Comparative Pharmacology
Head-to-head clinical analysis: MALARONE versus QUININE.
Peer-Reviewed Evidence
Head-to-head clinical analysis: MALARONE versus QUININE.
MALARONE vs Quinine
Comparing the clinical profiles, pharmacokinetic behaviors, and safety indices of these two therapeutic agents.
Atovaquone is a selective inhibitor of the mitochondrial electron transport chain at the cytochrome bc1 complex (Complex III), disrupting pyrimidine synthesis and ATP generation in Plasmodium species. Proguanil, via its metabolite cycloguanil, inhibits dihydrofolate reductase (DHFR), blocking DNA synthesis. Synergistic activity against erythrocytic and exoerythrocytic stages.
Quinine is a cinchona alkaloid that acts as a blood schizonticide against Plasmodium falciparum. It inhibits heme polymerase, leading to accumulation of toxic heme, and disrupts parasite membrane integrity. It also has mild analgesic and antipyretic properties.
For malaria treatment: 4 tablets (each containing atovaquone 250 mg/proguanil 100 mg) orally once daily for 3 consecutive days. For malaria prophylaxis: 1 tablet (atovaquone 250 mg/proguanil 100 mg) orally once daily starting 1-2 days before travel, continued during travel and for 7 days after leaving endemic area.
Adults: 648 mg (2 capsules) orally every 8 hours for 7 days for uncomplicated chloroquine-resistant malaria, typically used in combination with other antimalarials.
None Documented
Clinical Note
moderateQuinine + Gatifloxacin
"Quinine may increase the hypoglycemic activities of Gatifloxacin."
Clinical Note
moderateQuinine + Rosoxacin
"Quinine may increase the hypoglycemic activities of Rosoxacin."
Clinical Note
moderateQuinine + Levofloxacin
"Quinine may increase the hypoglycemic activities of Levofloxacin."
Clinical Note
moderateQuinine + Trovafloxacin
"Quinine may increase the hypoglycemic activities of Trovafloxacin."
None Documented
Atovaquone: 50-70 hours (mean ~60 h); proguanil: 12-21 hours (mean ~16 h); cycloguanil: 10-16 hours. Long half-life of atovaquone allows single-dose treatment, but may delay parasite clearance.
Terminal elimination half-life: 18 hours (range 8–21 h) in healthy adults; prolonged to 26–44 h in severe malaria or hepatic impairment.
Atovaquone: 94% excreted unchanged in feces via biliary elimination, 6% in urine. Proguanil: 40-60% excreted unchanged in urine; cycloguanil (active metabolite) and proguanil metabolites also cleared renally.
Renal: ~20% unchanged; Hepatic metabolism (CYP3A4) to inactive metabolites, excreted in urine and feces. Total renal elimination of parent and metabolites ~80%.
Category C
Category C
Antimalarial
Antimalarial