Meds and you

30 September 2013

Proguanil with atovaquone

The combination of proguanil and atovaquone is an anti-malarial. Anti-malarials are drugs that are used to prevent or treat malaria.


The combination of proguanil and atovaquone is the active ingredient of Malanil tablets (Nappi code: 700780-001).

General information
The combination of proguanil and atovaquone is an anti-malarial. Anti-malarials are drugs that are used to prevent or treat malaria caused by susceptible strains of the plasmodium parasite.

Proguanil is very effective anti-malaria drug. Resistance may however develop to it on its own and it is therefore combined with atovaquone.

Atovaquone is and anti-malarial drug, but is also an antibiotic registered for the treatment of mild to moderate chest infections and pneumonia caused by the fungus Pneymocystis carinnii. It is prescribed for those who cannot take the antibiotic co-trimoxaxole for the treatment of these airway infections.

On its own atovaquone is not of much use for the treatment of malaria. However, if it is combined with proguanil, it proves very effective in treating and preventing malaria.

This medication does not cure the underlying condition, but simply keeps the symptoms under control. For it to be effective, it has to be taken regularly, even if you do not notice an immediate effect. It is furthermore advised to take additional precautions to avoid being bitten by mosquitoes. These include using mosquito repellants, wearing protective clothing and sleeping under mosquito nets.

It is advised not to discontinue treatment before the recommended course has been completed.

For the best results, treatment with this medication should start 24 - 48 hours before entering a risk area, and continue until 7 days after return.

How does the combination of proguanil and atovaquone work?
This combination inhibits an enzyme essential for plasmodium parasites (which cause malaria) to reproduce. By inhibiting this enzyme, this medication prevents any malarial parasites that have entered the red blood cells from multiplying and in this way prevents the disease from developing.

Fast facts

Drug schedule: schedule 4
Available as: this combination is available as tablets.
What does it do? This medication prevents a person from getting malaria.
Overdose risk: medium
Dependence risk: low
Is the combination of proguanil and atovaquone available as a generic? no
Is this combination available on prescription only? yes

User information

Onset of effect: the full effect may only be seen after 24 hours.
Duration of action: it should be in the body for up to 48 hours.
Dietary advice: this medication should best be taken with a meal.
Stopping this medicine: it is advised not to discontinue treatment before the recommended course has been completed.
Prolonged use: this medication is generally not prescribed for prolonged periods of time.

Special precautions
Consult your doctor before using this drug if:

Pregnancy: avoid. Potential risk to the foetus has been reported. Consult your doctor before use, or if you are planning to fall pregnant.
Breastfeeding: avoid. It is unknown how this medication may affect your baby. Consult your doctor before use.
Porphyria: avoid. This medication may cause serious adverse effects. Consult your doctor before use.
Infants and children: this medication is not intended for use in children.
The elderly: caution is advised in the elderly as side effects are more likely to occur.
Driving and hazardous work: no special precautions need to be taken.
Alcohol: avoid concomitant use of alcohol with this medication.

Possible side effects

Side Effect
Consult your doctor

Only if severe
In all cases


nausea / vomiting


abdominal pain


loss of appetite






mouth ulcers




hair loss


skin rash




Drug interactions

warfarin increased risk of bleeding
magnesium trisilicate-containing products reduced absorption and effect of proguanil
fluvoxamine reduced effect of proguanil
chloroquine increased incidence of mouth ulcers
rifampicin reduced effect of atovaquone
metoclopramide reduced effect of atovaquone
tetracycline reduced effect of atovaquone with risk of treatment failure

Overdose action
A small overdose is no cause for concern. In case of intentional large overdose, seek emergency medical attention.

Recommended dosage
Adults > 40 kg, oral: 1 tablet daily.

This material is not intended to substitute medical advice, but is for informational purposes only. Please consult a physician for specific treatment and recommendations.


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