Proguanil with atovaquone is a combination antimalarial medication primarily used for preventing and treating malaria caused by Plasmodium falciparum, the most dangerous form of the parasite. Marketed under brand names like Malarone and generics such as Maloff Protect, this fixed-dose oral tablet synergistically inhibits parasite replication, making it a first-line choice for travelers to malaria-endemic regions.
About Proguanil with Atovaquone Tablets
Each tablet contains 250 mg atovaquone and 100 mg proguanil hydrochloride (adult dose). Pediatric formulations exist for children based on weight. This combination disrupts the parasite’s mitochondrial electron transport and folate metabolism, preventing the parasite from multiplying in the blood. Unlike single agents, the duo provides synergistic schizonticidal activity, effective against both blood and liver stages of P. falciparum.
Malarone does not protect against other Plasmodium species like P. vivax or P. ovale relapse, so additional measures may be needed in those areas. It is not a vaccine; personal protection against mosquito bites remains essential.
Key Facts
- Active ingredients: Atovaquone (inhibits mitochondrial function) + proguanil (blocks dihydrofolate reductase via cycloguanil metabolite).
- ATC code: P01BB51 (antimalarials).
- Forms: Film-coated tablets for adults (250/100 mg) and pediatrics (62.5/25 mg).
- Indications: Prophylaxis and curative treatment of P. falciparum malaria.
- Not suitable for: Severe renal impairment (creatinine clearance <30 mL/min), hypersensitivity, or prophylaxis in pregnancy unless benefits outweigh risks.
Before Taking Proguanil with Atovaquone Tablets
Allergy
Avoid if allergic to atovaquone, proguanil, or excipients. Rare cross-reactivity with other antimalarials reported.
Pregnancy and Breastfeeding
Limited data; no major malformations observed with individual components, but use only if maternal benefit exceeds fetal risk. Continue folate supplements if on them, as proguanil does not reduce efficacy. Excreted in breast milk; weigh risks for infants.
Babies and Children
Approved for children >5 kg (pediatric tablets). Dosing by weight: e.g., 5-8 kg: 2 pediatric tabs/day. Not for infants <5 kg.
Taking Other Medicines
Interactions include:
| Drug | Effect | Advice |
|---|---|---|
| Metoclopramide, tetracycline, rifampicin | Reduce atovaquone levels | Monitor efficacy; alternative prophylaxis if possible |
| Warfarin | Potential INR changes | Monitor coagulation |
| Chloroquine, mefloquine | No significant interaction | Safe to combine if needed |
Conditions to Look Out For
- Renal impairment: Adjust or avoid doses if CrCl <30 mL/min.
- Seizure disorders: Proguanil may lower threshold.
- Psychiatric history: Monitor for mood changes.
- G6PD deficiency: Generally safe, unlike primaquine.
How to Take Proguanil with Atovaquone Tablets
Adults (≥40 kg)
- Prevention: 1 tablet daily, starting 1-2 days before travel, during stay, and 7 days after leaving endemic area. Take with food or milk to enhance absorption.
- Treatment: 4 tablets once daily for 3 days.
Children
| Weight | Prevention (pediatric tabs/day) | Treatment |
|---|---|---|
| 5-8 kg | 2 | 2 tabs x 3 days |
| 9-10 kg | 3 | 3 tabs x 3 days |
| 11-20 kg | 1 adult | 1 adult x 3 days |
| >40 kg | Adult dose | Adult dose |
If vomiting within 1 hour, repeat dose. Take at fixed time daily with meals.
Side Effects of Proguanil with Atovaquone Tablets
Generally mild and transient. Common (>1/100):
- Abdominal pain, nausea, diarrhea, headache, vomiting.
- Rash, itching.
Rare but serious:
- Stevens-Johnson syndrome, anaphylaxis.
- Hepatitis, neutropenia (reversible).
- Psychiatric: Anxiety, depression, hallucinations.
No added toxicity from combination vs. single agents. Report persistent symptoms to a doctor.
Understanding Your Medicines
The parasites multiply rapidly; early treatment prevents severe disease like cerebral malaria. Prophylaxis targets liver and blood stages, allowing stop after 7 days post-exposure due to activity against hypnozoites in P. falciparum.
Common Questions About Proguanil with Atovaquone
Who Cannot Use Malarone?
Those with severe kidney disease, allergy, or pregnant without medical advice. Consult for children under 5 kg.
Does It Prevent All Malaria Types?
Primarily P. falciparum; does not prevent P. vivax relapse. Use bite prevention.
What If I Miss a Dose?
Take as soon as remembered, unless near next dose. Do not double.
Can I Drink Alcohol?
No known interaction, but limit to avoid worsening nausea.
How Effective Is It?
Highly effective (>95%) when taken correctly with mosquito protection.
Preventing Malaria While Travelling
- Avoid bites: DEET repellent (30-50%), permethrin clothes, sleep under nets.
- Check CDC/WHO maps for risks.
- Seek immediate care for fever in endemic areas.
- Combine with vaccination where available (no malaria vaccine yet, but RTS,S for children).
Frequently Asked Questions (FAQs)
Q: When should I start Malarone for prevention?
A: 1-2 days before entering malaria area, continue daily during stay and 7 days after.
Q: Is it safe for pregnant travelers?
A: Only if essential; prefer non-pharmacologic prevention first. Consult specialist.
Q: What if I vomit after taking it?
A: Repeat dose if within 1 hour; contact doctor if persistent.
Q: Can children take it?
A: Yes, from 5 kg with weight-based pediatric dosing.
Q: Does it cause stomach upset?
A: Common but mild; take with fatty food to minimize.
References
- MALARONE 250 mg/100 mg, comprimé pelliculé — Agence nationale de sécurité du médicament (ANSM). 2023. https://base-donnees-publique.medicaments.gouv.fr/medicament/61638010/extrait
- Malarone générique adultes — ParaetPharmacie. 2023. https://paraetpharmacie.com/catalogue-medicaments-sur-ordonnance-non-rembourses-pas-d-expedition-ou-de-vente-en-ligne/11949-malarone-ge-atovaquone-proguanil-250mg-100mg-12-comprimes.html
- ATOVAQUONE/PROGUANIL VIATRIS — Vidal.fr. Updated 2024. https://www.vidal.fr/medicaments/gammes/atovaquone-proguanil-viatris-61442.html
- ATOVAQUONE/PROGUANIL ZENTIVA — Vidal.fr. Updated 2024. https://www.vidal.fr/medicaments/gammes/atovaquone-proguanil-zentiva-61483.html
- Recommandations générales vaccination — Institut Pasteur. 2024. https://www.pasteur.fr/fr/centre-medical/vaccination/recommandations-generales
- Atovaquone/proguanil EG 250 mg/100 mg — Pharmacie de L’Herm. 2023. https://pharmacie-de-lherm.mesoigner.fr/medicament-produit-parapharmacie/79443-atovaquone-proguanil-eg-250-mg-100-mg-comprime-pellicule
- Information sur l’Atovaquone-Proguanil (Malarone®) — INSPQ. Updated 2024. https://www.inspq.qc.ca/sante-voyage/outils/atovaquone
