How does this medication work? What will it do for me?

This combination medication contains two active ingredients: atovaquone and proguanil. It is used to treat and prevent malaria. It works by killing P. falciparum, the parasite that causes malaria. It may be effective in areas where other antimalarial medications are no longer effective.

This medication may be available under multiple brand names and/or in several different forms. Any specific brand name of this medication may not be available in all of the forms or approved for all of the conditions discussed here. As well, some forms of this medication may not be used for all of the conditions discussed here.

Your doctor may have suggested this medication for conditions other than those listed in these drug information articles. If you have not discussed this with your doctor or are not sure why you are taking this medication, speak to your doctor. Do not stop taking this medication without consulting your doctor.

Do not give this medication to anyone else, even if they have the same symptoms as you do. It can be harmful for people to take this medication if their doctor has not prescribed it.

What form(s) does this medication come in?

Each pink, round, biconvex, bevelled-edge, film-coated tablet, debossed with "77" and "227" on one side, contains 250 mg of atovaquone and 100 mg proguanil hydrochloride (equivalent to 87.4 mg proguanil base). Nonmedicinal ingredients: low-substituted hydroxypropyl cellulose, magnesium stearate, microcrystalline cellulose, poloxamer 188, povidone K30, and sodium starch glycolate. Tablet coating: hydroxypropylmethylcellulose 2910, polyethylene glycol 8000, polyethylene glycol 400, titanium dioxide, and ferric oxide red.

How should I use this medication?

The usual recommended adult dose for preventing malaria is 1 tablet daily, starting 1 to 2 days before entering an area where malaria is present and continuing until 7 days after leaving the affected area.

The usual recommended adult dose for treating malaria is 4 tablets once daily for 3 days.

Children's doses for malaria prevention and treatment are based on body weight.

This medication should be swallowed whole with fluid; however, it may be crushed and mixed in condensed milk immediately before taking the dose if it cannot be swallowed whole.

This medication should be taken with food or a milky drink at the same time each day. If vomiting occurs within one hour of the dose, another dose should be taken. If vomiting continues, your doctor will likely consider using another treatment.

People who are unable to eat food should use a different treatment if possible, as the absorption of the medication is significantly reduced when the stomach is empty.

Many things can affect the dose of a medication that a person needs, such as body weight, other medical conditions, and other medications. If your doctor has recommended a dose different from the ones listed here, do not change the way that you are taking the medication without consulting your doctor.

It is important to take this medication exactly as prescribed by your doctor. If you miss a dose, take it as soon as possible and continue with your regular schedule. If it is almost time for your next dose, skip the missed dose and continue with your regular dosing schedule. Do not take a double dose to make up for a missed one. If you are not sure what to do after missing a dose, contact your doctor or pharmacist for advice.

Store this medication at room temperature, protect it from light and moisture, and keep it out of the reach of children.

Do not dispose of medications in wastewater (e.g. down the sink or in the toilet) or in household garbage. Ask your pharmacist how to dispose of medications that are no longer needed or have expired.

Who should NOT take this medication?

Do not take this medication if you:

  • are allergic to atovaquone, proguanil, or any  ingredients of the medication
  • have severe kidney impairment

What side effects are possible with this medication?

Many medications can cause side effects. A side effect is an unwanted response to a medication when it is taken in normal doses. Side effects can be mild or severe, temporary or permanent.

The side effects listed below are not experienced by everyone who takes this medication. If you are concerned about side effects, discuss the risks and benefits of this medication with your doctor.

The following side effects have been reported by at least 1% of people taking this medication. Many of these side effects can be managed, and some may go away on their own over time.

Contact your doctor if you experience these side effects and they are severe or bothersome. Your pharmacist may be able to advise you on managing side effects.

  • abdominal pain
  • back pain
  • constipation
  • coughing
  • diarrhea
  • difficulty sleeping
  • dizziness
  • hair loss
  • headache
  • heartburn
  • increased sensitivity to sunlight
  • indigestion
  • itching skin
  • loss of appetite
  • nausea
  • tiredness
  • vomiting

Although most of these side effects listed below don't happen very often, they could lead to serious problems if you do not check with your doctor or seek medical attention.

