ATOVAQUONE AND PROGUANIL HYDROCHLORIDE- atovaquone and proguanil hydrochloride tablet, film coated

United States - English - NLM (National Library of Medicine)

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Active ingredient:
ATOVAQUONE (UNII: Y883P1Z2LT) (ATOVAQUONE - UNII:Y883P1Z2LT), PROGUANIL HYDROCHLORIDE (UNII: R71Y86M0WT) (PROGUANIL - UNII:S61K3P7B2V)
Available from:
Aidarex Pharmaceuticals LLC
INN (International Name):
ATOVAQUONE
Composition:
ATOVAQUONE 250 mg
Administration route:
ORAL
Prescription type:
PRESCRIPTION DRUG
Therapeutic indications:
Atovaquone and proguanil hydrochloride tablets are indicated for the prophylaxis of P. falciparum malaria, including in areas where chloroquine resistance has been reported (see CLINICAL STUDIES ). Atovaquone and proguanil hydrochloride tablets are indicated for the treatment of acute, uncomplicated P. falciparum malaria. Atovaquone and proguanil hydrochloride tablets have been shown to be effective in regions where the drugs chloroquine, halofantrine, mefloquine, and amodiaquine may have unacceptable failure rates, presumably due to drug resistance. Atovaquone and proguanil hydrochloride is contraindicated in individuals with known hypersensitivity to atovaquone or proguanil hydrochloride or any component of the formulation. Rare cases of anaphylaxis following treatment with atovaquone/proguanil have been reported. Atovaquone and proguanil hydrochloride is contraindicated for prophylaxis of P. falciparum malaria in patients with severe renal impairment (creatinine clearance <30 mL/min) (see CLINICAL PHARM
Product summary:
Atovaquone and proguanil hydrochloride tablets, containing 250 mg atovaquone and 100 mg proguanil hydrochloride, are pinkish brown to brown colored, circular, biconvex beveled edge, film-coated tablets with ‘404’ debossed on one side and ‘G’ debossed on the other side. Atovaquone and proguanil hydrochloride tablets 250 mg/100 mg NDC 33261-900-01 unit dose pack of 24
Authorization status:
Abbreviated New Drug Application
Authorization number:
33261-900-01

ATOVAQUONE AND PROGUANIL HYDROCHLORIDE- atovaquone and proguanil

hydrochloride tablet, film coated

Aidarex Pharmaceuticals LLC

----------

Atovaquone and Proguanil Hydrochloride Tablets

Rx only

DESCRIPTION

Atovaquone and proguanil hydrochloride is a fixed-dose combination of the antimalarial agents

atovaquone and proguanil hydrochloride. The chemical name of atovaquone is trans-2-[4-(4-

chlorophenyl)cyclohexyl]-3-hydroxy-1,4-naphthalenedione. Atovaquone is a yellow crystalline solid

that is practically insoluble in water. It has a molecular weight of 366.84 and the molecular formula

H ClO . The compound has the following structural formula:

The chemical name of proguanil hydrochloride USP is 1-(4-chlorophenyl)-5-isopropyl-biguanide

hydrochloride. Proguanil hydrochloride USP is a white crystalline solid that is sparingly soluble in

water. It has a molecular weight of 290.22 and the molecular formula C

H ClN HCl. The compound

has the following structural formula:

Atovaquone and proguanil hydrochloride tablets are for oral administration. Each atovaquone and

proguanil hydrochloride tablet contains 250 mg of atovaquone and 100 mg of proguanil hydrochloride

USP. The inactive ingredients in the tablet are colloidal silicon dioxide, ferric oxide red, hypromellose

2910, low substituted hydroxypropyl cellulose, magnesium stearate, microcrystalline cellulose,

poloxamer 188, povidone K30, polyethylene glycol 400, polyethylene glycol 8000, sodium starch

glycolate, titanium dioxide.

glycolate, titanium dioxide.

CLINICAL PHARMACOLOGY

Microbiology:

Mechanism of Action:

The constituents of atovaquone and proguanil hydrochloride interfere with 2 different pathways

involved in the biosynthesis of pyrimidines required for nucleic acid replication. Atovaquone is a

selective inhibitor of parasite mitochondrial electron transport. Proguanil hydrochloride primarily

exerts its effect by means of the metabolite cycloguanil, a dihydrofolate reductase inhibitor. Inhibition

of dihydrofolate reductase in the malaria parasite disrupts deoxythymidylate synthesis.

Activity In Vitro and In Vivo:

Atovaquone and cycloguanil (an active metabolite of proguanil) are active against the erythrocytic and

exoerythrocytic stages of Plasmodium spp. Enhanced efficacy of the combination compared to either

atovaquone or proguanil hydrochloride alone was demonstrated in clinical studies in both immune and

non-immune patients (see CLINICAL STUDIES).

Drug Resistance:

Strains of P. falciparum with decreased susceptibility to atovaquone or proguanil/cycloguanil alone can

be selected in vitro or in vivo. The combination of atovaquone and proguanil hydrochloride may not be

effective for treatment of recrudescent malaria that develops after prior therapy with the combination.

Pharmacokinetics :

Absorption:

Atovaquone is a highly lipophilic compound with low aqueous solubility. The bioavailability of

atovaquone shows considerable inter-individual variability.

Dietary fat taken with atovaquone increases the rate and extent of absorption, increasing AUC 2 to 3

times and Cmax 5 times over fasting. The absolute bioavailability of the tablet formulation of

atovaquone when taken with food is 23%. Atovaquone and proguanil hydrochloride tablets should be

taken with food or a milky drink.

Proguanil hydrochloride is extensively absorbed regardless of food intake.

Distribution:

Atovaquone is highly protein bound (>99%) over the concentration range of 1 to 90 mcg/mL. A

population pharmacokinetic analysis demonstrated that the apparent volume of distribution of atovaquone

(V/F) in adult and pediatric patients after oral administration is approximately 8.8 L/kg.

Proguanil is 75% protein bound. A population pharmacokinetic analysis demonstrated that the apparent

V/F of proguanil in adult and pediatric patients >15 years of age with body weights from 31 to 110 kg

ranged from 1,617 to 2,502 L. In pediatric patients’ ≤15 years of age with body weights from 11 to 56

kg, the V/F of proguanil ranged from 462 to 966 L.

In human plasma, the binding of atovaquone and proguanil was unaffected by the presence of the other.

Metabolism:

In a study where

C-labeled atovaquone was administered to healthy volunteers, greater than 94% of

the dose was recovered as unchanged atovaquone in the feces over 21 days. There was little or no

excretion of atovaquone in the urine (less than 0.6%). There is indirect evidence that atovaquone may

undergo limited metabolism; however, a specific metabolite has not been identified. Between 40% to

60% of proguanil is excreted by the kidneys. Proguanil is metabolized to cycloguanil (primarily via

CYP2C19) and 4-chlorophenylbiguanide. The main routes of elimination are hepatic biotransformation

and renal excretion.

