Tetracycline Atovaquone

Atovaquone (Mepron) [Antiprotozoal] Uses Rx prevention PCP Action 4- nucleic acid ATP synth Dose Rx 750 mg PO bid for 21 d Prevention 1500 mg PO once/d (w/ meals) Caution [C, ] Disp Susp SE FevCT, HA, anxiety, insomnia, rash, N/V Interactions X Effects W/ metoclopramide, rifabutin, rifampin, tetracycline EMS None OD Sxs unknown but may cause a rash symptomatic and supportive... 

Atovaquone is poorly absorbed from the gastrointestinal tract, but absorption is increased with a fatty meal. Excretion of the drug, mostly unchanged, occurs in the feces. The elimination half-life is 2 to 3 days. Low plasma levels persist for several weeks. Concurrent administration of metoclopramide, tetracycline, or rifampin reduces atovaquone plasma levels by 40 to 50%. 

Malarone is generally well tolerated. Adverse effects include abdominal pain, nausea, vomiting, diarrhea, headache, and rash, and these are more common with the higher dosage required for treatment. Reversible elevations in liver enzymes have been reported. The safety of atovaquone in pregnancy is unknown. Plasma concentrations of atovaquone are decreased about 50% by co-administration of tetracycline or rifampin. 

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

TETRACYCLINE ANTIMALARIALS -ATOVAQUONE 1 atovaquone levels (40%) Uncertain Not clinically significant combination therapy has been used effectively... 

Tetracycline reduces the plasma levels of atovaquone by about 40%. Tlie effect of doxycycline does not appear to have been studied. 

An in vitro study found that doxycycline potentiated the antimalarial activity of atovaquone, but there appears to be no information on the effect of doxycycline on the absorption of atovaquone. A study looking at the population pharmacokinetics of atovaquone in 24 Thai patients found that neither the oral clearance nor the volume of distribution of atovaquone were significantly affected by the concurrent use of tetracycline. ... 

The manufacturers suggest that parasitaemia should be closely monitored in patients taking atovaquone/proguanil tablets with tetracycline. In the UK, they also say that tetracycline should be given with caution to patients taking atovaquone suspension for Pneumocystis pneumonia, until the interaction has been further studied, whereas the US manufacturers of atovaquone suspension do not mention tetracycline. ... 

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