Atovaquone and Proguanil

What is Atovaquone and Proguanil for?

Atovaquone-Proguanil is a medication used to prevent malaria. 

Malaria is a disease caused by a parasite (Plasmodium species), which can spread to humans by the bite of an infected female Anopheles mosquito.

How should I take or use Atovaquone and Proguanil?

• The medication is usually taken once a day, preferably at the same time of the day.
• This medication should be taken with food or a milky drink.
• Check with your pharmacist or doctor for the correct dose if you weigh less than 40kg.
• Start one to two days before entering the area with malaria risk and continue to take the medication every day during the trip. After leaving the area with malaria risk, continue to take the medication daily and for one week after travel or once you return to Singapore. It is important to complete the full course for complete protection.
• If you find it difficult to swallow the tablets, you can crush or mix the medication with small amounts of water, milk or other beverages.
• Do not stop taking your medication before checking with your healthcare professional.

What should I do if I forget to take or use Atovaquone and Proguanil?

If you forget to take a dose, take it as soon as you remember. However, if it is near the time for your next dose, skip the missed dose and go back to your usual schedule. Do not take two doses to make up for the missed dose.

What precautions should I take when taking or using Atovaquone and Proguanil?

Inform your healthcare professional if:

• You are allergic to Atovaquone, Proguanil hydrochloride or any of the other ingredients of this medication.
• You are pregnant or breast-feeding. Avoid pregnancy and use contraceptives while taking this medication and for 2 weeks after the last dose.
• You are taking any other medications, including supplements, traditional medications and herbal remedies.
• You have a history of kidney problems, liver problems, seizures (epilepsy or convulsions) or depression.
• You have tuberculosis.

What food or medication should I avoid when I take or use Atovaquone and Proguanil?

Inform your pharmacist or doctor if you are taking any of the medications below:

• Tetracycline (antibiotic)
• Metoclopramide (medicine to treat nausea or vomiting)
• Rifampin or Rifabutin (antibiotic)
• Etoposide (used to treat cancer)
• Efavirenz, Zidovudine, Indinavir (medicine to treat HIV)
• Warfarin, Dabigatran, Apixaban or Rivaroxaban (oral anticoagulants)

This is not a complete list of all possible drug interactions with this medication. Check with your healthcare professional if you are unsure.

What are some common side effects of Atovaquone and Proguanil?

• You may experience nausea, vomiting, stomach pain and diarrhea.
  • Take the medication after food to reduce gastric side effects.
  • If you vomit within 1 hour of taking the medicine, repeat the dose.
• You may experience headache and insomnia.
  • You should continue taking the medication unless you are unable to tolerate the side effects.
• You may experience dizziness while on this medication.
  • If affected, do not drive, operate machinery or do work that requires you to be alert.

What are some rare but serious side effects that I need to seek medical advice immediately?

• Severe skin reactions
  • Skin rash, which may blister and looks like small targets (central dark spots, surrounded by paler area with a dark ring around the edge) (erythema multiforme).
  • Severe widespread rash with blisters and peeling skin, particularly occurring around the mouth, nose, eyes and genitals (Stevens-Johnson syndrome).
• Liver problems
  • Symptoms include dark urine or light coloured stools, nausea, vomiting, loss of appetite, stomach pain, yellowing of your eyes or skin.
• Anemia
  • A condition where you do not have enough red blood cells.
  • May present with worsening tiredness, rapid breathing, pale skin/lips/nails, fast heartbeat while resting.
• Severe infection
  • May present with high fever, severe chills, body aches, sore throat.
• Drug allergy (symptoms include one or more of the following)
  • Swollen face/eyes/lips/tongue.
  • Difficulty in breathing.
  • Itchy skin rashes over your whole body.

If you experience any of these symptoms, you should stop your medication and see your healthcare professional immediately.

How should I store Atovaquone and Proguanil?

Store in a cool and dry place, away from direct sunlight. Keep this medication away from children. 

How do I throw away Atovaquone and Proguanil safely?

For general waste: Pack this medication into a black trash bag and seal it tightly before throwing into the rubbish chute or bin. 

What else should I know about Atovaquone and Proguanil?

To prevent malaria, you may protect yourself against mosquito bites by:

• Wearing long-sleeved clothing and long trousers between sunset and sunrise.
• Applying insect repellent containing more than 20% DEET (N-Diethyl-meta-toluamide) for adults or 10% and less DEET for children on exposed skin. DEET is a common active ingredient in mosquito repellents.
• Using mosquito coils in the room at night.
• Sleep with mosquito nets around your bed, with the net edges tucked under the bed or sleep in a screened room.
• Spray insecticide where mosquitos may rest. Mosquito larvae survive well in clear, slow-flowing streams.
• Avoid going to an area where malaria is common.

Following these guidelines and medication does not mean that you will not get malaria. If you have a fever or experience chills between 1 week and up to 1 year after your return, you should seek medical attention. Inform the doctor that you have been to a country where malaria is common. Malaria can be effectively treated if discovered early. A delay in treatment may result in serious health problems.