Check with your doctor as soon as possible if any of the following side effects occur:

  • flu-like symptoms (e.g., fever, muscle aches, sore throat)
  • hallucinations
  • irritation or sores in the mouth
  • rapid heart rate or abnormal heartbeat
  • severe dizziness when rising from a lying or sitting position
  • signs of anemia (low red blood cells; e.g., decreased energy, weakness, breathlessness)
  • signs of blood vessel inflammation (e.g., red or purple raised spots on the skin)
  • signs of depression (e.g., poor concentration, changes in weight, changes in sleep, decreased interest in activities, mood changes, thoughts of suicide)
  • signs of infection (fever, severe chills, sore throat, mouth ulcers)
  • signs of liver problems (e.g., nausea, vomiting, diarrhea, loss of appetite, weight loss, yellowing of the skin or whites of the eyes, dark urine, pale stools)
  • skin rash

Stop taking the medication and seek immediate medical attention if any of the following occur:

  • signs of a serious allergic reaction (e.g., abdominal cramps, difficulty breathing, nausea and vomiting, or swelling of the face and throat)
  • symptoms of a severe skin rash (e.g., blistering, peeling, a rash covering a large area of the body, a rash that spreads quickly, or a rash combined with fever or discomfort)

Some people may experience side effects other than those listed. Check with your doctor if you notice any symptom that worries you while you are taking this medication.

Are there any other precautions or warnings for this medication?

Before you begin using a medication, be sure to inform your doctor of any medical conditions or allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should use this medication.

Depression and mental illness: People taking this medication may feel agitated (restless, anxious, aggressive, emotional, and feeling not like themselves), or they may want to hurt themselves or others. These symptoms may occur within several weeks after starting this medication. If you experience these side effects or notice them in a family member who is taking this medication, contact your doctor immediately.

If you have a history of mental illness or depression, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Dizziness: This medication may cause dizziness, affecting your ability to drive or operate machinery. Avoid these and other hazardous tasks until you have determined how this medication affects you.

Epilepsy: Rarely, seizures have been reported by people taking this medication. If you have epilepsy or a history of seizure disorder, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Kidney function: Kidney disease or reduced kidney function may cause this medication to build up in the body, causing side effects. If you have kidney problems, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed. This medication is not recommended for people with severe kidney impairment.

Pregnancy: This medication should not be used during pregnancy unless the benefits outweigh the risks. If you become pregnant while taking this medication, contact your doctor immediately.

Breast-feeding: It is not known if atovaquone passes into breast milk. Proguanil passes into breast milk. If you are a breast-feeding mother and are taking atovaquone - proguanil, it may affect your baby. Talk to your doctor about whether you should continue breast-feeding.

Children: Atovaquone - proguanil may be used for treating malaria in children who are at least 3 years old and weigh at least 11 kilograms. Atovaquone - proguanil may be used for preventing malaria in children who weigh at least 11 kilograms. The safety and effectiveness of using this medication for children smaller than this have not been determined and should be avoided.

What other drugs could interact with this medication?

There may be an interaction between atovaquone - proguanil and any of the following:

  • antidiabetes medications (e.g., glyburide, insulin, metformin, repaglinide, rosiglitazone)
  • dapsone
  • efavirenz
  • etoposide
  • indinavir
  • metoclopramide
  • other antimalarial medications
  • phenothiazines (e.g., fluphenazine, perphenazine, thoridazine)
  • rifabutin
  • rifampin
  • ritonavir
  • tetracycline
  • typhoid vaccine (oral)
  • warfarin

If you are taking any of these medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:

  • stop taking one of the medications,
  • change one of the medications to another,
  • change how you are taking one or both of the medications, or
  • leave everything as is.

An interaction between two medications does not always mean that you must stop taking one of them. Speak to your doctor about how any drug interactions are being managed or should be managed.

Medications other than those listed above may interact with this medication. Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications you are taking. Also tell them about any supplements you take. Since caffeine, alcohol, the nicotine from cigarettes, or street drugs can affect the action of many medications, you should let your prescriber know if you use them.

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