Elimination:

The elimination half-life of atovaquone is about 2 to 3 days in adult patients.The elimination half-life of

proguanil is 12 to 21 hours in both adult patients and pediatric patients, but may be longer in individuals

who are slow metabolizers.

A population pharmacokinetic analysis in adult and pediatric patients showed that the apparent clearance

(CL/F) of both atovaquone and proguanil are related to the body weight. The values CL/F for both

atovaquone and proguanil in subjects with body weight ≥11 kg are shown in Table 1.

Table 1. Apparent Clearance for Atovaquone and Proguanil in Patients as a

Function of Body Weight

Body Weight

Atovaquone

Proguanil

CL/F (L/hr) Mean ± SD* (range)

CL/F (L/hr) Mean ± SD (range)

11-20 Kg

1.34 ± 0.63 (0.52-4.26)

29.5 ± 6.5 (10.3-48.3)

21-30 Kg

1.87 ± 0.81 (0.52-5.38)

40.0 ± 7.5 (15.9-62.7)

31-40 Kg

2.76 ± 2.07 (0.97-12.5)

49.5 ± 8.30 (25.8-71.5)

> 40 Kg

6.61 ± 3.92 (1.32-20.3)

67.9 ± 19.9 (14.0 - 145)

The pharmacokinetics of atovaquone and proguanil in patients with body weight below 11 kg have not

been adequately characterized.

Special Populations:

Pediatrics:

The pharmacokinetics of proguanil and cycloguanil are similar in adult patients and pediatric patients.

However, the elimination half-life of atovaquone is shorter in pediatric patients (1 to 2 days) than in

adult patients (2 to 3 days). In clinical trials, plasma trough levels of atovaquone and proguanil in

pediatric patients weighing 5 to 40 kg were within the range observed in adults after dosing by body

weight.

Geriatrics:

In a single-dose study, the pharmacokinetics of atovaquone, proguanil, and cycloguanil were compared

in 13 elderly subjects (age 65 to 79 years) to 13 younger subjects (age 30 to 45 years). In the elderly

subjects, the extent of systemic exposure (AUC) of cycloguanil was increased (point estimate = 2.36, CI

= 1.70, 3.28). T

was longer in elderly subjects (median 8 hours) compared with younger subjects

(median 4 hours) and average elimination half-life was longer in elderly subjects (mean 14.9 hours)

compared with younger subjects (mean 8.3 hours).

Hepatic Impairment:

In a single-dose study, the pharmacokinetics of atovaquone, proguanil, and cycloguanil were compared

SD = standard deviation.

in 13 subjects with hepatic impairment (9 mild, 4 moderate, as indicated by the Child-Pugh method) to 13

subjects with normal hepatic function. In subjects with mild or moderate hepatic impairment as compared

to healthy subjects, there were no marked differences (<50%) in the rate or extent of systemic exposure

of atovaquone. However, in subjects with moderate hepatic impairment, the elimination half-life of

atovaquone was increased (point estimate = 1.28, 90% CI = 1.00 to 1.63). Proguanil AUC, C

, and its

increased in subjects with mild hepatic impairment when compared to healthy subjects (Table 2).

Also, the proguanil AUC and its t

increased in subjects with moderate hepatic impairment when

compared to healthy subjects. Consistent with the increase in proguanil AUC, there were marked

decreases in the systemic exposure of cycloguanil (C

and AUC) and an increase in its elimination

half-life in subjects with mild hepatic impairment when compared to healthy volunteers (Table 2). There

were few measurable cycloguanil concentrations in subjects with moderate hepatic impairment (see

DOSAGE AND ADMINISTRATION). The pharmacokinetics of atovaquone, proguanil, and

cycloguanil after administration of a tovaquone and proguanil hydrochloride have not been studied in

patients with severe hepatic impairment.

Table 2. Point Estimates (90% CI) for Proguanil and

Cycloguanil Parameters in Subjects With Mild and Moderate

Hepatic Impairment Compared to Healthy Volunteers

ND = not determined due to lack of quantifiable data.

Parameter

Comparison

Proguanil

Cycloguanil

mild : healthy

1.96 (1.51, 2.54)

0.32 (0.22, 0.45)

mild : healthy

1.41 (1.16, 1.71)

0.35 (0.24, 0.50)

T 1/2

mild : healthy

1.21 (0.92, 1.60)

0.86 (0.49, 1.48)

moderate : healthy

1.64 (1.14, 2.34)

moderate : healthy

0.97 (0.69, 1.36)

T 1/2

moderate : healthy

1.46 (1.05, 2.05)

Renal Impairment:

In patients with mild renal impairment (creatinine clearance 50 to 80 mL/min), oral clearance and/or AUC

data for atovaquone, proguanil, and cycloguanil are within the range of values observed in patients with

normal renal function (creatinine clearance >80 mL/min). In patients with moderate renal impairment

(creatinine clearance 30 to 50 mL/min), mean oral clearance for proguanil was reduced by

approximately 35% compared with patients with normal renal function (creatinine clearance >80 mL/min)

and the oral clearance of atovaquone was comparable between patients with normal renal function and

mild renal impairment. No data exist on the use of atovaquone and proguanil hydrochloride for long-

term prophylaxis (over 2 months) in individuals with moderate renal failure. In patients with severe renal

impairment (creatinine clearance <30 mL/min), atovaquone C

and AUC are reduced but the

elimination half-lives for proguanil and cycloguanil are prolonged, with corresponding increases in

AUC, resulting in the potential of drug accumulation and toxicity with repeated dosing (see

CONTRAINDICATIONS).

Drug Interactions:

Ratio of geometric means.

Mean difference.

(0-inf)

(0-inf)

Drug Interactions:

There are no pharmacokinetic interactions between atovaquone and proguanil at the recommended dose.

Concomitant treatment with tetracycline has been associated with approximately a 40% reduction in

plasma concentrations of atovaquone.

Concomitant treatment with metoclopramide has also been associated with decreased bioavailability of

atovaquone.

Concomitant administration of rifampin or rifabutin is known to reduce atovaquone levels by

approximately 50% and 34%, respectively (see PRECAUTIONS: Drug Interactions). The

mechanisms of these interactions are unknown.

Concomitant administration of atovaquone (750 mg BID with food for 14 days) and indinavir (800 mg

TID without food for 14 days) did not result in any change in the steady-state AUC and C

indinavir but resulted in a decrease in the C

of indinavir (23% decrease [90% CI 8%, 35%]).

