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Anti-Malarials / Anti-protozoals / Amebicides

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Atovaquone (Mepron ®) Chloroquine (Aralen ®)
Iodoquinol (Yodoxin ®) Mefloquine (Lariam ®)
Primaquine Pyrimethamine (Daraprim ®)
Pyrimethamine-Sulfadoxine(Fansidar®) Quinine Sulfate
Infectious Disease -ALL Agents (INDEX)  

Atovaquone (Mepron ®) top of page

Antiprotozoal.
Dosing (Adults): 
Prevention of PCP
: Oral: 1500 mg once daily with food.
Treatment of mild-to-moderate PCP: Oral: 750 mg twice daily with food for 21 days.

Supplied: Oral Suspension: 750 mg/5 ml.

Chloroquine  (Aralen ®) top of page

Antimalarial.

Dosing (Adults):
Malaria, suppression or prophylaxis: Oral: 500 mg/week (300 mg base) on the same day each week; begin 1-2 weeks prior to exposure; continue for 4-6 weeks after leaving endemic area; if suppressive therapy is not begun prior to exposure, double the initial loading dose to 1 g (600 mg base) and administer in 2 divided doses 6 hours apart, followed by the usual dosage regimen.
Malaria, acute attack: Oral: 1 g (600 mg base) on day 1, followed by 500 mg (300 mg base) 6 hours later, followed by 500 mg (300 mg base) on days 2 and 3.

Extraintestinal amebiasis: Oral: 1 g/day (600 mg base) for 2 days followed by 500 mg/day (300 mg base) for at least 2-3 weeks.

Rheumatoid arthritis, lupus erythematosus (unlabeled uses): Oral: 250 mg (150 mg base) once daily; reduce dosage following maximal response (taper to discontinue after response in lupus); generally requires 3-6 weeks. Note: Not considered first-line agent.

Renal Dosing: Clcr <10 mL/min: Administer 50% of dose.

Supplied: Tablet: 250 mg [equivalent to 150 mg base];
500 mg [equivalent to 300 mg base]

Iodoquinol  (Yodoxin ®) top of page

Amebicide.
Dosing (Adults): Treatment of susceptible infections: Oral: 650 mg 3 times/day after meals for 20 days; not to exceed 2 g/day

Supplied: 210 mg, 650 mg tablet.

Mefloquine  (Lariam ®) top of page

Antimalarial.
Dosing (Adults): Dose expressed as mg of mefloquine HCL:
Malaria treatment (mild to moderate infection): Oral: 5 tablets (1250 mg) as a single dose. Take with food and at least 8 oz of water. If clinical improvement is not seen within 48-72 hours, an alternative therapy should be used for retreatment.

Malaria prophylaxis: Oral: 1 tablet (250 mg) weekly starting 1 week before, arrival in endemic area, continuing weekly during travel and for 4 weeks after leaving endemic area. Take with food and at least 8 oz of water.

Supplied: Tablet, as hydrochloride: 250 mg [equivalent to 228 mg base]

Primaquine top of page

Antimalarial.
Take with meals to decrease adverse GI effects. Drug has a bitter taste.
Dosing (Adults): Dosage expressed as mg of base (15 mg base = 26.3 mg primaquine phosphate).

Treatment of malaria: To decrease risk of delayed primary attacks and prevent relapse: Oral: 15 mg/day (base) once daily for 14 days or 45 mg base once weekly for 8 weeks. CDC treatment recommendations: Begin therapy during last 2 weeks of, or following a course of, suppression with chloroquine or a comparable drug. Note: A second course (30 mg/day) for 14 days may be required in patients with relapse. Higher initial doses (30 mg/day) have also been used following exposure in S.E. Asia or Somalia.

Prevention of malaria (unlabeled use): Initiate prior to travel and continue for 7 days after departure from malaria-endemic area: Oral: 30 mg once daily.

