Comparative Pharmacology
Head-to-head clinical analysis: MALARONE PEDIATRIC versus PRIMAQUINE.
Peer-Reviewed Evidence
Head-to-head clinical analysis: MALARONE PEDIATRIC versus PRIMAQUINE.
MALARONE PEDIATRIC vs PRIMAQUINE
Comparing the clinical profiles, pharmacokinetic behaviors, and safety indices of these two therapeutic agents.
MALARONE PEDIATRIC is a fixed-dose combination of atovaquone and proguanil. Atovaquone selectively inhibits the mitochondrial electron transport chain of Plasmodium species at the cytochrome bc1 complex, collapsing mitochondrial membrane potential and disrupting pyrimidine synthesis. Proguanil is a prodrug converted to cycloguanil, which inhibits dihydrofolate reductase in the parasite, blocking DNA synthesis. The combination synergistically kills blood-stage schizonts and inhibits liver-stage hypnozoites of P. falciparum.
Antimalarial agent that eliminates exoerythrocytic forms (hypnozoites) of Plasmodium vivax and P. ovale; also active against gametocytes. Mechanism involves generation of reactive oxygen species via redox cycling, disrupting parasite mitochondrial function.
Adults: 250 mg atovaquone/100 mg proguanil orally once daily for 3 consecutive days for treatment; for prophylaxis, 250 mg/100 mg orally once daily starting 1-2 days before travel and continued for 7 days after leaving endemic area.
15 mg (base) orally once daily for 14 days for radical cure of P. vivax and P. ovale; 30 mg (base) orally once daily for 7 days for terminal prophylaxis.
None Documented
Clinical Note
moderatePrimaquine + Norfloxacin
"Primaquine may increase the QTc-prolonging activities of Norfloxacin."
Clinical Note
moderatePrimaquine + Haloperidol
"Primaquine may increase the QTc-prolonging activities of Haloperidol."
Clinical Note
moderatePrimaquine + Ibandronate
"Primaquine may increase the QTc-prolonging activities of Ibandronate."
Clinical Note
moderatePrimaquine + Tenofovir disoproxil
"The metabolism of Tenofovir disoproxil can be decreased when combined with Primaquine."
None Documented
Atovaquone: terminal half-life 1.5-3 days (range 2-3 days in adults, longer in children). Proguanil: terminal half-life 12-21 hours (parent drug) and 14-23 hours (cycloguanil). Clinically, atovaquone's long half-life supports single daily dosing.
Terminal elimination half-life of approximately 4-7 hours; in patients with glucose-6-phosphate dehydrogenase (G6PD) deficiency, half-life may be prolonged due to accumulation in erythrocytes
Atovaquone: >90% excreted unchanged in feces via biliary elimination; <1% renal. Proguanil: ~40-60% excreted renally as unchanged drug and active metabolite cycloguanil; ~30% fecal.
Primarily renal (60-65% as unchanged drug and metabolites); small amounts in feces (<5%)
Category C
Category D/X
Antimalarial
Antimalarial