Caution should be exercised when prescribing atovaquone with indinavir due to the decrease in trough

levels of indinavir.

Atovaquone is highly protein bound (>99%) but does not displace other highly protein-bound drugs in

vitro, indicating significant drug interactions arising from displacement are unlikely (see

PRECAUTIONS: Drug Interactions). Proguanil is metabolized primarily by CYP2C19. Potential

pharmacokinetic interactions with other substrates or inhibitors of this pathway are unknown.

INDICATIONS AND USAGE

Prevention of Malaria:

Atovaquone and proguanil hydrochloride tablets are indicated for the prophylaxis of P. falciparum

malaria, including in areas where chloroquine resistance has been reported (see CLINICAL

STUDIES).

Treatment of Malaria:

Atovaquone and proguanil hydrochloride tablets are indicated for the treatment of acute, uncomplicated

P. falciparum malaria. Atovaquone and proguanil hydrochloride tablets have been shown to be effective

in regions where the drugs chloroquine, halofantrine, mefloquine, and amodiaquine may have

unacceptable failure rates, presumably due to drug resistance.

CONTRAINDICATIONS

Atovaquone and proguanil hydrochloride is contraindicated in individuals with known hypersensitivity

to atovaquone or proguanil hydrochloride or any component of the formulation. Rare cases of

anaphylaxis following treatment with atovaquone/proguanil have been reported.

Atovaquone and proguanil hydrochloride is contraindicated for prophylaxis of P. falciparum malaria in

patients with severe renal impairment (creatinine clearance <30 mL/min) (see CLINICAL

PHARMACOLOGY: Special Populations: Renal Impairment).

PRECAUTIONS

General:

Atovaquone and proguanil hydrochloride has not been evaluated for the treatment of cerebral malaria or

other severe manifestations of complicated malaria, including hyperparasitemia, pulmonary edema, or

renal failure. Patients with severe malaria are not candidates for oral therapy.

Elevated liver function tests and rare cases of hepatitis have been reported with prophylactic use of

trough

atovaquone and proguanil hydrochloride. A single case of hepatic failure requiring liver transplantation

has also been reported with prophylactic use.

Absorption of atovaquone may be reduced in patients with diarrhea or vomiting. If atovaquone and

proguanil hydrochloride is used in patients who are vomiting (see DOSAGE AND

ADMINISTRATION), parasitemia should be closely monitored and the use of an antiemetic

considered. Vomiting occurred in up to 19% of pediatric patients given treatment doses of atovaquone

and proguanil hydrochloride. In the controlled clinical trials of atovaquone and proguanil

hydrochloride, 15.3% of adults who were treated with atovaquone/proguanil received an antiemetic

drug during that part of the trial when they received atovaquone/proguanil. Of these patients, 98.3%

were successfully treated. In patients with severe or persistent diarrhea or vomiting, alternative

antimalarial therapy may be required.

Parasite relapse occurred commonly when P. vivax malaria was treated with atovaquone and proguanil

hydrochloride alone.

In the event of recrudescent P. falciparum infections after treatment with atovaquone and proguanil

hydrochloride or failure of chemoprophylaxis with atovaquone and proguanil hydrochloride, patients

should be treated with a different blood schizonticide.

Information for Patients:

Patients should be instructed:

to take atovaquone and proguanil hydrochloride tablets at the same time each day with food or a

milky drink.

to take a repeat dose of atovaquone and proguanil hydrochloride if vomiting occurs within 1 hour

after dosing.

to take a dose as soon as possible if a dose is missed, then return to their normal dosing schedule.

However, if a dose is skipped, the patient should not double the next dose.

that rare serious adverse events such as hepatitis, severe skin reactions, neurological, and

hematological events have been reported when atovaquone and proguanil hydrochloride was used

for the prophylaxis or treatment of malaria.

to consult a healthcare professional regarding alternative forms of prophylaxis if prophylaxis with

atovaquone and proguanil hydrochloride is prematurely discontinued for any reason.

that protective clothing, insect repellants, and bednets are important components of malaria

prophylaxis.

that no chemoprophylactic regimen is 100% effective; therefore, patients should seek medical

attention for any febrile illness that occurs during or after return from a malaria-endemic area and

inform their healthcare professional that they may have been exposed to malaria.

that falciparum malaria carries a higher risk of death and serious complications in pregnant women

than in the general population. Pregnant women anticipating travel to malarious areas should discuss

the risks and benefits of such travel with their physicians (see Pregnancy section).

Drug Interactions:

Concomitant treatment with tetracycline has been associated with approximately a 40% reduction in

plasma concentrations of atovaquone. Parasitemia should be closely monitored in patients receiving

tetracycline. While antiemetics may be indicated for patients receiving atovaquone and proguanil

hydrochloride, metoclopramide may reduce the bioavailability of atovaquone and should be used only

if other antiemetics are not available.

Concomitant administration of rifampin or rifabutin is known to reduce atovaquone levels by

approximately 50% and 34%, respectively. The concomitant administration of atovaquone and proguanil

hydrochloride and rifampin or rifabutin is not recommended.

Proguanil may potentiate the anticoagulant effect of warfarin and other coumarin-based anticoagulants.

The mechanism of this potential drug interaction has not been established. Caution is advised when

The mechanism of this potential drug interaction has not been established. Caution is advised when

initiating or withdrawing malaria prophylaxis or treatment with atovaquone and proguanil hydrochloride

in patients on continuous treatment with coumarin-based anticoagulants. When these products are

administered concomitantly, suitable coagulation tests should be closely monitored.

Atovaquone is highly protein bound (>99%) but does not displace other highly protein-bound drugs in

vitro, indicating significant drug interactions arising from displacement are unlikely.

Potential interactions between proguanil or cycloguanil and other drugs that are CYP2C19 substrates or

inhibitors are unknown.

Carcinogenesis, Mutagenesis, Impairment of Fertility:

Atovaquone:

Carcinogenicity studies in rats were negative; 24-month studies in mice showed treatment-related

increases in incidence of hepatocellular adenoma and hepatocellular carcinoma at all doses tested

which ranged from approximately 5 to 8 times the average steady-state plasma concentrations in humans

during prophylaxis of malaria. Atovaquone was negative with or without metabolic activation in the

Ames Salmonella mutagenicity assay, the Mouse Lymphoma mutagenesis assay, and the Cultured Human

Lymphocyte cytogenetic assay. No evidence of genotoxicity was observed in the in vivo Mouse

Micronucleus assay.

Proguanil:

No evidence of a carcinogenic effect was observed in 24-month studies conducted in CD-1 mice

(doses up to 1.5 times the average systemic human exposure based on AUC) and in Wistar Hannover rats

(doses up to 1.1 times the average systemic human exposure).

