Proguanil

	Zambia HIV National Guidelines
	Introduction HIV Counseling and Testing Sexually Transmitted Infections (STIs) General Principles of Antiretroviral Therapy for Chronic HIV Infection in Adults and Adolescents When to Start ARV Therapy for Chronic HIV Infection in Adults and Adolescents Initial Regimen for ARV Therapy Adherence Baseline evaluation and Monitoring Calculations: Ideal Body Weight, Body Mass Index and Creatinine Clearance ARV Therapy for Individuals with Tuberculosis Co-Infection Adverse Effects and Toxicity Immune Reconstitution Inflammatory Syndrome (IRIS) Changing or Stopping ART Treatment Failure Stopping ARV Therapy Post Exposure Prophylaxis Cotrimoxazole Prophylaxis WHO Staging in Adults and Adolescents Nutrition Care and Support Palliative Care in HIV and AIDS
	Guide Editors
	Editor In Chief Joel E. Gallant, MD, MPH Pharmacology Editor Paul Pham, PharmD, BCPS Zambia Guideline Team Peter Mwaba MMed PhD FRCP Alywn Mwinga MMed Isaac Zulu MMed MPH Velepie Mtonga MMed Albert Mwango MBChB Jabbin Mulwanda MMed FCS

Drugs>Antimicrobial Agents>

Proguanil

Paul A. Pham Pharm.D.
03-31-2008

Zambia Specific Information

Available formulation in Zambia: tab: Proguanil 100 mg (hydrochloride).
Must be used in combination with chloroquine.
LPV/r may decrease formation of active metabolite cycloguanil. Monitor for anti-malarial efficacy with co-administration.
Proguanil plus chloroquine may be considered in 1st trimester of pregnancy.
Co-formulation with atovaquone not available in Zambia.

Zambia Information Author: Paul A. Pham, Pharm. D.

INDICATIONS

FDA

FDA approved (in combination with atovaquone) for treatment and prophylaxis of P. falciparum malaria.

FORMS

brand name	generic	Mfg	brand forms	cost*
Malarone	atovaquone/proguanil	Glaxo Smithkline	PO tab 62.5/25 mg	$2.26
			PO tab 250/100 mg	$6.12

*Prices represent cost per unit specified and are representative of "Average Wholesale Price" (AWP). AWP Prices were obtained and gathered by Lakshmi Vasist Pharm D using the Red Book, manufacturer's information, and the McKesson database.

^Dosage is indicated in mg unless otherwise noted.

USUAL ADULT DOSING

Treatment of malaria : atovaquone/proguanil 1000/400mg or 15/6 mg/kg (usual adult : 4 tabs as single dose) PO daily x 3 d.
Prevention of malaria : atovaquone/proguanil 250/100mg (1 tab) once daily beginning 1-2d before travel and continuing for 1 wk after leaving endemic area.
Administer with food (when given with atovaquone).

RENAL DOSING

DOSING FOR GLOMERULAR FILTRATION OF 50-80

Usual dose

DOSING FOR GLOMERULAR FILTRATION OF 10-50

Usual dose

DOSING FOR GLOMERULAR FILTRATION OF <10 ML/MIN

No data, may need to be decreased

DOSING IN HEMODIALYSIS

No data, unlikely to be removed.

DOSING IN PERITONEAL DIALYSIS

No data, unlikely to be removed.

DOSING IN HEMOFILTRATION

No data

ADVERSE DRUG REACTIONS

GENERAL

One of best tolerated anti-malarial drugs.

OCCASIONAL

GI: abdominal pain, nausea, vomiting, diarrhea, anorexia (but resolve with continued treatment).
Reversible LFTs elevations.
Dreams and insomnia (less compared to mefloquine)

RARE

Mouth ulcers
Rash
Alopecia
Dizziness and headache.

DRUG INTERACTIONS

No known drug interactions. Potential for drug interactions with substrates, inhibitors and inducers at CYP2C19.
Rifampin may decrease proguanil serum concentrations.
LPV/r may decrease the formation of active metabolite cycloguanil. Monitor for anti-malarial efficacy with co-administration.
Etravirine may increase proguanil serum concentrations.

SPECTRUM

P. falciparum and P. vivax
P. ovaleP. malariae (limited data)

PHARMACOLOGY

Pharmacology

COMMENTS

In combination with atovaquone, proguanil offers well-tolerated alternative to mefloquine for treatment and prevention of chloroquine-resistant P. falciparum malaria. Disadvantages include a higher price and need for daily administration.

REFERENCES

REFERENCED WITHIN THIS GUIDE

Pyrimethamine

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