Pneumonia due to Pneumocystis carinii (unlabeled use): Oral: 30 mg once daily for 21 days (in conjunction with clindamycin)

Supplied: Tablet, as phosphate: 26.3 mg [15 mg base]

Pyrimethamine (Daraprim ®) top of page

Antimalarial.
Dosing (Adults):
Malaria chemoprophylaxis (for areas of chloroquine-resistant P. falciparum): Oral: Begin prophylaxis 2 weeks before entering endemic area: 25 mg once weekly. Dosage should be continued for all age groups for at least 6-10 weeks after leaving endemic areas.
Chloroquine-resistant P. falciparummalaria (when used in conjunction with quinine and sulfadiazine): Oral: 25 mg twice daily for 3 days.

Toxoplasmosis: Oral: 50-75 mg/day together with 1-4 g of a sulfonamide for 1-3 weeks depending on patient's tolerance and response, then reduce dose by 50% and continue for 4-5 weeks or 25-50 mg/day for 3-4 weeks.
Prophylaxis for first episode of Toxoplasma gondii: Oral: 50 mg once weekly with dapsone, plus oral folinic acid 25 mg once weekly.
Prophylaxis to prevent recurrence of Toxoplasma gondii: Oral: 25-50 mg once daily in combination with sulfadiazine or clindamycin, plus oral folinic acid 10-25 mg daily. Atovaquone plus oral folinic acid 10 mg daily has also been used in combination with pyrimethamine.

Supplied: 25 mg tablet.

Pyrimethamine -Sulfadoxine  (Fansidar ®) top of page

Antimalarial.

Dosing (Adults): Treatment of acute malaria attacks: Oral: A single dose of the following number of Fansidar® tablets is used in sequence with quinine or alone: 3 tablets

Malaria prophylaxis: A single dose should be carried for self-treatment in the event of febrile illness when medical attention is not immediately available: Oral: 3 tablets

Supplied: Tablet: Sulfadoxine 500 mg and pyrimethamine 25 mg

Quinine Sulfate top of page

Antimalarial.
Dosing (Adults): Treatment of chloroquine-resistant malaria: Oral: 650 mg every 8 hours for 3-7 days with tetracycline.
Suppression of malaria: Oral: 325 mg twice daily and continued for 6 weeks after exposure.
Babesiosis: Oral: 650 mg every 6-8 hours for 7 days.

Leg cramps: Oral: 200-300 mg at bedtime.
Leg Cramps: The mechanism by which quinine sulfate decreases the incidence of leg cramps remains obscure. It appears to reduce the excitability of the motor end plate, thereby reducing muscle contractility.

Other medications — The following medications have also been used for nocturnal leg cramps with variable success:

1) Diphenhydramine (Benadryl) 12.5 to 50 mg nightly
2) Muscle relaxant: E.G. Cyclobenzeprine 10mg qhs
3) Verapamil, 120 mg at bedtime
4) Chloroquine phosphate (250 mg daily for two to three weeks, followed by 250 to 500 mg once per week.
5) Also used hydroxychloroquine sulfate (200 mg daily for two weeks, then once per week) with good results.
6) Gabapentin (600 mg daily with increased dosage as necessary).
[Source: UpToDate.]


Renal Dosing: Clcr 10-50 mL/minute: Administer every 8-12 hours or 75% of normal dose. Clcr <10 mL/minute: Administer every 24 hours or 30% to 50% of normal dose. Not removed by hemo- or peritoneal dialysis; dose for Clcr <10 mL/minute.

Supplied: Capsule, as sulfate: 200 mg, 325 mg.
Tablet, as sulfate: 260 mg

Reference(s)

National Institutes of Health, U.S. National Library of Medicine, DailyMed Database.
Provides access to the latest drug monographs submitted to the Food and Drug Administration (FDA). Please review the latest applicable package insert for additional information and possible updates.  A local search option of this data can be found here.

Disclaimer

Listed dosages are for - Adult patients ONLY. PLEASE READ THE DISCLAIMER CAREFULLY BEFORE ACCESSING OR USING THIS SITE. BY ACCESSING OR USING THIS SITE, YOU AGREE TO BE BOUND BY THE TERMS AND CONDITIONS SET FORTH IN THE DISCLAIMER. GlobalRPH does not directly or indirectly practice medicine or provide medical services and therefore assumes no liability whatsoever of any kind for the information and data accessed through the Service or for any diagnosis or treatment made in reliance thereon.

David F. McAuley, Pharm.D., R.Ph.  GlobalRPh Inc.
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