Proguanil was negative with or without metabolic activation in the Ames Salmonella mutagenicity assay

and the Mouse Lymphoma mutagenesis assay. No evidence of genotoxicity was observed in the in vivo

Mouse Micronucleus assay.

Cycloguanil, the active metabolite of proguanil, was also negative in the Ames test, but was positive in

the Mouse Lymphoma assay and the Mouse Micronucleus assay. These positive effects with

cycloguanil, a dihydrofolate reductase inhibitor, were significantly reduced or abolished with folinic

acid supplementation.

A fertility study in Sprague-Dawley rats revealed no adverse effects at doses up to 16 mg/kg/day of

proguanil hydrochloride (up to 0.2-times the average human exposure based on AUC comparisons.)

Fertility studies of proguanil in animals at exposures similar to or greater than those observed in humans

have not been conducted.

Genotoxicity studies have not been performed with atovaquone in combination with proguanil. Effects

of atovaquone and proguanil hydrochloride on male and female reproductive performance are unknown.

Pregnancy:

Pregnancy Category C. Falciparum malaria carries a higher risk of morbidity and mortality in pregnant

women than in the general population. Maternal death and fetal loss are both known complications of

falciparum malaria in pregnancy. In pregnant women who must travel to malaria-endemic areas, personal

protection against mosquito bites should always be employed (see Information for Patients) in addition

to antimalarials.

Atovaquone was not teratogenic and did not cause reproductive toxicity in rats at maternal plasma

concentrations up to 5 to 6.5 times the estimated human exposure during treatment of malaria. Following

single-dose administration of

C-labeled atovaquone to pregnant rats, concentrations of radiolabel in

rat fetuses were 18% (mid-gestation) and 60% (late gestation) of concurrent maternal plasma

concentrations. In rabbits, atovaquone caused maternal toxicity at plasma concentrations that were

approximately 0.6 to 1.3 times the estimated human exposure during treatment of malaria. Adverse fetal

effects in rabbits, including decreased fetal body lengths and increased early resorptions and post-

implantation losses, were observed only in the presence of maternal toxicity. Concentrations of

atovaquone in rabbit fetuses averaged 30% of the concurrent maternal plasma concentrations.

A pre- and post-natal study in Sprague-Dawley rats revealed no adverse effects at doses up to 16

mg/kg/day of proguanil hydrochloride (up to 0.2-times the average human exposure based on AUC

comparisons.) Pre- and post-natal studies of proguanil in animals at exposures similar to or greater than

those observed in humans have not been conducted.

The combination of atovaquone and proguanil hydrochloride was not teratogenic in rats at plasma

concentrations up to 1.7 and 0.10 times, respectively, the estimated human exposure during treatment of

malaria. In rabbits, the combination of atovaquone and proguanil hydrochloride was not teratogenic or

embryotoxic to rabbit fetuses at plasma concentrations up to 0.34 and 0.82 times, respectively, the

estimated human exposure during treatment of malaria.

While there are no adequate and well-controlled studies of atovaquone and/or proguanil hydrochloride

in pregnant women, atovaquone and proguanil hydrochloride may be used if the potential benefit

justifies the potential risk to the fetus. The proguanil component of atovaquone and proguanil

hydrochloride acts by inhibiting the parasitic dihydrofolate reductase (see CLINICAL

PHARMACOLOGY: Microbiology: Mechanism of Action). However, there are no clinical data

indicating that folate supplementation diminishes drug efficacy, and for women of childbearing age

receiving folate supplements to prevent neural tube birth defects, such supplements may be continued

while taking atovaquone and proguanil hydrochloride.

Nursing Mothers:

It is not known whether atovaquone is excreted into human milk. In a rat study, atovaquone concentrations

in the milk were 30% of the concurrent atovaquone concentrations in the maternal plasma.

Proguanil is excreted into human milk in small quantities.

Caution should be exercised when atovaquone and proguanil hydrochloride is administered to a nursing

mother.

Pediatric Use:

Treatment of Malaria:

The efficacy and safety of atovaquone and proguanil hydrochloride for the treatment of malaria have

been established in controlled studies involving pediatric patients weighing 5 kg or more (see

CLINICAL STUDIES). Safety and effectiveness have not been established in pediatric patients who

weigh less than 5 kg.

Prophylaxis of Malaria:

The efficacy and safety of atovaquone and proguanil hydrochloride have been established for the

prophylaxis of malaria in controlled studies involving pediatric patients weighing 11 kg or more (see

CLINICAL STUDIES). Safety and effectiveness have not been established in pediatric patients who

weigh less than 11 kg.

Geriatric Use:

Clinical studies of atovaquone and proguanil hydrochloride did not include sufficient numbers of

subjects aged 65 and over to determine whether they respond differently from younger subjects. In

general, dose selection for an elderly patient should be cautious, reflecting the greater frequency of

decreased hepatic, renal, or cardiac function, the higher systemic exposure to cycloguanil (see

CLINICAL PHARMACOLOGY: Special Populations: Geriatrics), and the greater frequency of

concomitant disease or other drug therapy.

ADVERSE REACTIONS

Because atovaquone and proguanil hydrochloride contains atovaquone and proguanil hydrochloride, the

type and severity of adverse reactions associated with each of the compounds may be expected. The

higher treatment doses of atovaquone and proguanil hydrochloride were less well tolerated than the

lower prophylactic doses.

Among adults who received atovaquone and proguanil hydrochloride for treatment of malaria,

attributable adverse experiences that occurred in ≥5% of patients were abdominal pain (17%), nausea

(12%), vomiting (12%), headache (10%), diarrhea (8%), asthenia (8%), anorexia (5%), and dizziness

(5%). Treatment was discontinued prematurely due to an adverse experience in 4 of 436 adults treated

with atovaquone and proguanil hydrochloride.

Among pediatric patients (weighing 11 to 40 kg) who received atovaquone and proguanil hydrochloride

for the treatment of malaria, attributable adverse experiences that occurred in ≥5% of patients were

vomiting (10%) and pruritus (6%). Vomiting occurred in 43 of 319 (13%) pediatric patients who did not

have symptomatic malaria but were given treatment doses of atovaquone and proguanil hydrochloride

for 3 days in a clinical trial. The design of this clinical trial required that any patient who vomited be

withdrawn from the trial. Among pediatric patients with symptomatic malaria treated with atovaquone and

proguanil hydrochloride, treatment was discontinued prematurely due to an adverse experience in 1 of

116 (0.9%).

