Suspension: 750 mg/5ml
Mild to moderate PCP: 750 mg (5ml) orally twice a day for 21 days.
The preparation needs to be taken with high-fat food
PCP prophylaxis (fourth-line): 750 mg (5ml) orally twice a day
Maintenance of toxoplasmosis (third-line): 1500 mg (10 ml) orally twice a day with pyrimethamine and folinic acid
Rash, fever, abnormal LFTs, headache, nausea and vomiting, diarrhoea, neutropenia, anaemia
Care with any agent that may decrease GI transit time.
Highly bound to plasma proteins (>99%): caution should be used when administering with other drugs that are highly protein bound and have a narrow therapeutic index e.g. phenytoin and warfarin
Interaction reported with ritonavir when used as both PI or pharmacokinetic enhancer resulting in decreased atovaquone levels – caution
Atovaquone has not been studied in patients with renal or hepatic disease. It is thought to be predominantly excreted unchanged in faeces.
No dosage adjustment currently recommended
Compatible – Maternal Benefit >> Embryo-Foetal Risk
Poor bioavailability. Presence of food (particularly high fat) increases the absorption two to three fold.
Doses for treatment of toxoplasmosis have not been defined with the liquid formulation. A dose of 750 mg four times a day with the tablet formulation was previously used; however, this is no longer available. The liquid formulation has higher bioavailability. Atovaquone liquid 750 mg twice a day should provide similar drug exposure.