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Antiprotozoal / Antipneumocystis

Atovaquone

Brand names: Wellvone

Adult dose

Dose: PCP treatment: 750 mg twice daily with food for 21 days. PCP prophylaxis: 750 mg once daily. Toxoplasmosis (alternative): 1500 mg twice daily
Route: Oral suspension
Frequency: Once or twice daily with high-fat food

Clinical pearls

  • Alternative to co-trimoxazole for treatment and prophylaxis of Pneumocystis jirovecii pneumonia (PCP) in sulfonamide-intolerant patients
  • Must be taken with high-fat meal — significantly enhances bioavailability (food increases absorption 3-fold)
  • BHIVA HIV guidelines: atovaquone is second-line for PCP prophylaxis after co-trimoxazole
  • Also used for cerebral toxoplasmosis prophylaxis/treatment in HIV when sulfonamide-intolerant
  • For malaria chemoprevention: see atovaquone-proguanil entry
  • Lower efficacy than co-trimoxazole for moderate-to-severe PCP

Contraindications

  • Hypersensitivity to atovaquone
  • Severe GI disease (impairs absorption)

Side effects

  • Rash (common)
  • Nausea, diarrhoea
  • Headache
  • Elevated liver enzymes
  • Anaemia, neutropenia

Interactions

  • Rifampicin — substantially reduces atovaquone levels (reduces plasma concentrations by ~52%); avoid
  • Tetracycline — reduces atovaquone levels; avoid
  • Metoclopramide — reduces atovaquone levels
  • Ritonavir — reduces atovaquone levels

Monitoring

  • Clinical response in PCP treatment (oxygen saturation, radiological improvement)
  • LFTs
  • FBC
  • PCP prophylaxis: annual review and patient adherence check

Reference: BNF; BHIVA Guidelines on the management of opportunistic infection (2019); NICE HIV management guidelines; https://bnf.nice.org.uk/drugs/atovaquone/. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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