In a study of 100 pediatric patients (5 to <11 kg body weight) who received atovaquone and proguanil

hydrochloride for the treatment of uncomplicated P. falciparum malaria, only diarrhea (6%) occurred in

≥5% of patients as an adverse experience attributable to atovaquone and proguanil hydrochloride. In 3

patients (3%), treatment was discontinued prematurely due to an adverse experience.

Abnormalities in laboratory tests reported in clinical trials were limited to elevations of transaminases

in malaria patients being treated with atovaquone and proguanil hydrochloride. The frequency of these

abnormalities varied substantially across studies of treatment and were not observed in the randomized

portions of the prophylaxis trials.

In one phase III trial of malaria treatment in Thai adults, early elevations of ALT and AST were

observed to occur more frequently in patients treated with atovaquone and proguanil hydrochloride

compared to patients treated with an active control drug. Rates for patients who had normal baseline

levels of these clinical laboratory parameters were: Day 7: ALT 26.7% vs. 15.6%; AST 16.9% vs.

8.6%. By day 14 of this 28-day study, the frequency of transaminase elevations equalized across the 2

groups.

In this and other studies in which transaminase elevations occurred, they were noted to persist for up to

4 weeks following treatment with atovaquone and proguanil hydrochloride for malaria. None were

associated with untoward clinical events.

Among subjects who received atovaquone and proguanil hydrochloride for prophylaxis of malaria in

placebo-controlled trials, adverse experiences occurred in similar proportions of subjects receiving

atovaquone and proguanil hydrochloride or placebo (Table 3). The most commonly reported adverse

experiences possibly attributable to atovaquone and proguanil hydrochloride or placebo were headache

and abdominal pain. Prophylaxis with atovaquone and proguanil hydrochloride was discontinued

prematurely due to a treatment-related adverse experience in 3 of 381 adults and 0 of 125 pediatric

patients.

Table 3. Adverse Experiences in Placebo-Controlled Clinical Trials of Atovaquone and Proguanil

hydrochloride for Prophylaxis of Malaria

Percent of Subjects With Adverse Experiences (Percent of Subjects With Adverse

Experiences Attributable to Therapy)

Adverse

Experience

Adults

Children and Adolescents

Placebo

n=206

Atovaquone and

Proguanil

hydrochloride

n=206

Atovaquone and

Proguanil

hydrochloride

n=381

Placebo

n=140

Atovaquone and

Proguanil

hydrochloride n=125

Headache

27 (7)

22 (3)

17 (5)

21 (14)

19 (14)

Fever

13 (1)

5 (0)

3 (0)

11 (<1)

6 (0)

Myalgia

11 (0)

12 (0)

7 (0)

0 (0)

0 (0)

Abdominal

pain

10 (5)

9 (4)

6 (3)

29 (29)

33 (31)

Cough

8 (<1)

6 (<1)

4 (1)

9 (0)

9 (0)

Diarrhea

8 (3)

6 (2)

4 (1)

3 (1)

2 (0)

Upper

respiratory

infection

7 (0)

8 (0)

5 (0)

0 (0)

<1 (0)

Dyspepsia

5 (4)

3 (2)

2 (1)

0 (0)

0 (0)

Back pain

4 (0)

8 (0)

4 (0)

0 (0)

0 (0)

Gastritis

3 (2)

3 (3)

2 (2)

0 (0)

0 (0)

Vomiting

2 (<1)

1 (<1)

<1 (<1)

6 (6)

7 (7)

Flu syndrome

1 (0)

2 (0)

4 (0)

6 (0)

9 (0)

Any adverse

experience

65 (32)

54 (17)

49 (17)

62 (41)

60 (42)

In an additional placebo-controlled study of malaria prophylaxis with atovaquone and proguanil

hydrochloride involving 330 pediatric patients in a malaria-endemic area (see CLINICAL STUDIES),

the safety profile of atovaquone and proguanil hydrochloride was consistent with that described above.

The most common treatment-emergent adverse events with atovaquone and proguanil hydrochloride

were abdominal pain (13%), headache (13%), and cough (10%). Abdominal pain (13% vs. 8%) and

vomiting (5% vs. 3%) were reported more often with atovaquone and proguanil hydrochloride than with

placebo, while fever (5% vs. 12%) and diarrhea (1% vs. 5%) were more common with placebo. No

patient withdrew from the study due to an adverse experience with atovaquone and proguanil

hydrochloride. No routine laboratory data were obtained during this study.

Among subjects who received atovaquone and proguanil hydrochloride for prophylaxis of malaria in

Subjects receiving the recommended dose of atovaquone and proguanil hydrochloride in placbo-controlled trials.

Subjects receiving the recommended dose of atovaquone and proguanil hydrochloride in any trial.

clinical trials with an active comparator, adverse experiences occurred in a similar or lower proportion

of subjects receiving atovaquone and proguanil hydrochloride than an active comparator (Table 4). The

mean durations of dosing and the periods for which the adverse experiences are summarized in Table 4,

were 28 days (Study 1) and 26 days (Study 2) for atovaquone and proguanil hydrochloride, 53 days for

mefloquine, and 49 days for chloroquine plus proguanil (reflecting the different recommended dosing

regimens). Fewer neuropsychiatric adverse experiences occurred in subjects who received atovaquone

and proguanil hydrochloride than mefloquine. Fewer gastrointestinal adverse experiences occurred in

subjects receiving atovaquone and proguanil hydrochloride than chloroquine/proguanil. Compared with

active comparator drugs, subjects receiving atovaquone and proguanil hydrochloride had fewer adverse

experiences overall that were attributed to prophylactic therapy (Table 4). Prophylaxis with atovaquone

and proguanil hydrochloride was discontinued prematurely due to a treatment-related adverse

experience in 7 of 1,004 travelers.

Table 4. Adverse Experiences in Active-Controlled Clinical Trials of Atovaquone and Proguanil

hydrochloride for Prophylaxis of Malaria

Percent of Subjects With Adverse Experiences (Percent of Subjects With Adverse

Experiences Attributable to Therapy)

Study 1

Study 2

Adverse Experience

Atovaquone and

Proguanil

hydrochloride n=493

Mefloquine

n=483

Atovaquone and

Proguanil

hydrochloride n=511

Chloroquine Plus

Proguanil n=511

Diarrhea

38 (8)

36 (7)

34 (5)

39 (7)

Nausea

14 (3)

20 (8)

11 (2)

18 (7)

Abdominal pain

17 (5)

16 (5)

14 (3)

22 (6)

Headache

12 (4)

17 (7)

12 (4)

14 (4)

Dreams

7 (7)

16 (14)

6 (4)

7 (3)

Insomnia

5 (3)

16 (13)

4 (2)

5 (2)

Fever

9 (<1)

11 (1)

8 (<1)

8 (<1)

Dizziness

5 (2)

14 (9)

7 (3)

8 (4)

Vomiting

8 (1)

10 (2)

8 (0)

14 (2)

Oral ulcers

9 (6)

6 (4)

5 (4)

7 (5)

Pruritus

4 (2)

5 (2)

3 (1)

2 (<1)

Visual difficulties

2 (2)

5 (3)

3 (2)

3 (2)

Depression

<1 (<1)

5 (4)

<1 (<1)

1 (<1)

* Adverse experiences that started while receiving active study drug.

