Proguanil adverse effects

CIMETIDINE ANTIMALARIALS OTHER THAN PROGUANIL t efficacy and adverse effects of antimalarials Inhibition of metabolism, some definitely via CYP3A4 Avoid co-administration... 

Adverse effects. In prophylactic doses it is well tolerated. Mouth ulcers and stomatitis have been reported. Proguanil should be avoided or used in reduced dose for patients with impaired renal function. 

Atovaquone acts synergistically with proguanil, and the combination of these two drugs (Malarone ) is highly efficacious in the treatment of uncomplicated malaria (8), including that against multidrug resistant forms, and in prophylaxis (9). It has not yet been widely marketed, so data on rare adverse effects are currently sparse. 

An inpatient study of 79 patients given proguanil + atovaquone compared with 79 patients given mefloquine showed no malaria-independent adverse effects (10). Although there was a significant transient increase in liver enzymes, this was probably of limited clinical importance. 

The adverse effects of mefloquine have been extensively reviewed both for prophylaxis (when rare neuropsychiatric adverse effects make its use controversial) and in treatment doses, when it has been linked to an increased incidence of the postmalaria neurological syndrome. A retrospective review of 5120 Itahan soldiers showed an overall chemoprophylaxis curtailment rate of less than 1%, which was not significantly different from the combination of chloroquine and proguanil (11). A semi-systematic review also suggested no significant difference in tolerabihty compared with other antimalarial drugs (12). 

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