetus, but experience from humans are lacking. Malarone should therefore only be used in pregnancy in special cases and after informed consent of the pregnant woman.
Lactation The same restrains as for pregnant women.
Side effects Use for prophylaxis the most frequently reported symptoms are headache, stomach pain and diarrhoea. Used for treatment additional loss of appetite, nausea, vomiting and cough has been reported. Allergic rash has been described.
Who can not use malarone ? People with previous reactions to either atovaquone or proguanil or malarone. Should be used with caution in patients with reduced kidney function as proguanil is excreted through the kidneys.
Interaction with other drugs Concomitant treatment with metoclopramid, tetracyclines or rifampicin significantly reduces atovaquone concentration (and efficacy) in the blood. The efficacy of atovaquone is reduced if used at the same time as chloroquine, quinine, pyrimethamine, mefloquine and artemisinins.
Note No antimalarial drug provides 100% protection even if used strictly according to the recommendations. Malaria drugs reduce the risk of infection with around 80% to 95% depending of your destination and living conditions. Prevention of mosquito bites is therefore still important even if you take malaria drugs regularly.