Anxiety

1 (<1)

5 (4)

<1 (<1)

1 (<1)

Any adverse

experience

64 (30)

69 (42)

58 (22)

66 (28)

neuropsychiatric

event

20 (14)

37 (29)

16 (10)

20 (10)

Any GI event

49 (16)

50 (19)

43 (12)

54 (20)

In a third active-controlled study, atovaquone and proguanil hydrochloride (n = 110) was compared with

chloroquine/proguanil (n = 111) for the prophylaxis of malaria in 221 non-immune pediatric patients (see

CLINICAL STUDIES). The mean duration of exposure was 23 days for atovaquone and proguanil

hydrochloride, 46 days for chloroquine, and 43 days for proguanil, reflecting the different

recommended dosage regimens for these products. Fewer patients treated with atovaquone and

proguanil hydrochloride reported abdominal pain (2% vs. 7%) or nausea (<1% vs. 7%) than children

who received chloroquine/proguanil. Oral ulceration (2% vs. 2%), vivid dreams (2% vs. <1%), and

blurred vision (0% vs. 2%) occurred in similar proportions of patients receiving either atovaquone and

proguanil hydrochloride or chloroquine/proguanil, respectively. Two patients discontinued

prophylaxis with chloroquine/proguanil due to adverse events, while none of those receiving

atovaquone and proguanil hydrochloride discontinued due to adverse events.

Post-Marketing Adverse Reactions:

In addition to adverse events reported from clinical trials, the following events have been identified

during world-wide post-approval use of atovaquone and proguanil hydrochloride. Because they are

reported voluntarily from a population of unknown size, estimates of frequency cannot be made. These

events have been chosen for inclusion due to a combination of their seriousness, frequency of

reporting, or potential causal connection to atovaquone and proguanil hydrochloride.

Blood and Lymphatic System Disorders: Neutropenia and rarely anemia. Pancytopenia in patients with

severe renal impairment treated with proguanil.

Immune System Disorders:Allergic reactions including angioedema, urticaria, and rare cases of

anaphylaxis and vasculitis.

Nervous System Disorders: Rare cases of seizures and psychotic events (such as hallucinations);

however, a causal relationship has not been established.

Gastrointestinal Disorders: Stomatitis.

Hepatobiliary Disorders: Elevated liver function tests and rare cases of hepatitis; a single case of

hepatitis, cholestatis; failure requiring transplant has been reported.

Skin and Subcutaneous Tissue Disorders: Photosensitivity, rash, and rare cases of erythema multiforme

and Stevens-Johnson syndrome.

OVERDOSAGE

There is no information on overdoses of atovaquone and proguanil hydrochloride substantially higher

than the doses recommended for treatment.

There is no known antidote for atovaquone, and it is currently unknown if atovaquone is dialyzable. The

median lethal dose is higher than the maximum oral dose tested in mice and rats (1,825 mg/kg/day).

Overdoses up to 31,500 mg of atovaquone have been reported. In one such patient who also took an

unspecified dose of dapsone, methemoglobinemia occurred. Rash has also been reported after

overdose.

Overdoses of proguanil hydrochloride as large as 1,500 mg have been followed by complete recovery,

and doses as high as 700 mg twice daily have been taken for over 2 weeks without serious toxicity.

Adverse experiences occasionally associated with proguanil hydrochloride doses of 100 to 200

mg/day, such as epigastria discomfort and vomiting would be likely to occur with overdose. There are

also reports of reversible hair loss and scaling of the skin on the palms and/or soles, reversible

aphthous ulceration, and hematologic side effects.

DOSAGE AND ADMINISTRATION

The daily dose should be taken at the same time each day with food or a milky drink. In the event of

vomiting within 1 hour after dosing, a repeat dose should be taken.

Prevention of Malaria:

Prophylactic treatment with atovaquone and proguanil hydrochloride should be started 1 or 2 days

before entering a malaria-endemic area and continued daily during the stay and for 7 days after return.

Adults:

One atovaquone and proguanil hydrochloride tablet (adult strength = 250 mg atovaquone/100 mg

proguanil hydrochloride) per day.

Treatment of Acute Malaria:

Adults:

Four Atovaquone and proguanil hydrochloride tablets (adult strength; total daily dose 1 g

atovaquone/400 mg proguanil hydrochloride) as a single dose daily for 3 consecutive days.

Patients with Renal Impairment:

Atovaquone and proguanil hydrochloride tablet should not be used for malaria prophylaxis in patients

with severe renal impairment (creatinine clearance <30 mL/min). Atovaquone and proguanil

hydrochloride tablet may be used with caution for the treatment of malaria in patients with severe renal

impairment (creatinine clearance <30 mL/min), only if the benefits of the 3-day treatment regimen

outweigh the potential risks associated with increased drug exposure (see CLINICAL

PHARMACOLOGY: Special Populations: Renal Impairment). No dosage adjustments are needed in

patients with mild (creatinine clearance 50 to 80 mL/min) and moderate (creatinine clearance 30 to 50

mL/min) renal impairment (see CLINICAL PHARMACOLOGY: Special Populations).

Patients with Hepatic Impairment:

No dosage adjustments are needed in patients with mild to moderate hepatic impairment. No studies have

been conducted in patients with severe hepatic impairment (see CLINICAL PHARMACOLOGY:

Special Populations: Hepatic Impairment).

HOW SUPPLIED

Atovaquone and proguanil hydrochloride tablets, containing 250 mg atovaquone and 100 mg proguanil

hydrochloride, are pinkish brown to brown colored, circular, biconvex beveled edge, film-coated

tablets with ‘404’ debossed on one side and ‘G’ debossed on the other side.

Atovaquone and proguanil hydrochloride tablets 250 mg/100 mg

NDC 33261-900-01 unit dose pack of 24

Store at 25°C (77°F); excursions permitted to 15° to 30°C (59° to 86°F) (see USP Controlled

Room Temperature).

