Drug Characteristics
  • Formulation

    Suspension: 750 mg/5ml

  • Dose

    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        

  • Side Effects

    Rash, fever, abnormal LFTs, headache, nausea and vomiting, diarrhoea, neutropenia, anaemia

  • Interactions

    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        

  • Renal

    Atovaquone has not been studied in patients with renal or hepatic disease. It is thought to be predominantly excreted unchanged in faeces.

  • Hepatic

    No dosage adjustment currently recommended

  • Pregnancy

    Compatible – Maternal Benefit >> Embryo-Foetal Risk

  • Other Information

    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.