Proguanil Chloroquine

ACTs with amodiaquine, atovaquone-proguanil, chloroquine, clindamycin, doxycycline, lumefantrine,... 

ANTACIDS ANTIMALARIALS - PROGUANIL, CHLOROQUINE 1 chloroquine and proguanil levels 1 absorption Separate doses by at least 4 hours... 

VI.a.2.2. Biguanides. Proguanil is a dihydrofolate reductase inhibitor. It is a slow acting blood schizonticide and not effective on its own. It has also a marked effect on the primary tissue stages of Plasmodium falciparum. It is used in combination with chloroquine for the prophylaxis of chloroquine-resistant Plasmodium falciparum. 

VLa.2,6. Other antimalarials. Doxycydine (see Section ILb) is a useful and effective short-term prophylactic agent for travellers to chloroquine-resistant areas and can be used as an alternative when mefloquine or proguanil is unavailable or mefloquine is contraindicated. In combination with quinine also tetracycline is used as an antimalarial. 

Travelers to areas endemic for chloroquine-resistant disease Mefloquine, doxycycline, or atovaquone/proguanil Excellent... 

Malarone Areas with chloroquine-resistant P falciparum 1 tablet (250 mg atovaquone/100 mg proguanil) daily... 

Uncomplicated infections with chloroquine-resistant P falciparum Quinine sulfate, 650 mg 3 times daily for 3-7 days Malarone, 4 tablets (total of 1 g atovaquone, 400 mg proguanil) daily for 3 days... 

Oral 250 mg atovaquone + 100 mg proguanil tablets pediatric 62.5 mg atovaquone + 25 mg proguanil tablets Chloroquine (generic, Aralen)... 

Several drugs (for example amiodarone, androgens, glucocorticoids, phenytoin, and salicylates) interfere with the transport or metabolism of thyroid hormones and thereby alter thyroid function tests. These have been reviewed (90). In patients taking levothyroxine serum TSH rises after treatment with sertraline (91) and antimalarial prophylaxis with chloroquine and proguanil... 

Chloroquine-resistant Quinine Artemisinin derivatives Atovaquone-proguanil Mefloquine Pyrimethamine-sulfadoxine Antibacterials (e.g., clindamycin, doxycycline, sulfamethoxazole, or tetracycline] ... 

In another major review the risk of depression, psychosis, a panic attack, or a suicide attempt during current or previous use of mefloquine was compared with the risk during the use of proguanil and/or chloroquine or doxy-cycline (513). The study population (n = 35 370) was aged 17-79 years (45% men). There was no evidence that the risk of depression was increased during or after the use of mefloquine, but psychoses and panic attacks were more frequent in current users of mefloquine than in those using other antimalarial drugs. 

Petersen E, Ronne T, Ronn A, Bygbjerg I, Larsen SO. Reported side effects to chloroquine, chloroquine plus proguanil, and mefloquine as chemoprophylaxis against malaria in Danish travelers. I Travel Med 2000 7(2) 79-84. 

Chloroquine, quinine, mefloquine, halofantrine, proguanil, pyrimethamine, and tetracyclines blood schizontocides) kill these asexual forms. Drugs which act on this stage in the cycle of the parasite may be used for ... 

Mefloquine, chloroquine, proguanil, and pyrimethamine plus dapsone (Maloprim), alone or in combination are most commonly advised for prophylaxis regimens and doxycycline for special cases (drug resistance or intolerance) primaquine is being re-evaluated. 

Chloroquine and proguanil may be used for periods of up to 5 years, and mefloquine for up to 1 or 2 years expert advice should be taken by long-term travellers, especially those going to areas for which other prophylactic drugs are recommended. 

The use of proguanil plus atovaquone has been reviewed (14). Neuropsychiatric adverse events were more frequent with mefloquine, whereas other adverse events occurred with similar frequencies as with chloroquine plus proguanil and mefloquine. Proguanil plus atovaquone is contraindicated in severe renal insufficiency. Co-administration of proguanil plus atovaquone with rifampicin is not recommended because of reductions in plasma atovaquone concentrations. 

A marked increase in serum TSH occurred in the same patient on two occasions after several weeks of anti-malarial prophylaxis with chloroquine and proguanil, the likely mechanism being enzyme induction and increased thyroxine catabolism (SEDA-22, 469). 

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). 

It has tentatively been suggested that mefloquine can exacerbate psoriasis (as can other antimalarial drugs, such as quinidine, chloroquine, and proguanil) (38). 

Peragallo MS, Sabatinelli G, Sarnicola G. Compliance and tolerability of mefloquine and chloroquine plus proguanil for long-term malaria chemoprophylaxis in groups at particular risk (the military). Trans R Soc Trop Med Hyg 1999 93(l) 73-7. 

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