ANIMAL TOXICOLOGY

Fibrovascular proliferation in the right atrium, pyelonephritis, bone marrow hypocellularity, lymphoid

atrophy, and gastritis/enteritis were observed in dogs treated with proguanil hydrochloride for 6 months

at a dose of 12 mg/kg/day (approximately 3.9 times the recommended daily human dose for malaria

prophylaxis on a mg/m basis). Bile duct hyperplasia, gall bladder mucosal atrophy, and interstitial

pneumonia were observed in dogs treated with proguanil hydrochloride for 6 months at a dose of 4

mg/kg/day (approximately 1.3 times the recommended daily human dose for malaria prophylaxis on a

mg/m basis). Mucosal hyperplasia of the cecum and renal tubular basophilia were observed in rats

treated with proguanil hydrochloride for 6 months at a dose of 20 mg/kg/day (approximately 1.6 times

the recommended daily human dose for malaria prophylaxis on a mg/m basis). Adverse heart, lung,

liver, and gall bladder effects observed in dogs and kidney effects observed in rats were not shown to

be reversible.

CLINICAL STUDIES

Treatment of Acute Malarial Infections:

In 3 phase II clinical trials, atovaquone alone, proguanil hydrochloride alone, and the combination of

atovaquone and proguanil hydrochloride were evaluated for the treatment of acute, uncomplicated

malaria caused by P. falciparum. Among 156 evaluable patients, the parasitological cure rate was 59/89

(66%) with atovaquone alone, 1/17 (6%) with proguanil hydrochloride alone, and 50/50 (100%) with the

combination of atovaquone and proguanil hydrochloride.

Atovaquone and proguanil hydrochloride was evaluated for treatment of acute, uncomplicated malaria

caused by P. falciparum in 8 phase III controlled clinical trials. Among 471 evaluable patients treated

with the equivalent of 4 atovaquone and proguanil hydrochloride tablets once daily for 3 days, 464 had

a sensitive response (elimination of parasitemia with no recurrent parasitemia during follow-up for 28

days) (see Table 5). Seven patients had a response of RI resistance (elimination of parasitemia but with

recurrent parasitemia between 7 and 28 days after starting treatment). In these trials, the response to

treatment with atovaquone and proguanil hydrochloride was similar to treatment with the comparator

drug in 4 trials, and better than the response to treatment with the comparator drug in the other 4 trials.

The overall efficacy in 521 evaluable patients was 98.7% (Table 5).

Table 5. Parasitological Response in Clinical Trials of Atovaquone and Proguanil hydrochloride

for Treatment of P. falciparum Malaria

Atovaquone and proguanil

hydrochloride

Comparator

Study Site

Evaluable

Patients (n)

% Sensitive

Response

Drug (s)

Evaluable

Patients (n)

% Sensitive

Response

Brazil

98.6%

Quinine and tetracycline

100.0%

Thailand

100.0%

Mefloquine

86.1%

France

100.0%

Halofantrine

100.0%

Kenya ,

93.8%

Halofantrine

90.4%

Zambia

100.0%

Pyrimethamine/sulfadoxine

(P/S)

98.8%

Gabon

98.4%

Amodiaquine

81.0%

Phillipines

100.0%

Chloroquine (C/q)

Cq and P/S

30.4%

87.5%

Peru

100.0%

Chloroquine

7.7%

100.0%

Eighteen of 521 (3.5%) evaluable patients with acute falciparum malaria presented with a pretreatment

serum creatinine greater than 2.0 mg/dL (range 2.1 to 4.3 mg/dL). All were successfully treated with

atovaquone and proguanil hydrochloride and 17 of 18 (94.4%) had normal serum creatinine levels by

day 7.

Data from a phase II trial of atovaquone conducted in Zambia suggested that approximately 40% of the

study population in this country were HIV-infected patients. The enrollment criteria were similar for the

phase III trial of atovaquone and proguanil hydrochloride conducted in Zambia and the results are

presented in Table 5. Efficacy rates for atovaquone and proguanil hydrochloride in this study

population were high and comparable to other populations studied.

The efficacy of atovaquone and proguanil hydrochloride in the treatment of the erythrocytic phase of

nonfalciparum malaria was assessed in a small number of patients. Of the 23 patients in Thailand infected

with P. vivax and treated with atovaquone/proguanil hydrochloride 1,000 mg/400 mg daily for 3 days,

parasitemia cleared in 21 (91.3%) at 7 days. Parasite relapse occurred commonly when P. vivax malaria

was treated with atovaquone and proguanil hydrochloride alone. Seven patients in Gabon with malaria

due to P. ovale or P. malariae were treated with atovaquone/proguanil hydrochloride 1,000 mg/400 mg

daily for 3 days. All 6 evaluable patients (3 with P. malariae, 2 with P. ovale, and 1 with mixed P.

falciparum and P. ovale) were cured at 28 days. Relapsing malarias including P. vivax and P. ovale

require additional treatment to prevent relapse.

Prevention of Malaria:

Atovaquone and proguanil hydrochloride was evaluated for prophylaxis of malaria in 5 clinical trials in

malaria-endemic areas and in 3 active-controlled trials in non-immune travelers to malaria-endemic

areas.

Three placebo-controlled studies of 10 to 12 weeks' duration were conducted among residents of

malaria-endemic areas in Kenya, Zambia, and Gabon. Of a total of 669 randomized patients (including

264 pediatric patients 5 to 16 years of age), 103 were withdrawn for reasons other than falciparum

malaria or drug-related adverse events. (Fifty-five percent of these were lost to follow-up and 45%

were withdrawal for protocol violations). The results are listed in Table 6.

Atovaquone and proguanil hydrochloride = 1,000 mg atovaquone and 4 00 mg proguanil hydrochloride (or

equivalent based on body weight for patients weighing ≤ 4 0 kg) once daily for 3 days.

Elimination of parasitemia with no recurrent parasitemia during follow-up for 28 days.

Patients hospitalized only for acute care. Follow-up conducted in outpatients.

Study in pediatric patients 3 to 12 years of age.

‡ §

Table 6. Prevention of Parasitemia in Placebo-Controlled Clinical Trials of

Atovaquone and Proguanil hydrochloride for Prophylaxis of P. falciparum Malaria in

Residents of Malaria-Endemic Areas

Atovaquone and proguanil hydrochloride

Placebo

Total number of patients randomized

Failed to complete study

Developed parasitemia (P. falciparum)

In another study, 330 Gabonese pediatric patients (weighing 13 to 40 kg, and aged 4 to 14 years) who

had received successful open-label radical cure treatment with artesunate, were randomized to receive

either atovaquone and proguanil hydrochloride (dosage based on body weight) or placebo in a double-

blind fashion for 12 weeks. Blood smears were obtained weekly and any time malaria was suspected.

Nineteen of the 165 children given atovaquone and proguanil hydrochloride and 18 of 165 patients

given placebo withdrew from the study for reasons other than parasitemia (primary reason was lost to

follow-up). In the per-protocol population, 1 out of 150 patients (<1%) who received atovaquone and

proguanil hydrochloride developed P. falciparum parasitemia while receiving prophylaxis with

atovaquone and proguanil hydrochloride compared with 31 (22%) of the 144 placebo recipients.

In a 10-week study in 175 South African subjects who moved into malaria-endemic areas and were given

prophylaxis with 1 atovaquone and proguanil hydrochloride daily, parasitemia developed in 1 subject

who missed several doses of medication. Since no placebo control was included, the incidence of

malaria in this study was not known.

Two active-controlled studies were conducted in non-immune travelers who visited a malaria-endemic

area. The mean duration of travel was 18 days (range 2 to 38 days). Of a total of 1,998 randomized

patients who received atovaquone and proguanil hydrochloride or controlled drug, 24 discontinued

from the study before follow-up evaluation 60 days after leaving the endemic area. Nine of these were

lost to follow-up, 2 withdrew because of an adverse experience, and 13 were discontinued for other

reasons. These studies were not large enough to allow for statements of comparative efficacy. In

addition, the true exposure rate to P. falciparum malaria in both studies is unknown. The results are

listed in Table 7.

Table 7. Prevention of Parasitemia in Active-Controlled Clinical Trials of Atovaquone and

Proguanil hydrochloride for Prophylaxis of P. falciparum Malaria in Non-Immune Travelers

Atovaquone and Proguanil

hydrochloride

Mefloquine

Chloroquine Plus

Proguanil

Total number of randomized patients

who received study drug

1,004

Failed to complete study

Developed parasitemia (P. falciparum)

A third randomized, open-label study was conducted which included 221 otherwise healthy pediatric

patients (weighing ≥11 kg and 2 to 17 years of age) who were at risk of contracting malaria by traveling

to an endemic area. The mean duration of travel was 15 days (range 1 to 30 days). Prophylaxis with

atovaquone and proguanil hydrochloride (n = 110, dosage based on body weight) began 1 or 2 days

before entering the endemic area and lasted until 7 days after leaving the area. A control group (n = 111)

received prophylaxis with chloroquine/proguanil dosed according to WHO guidelines. No cases of

malaria occurred in either group of children. However, the study was not large enough to allow for

statements of comparative efficacy. In addition, the true exposure rate to P. falciparum malaria in this

study is unknown.

In a malaria challenge study conducted in healthy US volunteers, atovaquone alone prevented malaria in

6 of 6 individuals, whereas 4 of 4 placebo-treated volunteers developed malaria.

Causal Prophylaxis:

In separate studies with small numbers of volunteers, atovaquone and proguanil hydrochloride were

independently shown to have causal prophylactic activity directed against liver-stage parasites of P.

falciparum. Six patients given a single dose of atovaquone 250 mg 24 hours prior to malaria challenge

were protected from developing malaria, whereas all 4 placebo-treated patients developed malaria.

During the 4 weeks following cessation of prophylaxis in clinical trial participants who remained in

malaria-endemic areas and were available for evaluation, malaria developed in 24 of 211 (11.4%)

subjects who took placebo and 9 of 328 (2.7%) who took atovaquone and proguanil hydrochloride .

While new infections could not be distinguished from recrudescent infections, all but 1 of the infections

in patients treated with atovaquone and proguanil hydrochloride occurred more than 15 days after

stopping therapy, probably representing new infections. The single case occurring on day 8 following

cessation of therapy with atovaquone and proguanil hydrochloride probably represents a failure of

prophylaxis with atovaquone and proguanil hydrochloride.

The possibility that delayed cases of P. falciparum malaria may occur some time after stopping

prophylaxis with atovaquone and proguanil hydrochloride cannot be ruled out. Hence, returning

travelers developing febrile illnesses should be investigated for malaria.

Manufactured by:

Glenmark Generics Ltd.

Colvale-Bardez, Goa 403 513, India

Manufactured for:

Glenmark Generics Inc., USA

Mahwah, NJ 07430

Questions? 1 (888)721-7115

www.glenmarkgenerics.com

Repackaged By:

Aidarex Pharmaceuticals, LLC.

Corona, CA 92880

January 2011

Carton-label

Imag e Label

Bottle-Label

ATOVAQUONE AND PROGUANIL HYDROCHLORIDE

atovaquone and proguanil hydrochloride tablet, film coated

Product Information

Product T ype

HUMAN PRESCRIPTION DRUG

Ite m Code (Source )

NDC:3326 1-9 0 0 (NDC:6 8 46 2-40 4)

Route of Administration

ORAL

Active Ingredient/Active Moiety

Ingredient Name

Basis of Strength

Stre ng th

ATO VAQ UO NE (UNII: Y8 8 3P1Z2LT) (ATOVAQUONE - UNII:Y8 8 3P1Z2LT)

ATOVAQUONE

250 mg

PRO GUANIL HYDRO CHLO RIDE (UNII: R71Y8 6 M0 WT) (PROGUANIL -

UNII:S6 1K3P7B2V)

PROGUANIL

HYDROCHLORIDE

10 0 mg

Inactive Ingredients

Ingredient Name

Stre ng th

CELLULO SE, MICRO CRYSTALLINE (UNII: OP1R32D6 1U)

HYDRO XYPRO PYL CELLULO SE, LO W SUBSTITUTED (UNII: 216 5RE0 K14)

PO LO XAMER 18 8 (UNII: LQA7B6 G8 JG)

PO VIDO NE K3 0 (UNII: U725QWY32X)

SILICO N DIO XIDE (UNII: ETJ7Z6 XBU4)

MAGNESIUM STEARATE (UNII: 70 0 9 7M6 I30 )

PO LYETHYLENE GLYCO L 4 0 0 (UNII: B6 9 78 9 4SGQ)

PO LYETHYLENE GLYCO L 8 0 0 0 (UNII: Q6 6 2QK8 M3B)

TITANIUM DIO XIDE (UNII: 15FIX9 V2JP)

FERRIC O XIDE RED (UNII: 1K0 9 F3G6 75)

Product Characteristics

Aidarex Pharmaceuticals LLC

Color

PINK (pinkish bro wn to bro wn)

S core

no sco re

S hap e

ROUND (circular, bico nvex, beveled edge)

S iz e

11mm

Flavor

Imprint Code

40 4;G

Contains

Packag ing

#

Item Code

Package Description

Marketing Start Date

Marketing End Date

1

NDC:3326 1-9 0 0 -0 1

24 in 1 BLISTER PACK

Marketing Information

Marke ting Cate gory

Application Numbe r or Monograph Citation

Marke ting Start Date

Marke ting End Date

ANDA

ANDA0 9 1211

0 8 /18 /20 11

Labeler -

Aidarex Pharmaceuticals LLC (801503249)

Revised: 9/2012

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