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INTRODUCTION

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atovaquone (a-toe-va-kwone)

Mepron

Classification

Therapeutic: antiprotozoals

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Indications
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Treatment of mild-to-moderate Pneumocystis carinii pneumonia (PCP) in patients who are unable to tolerate trimethoprim-sulfamethoxazole. Prophylaxis of PCP.

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Action
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Inhibits the action of enzymes necessary to nucleic acid and ATP synthesis in protozoa. Therapeutic Effects: Antiprotozoal action against P. carinii.

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Adverse Reactions/Side Effects
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CNS: headache, insomnia. Resp: cough. GI: diarrhea, nausea, vomiting. Derm: rash. Misc: fever.

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PHYSICAL THERAPY IMPLICATIONS

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Examination and Evaluation
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  • Assess pulmonary function by measuring lung volumes, breath sounds, respiratory rate, and other symptoms (cough, dyspnea, shortness of breath) (See Appendices I, J, K). Report changes in pulmonary function to help document the effects of drug therapy in treating PCP infections.

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Interventions
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  • Implement therapeutic exercises and airway clearance techniques as needed to maintain and improve pulmonary function in patients with respiratory infections.

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Patient/Client-Related Instruction
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  • Remind patient to take this drug as directed for the full course of treatment even if feeling better.

  • Instruct patient and family/caregivers to report other troublesome side effects such as severe or prolonged headache, sleep loss, skin rash, fever, or GI problems (diarrhea, nausea, vomiting).

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Pharmacokinetics
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Absorption: Absorption is poor but is increased by food, particularly fat.

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Distribution: Enters CSF in very low concentrations (<1% of plasma levels).

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Protein Binding: >99.9%.

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Metabolism and Excretion: Undergoes enterohepatic recycling; elimination occurs in feces.

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Half-life: 2.2–2.9 days.

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TIME/ACTION PROFILE (blood levels)

ROUTE ONSET PEAK DURATION
PO unknown 1–8 hr; 24–96 hr* 12 hr

*Two peaks are due to enterohepatic recycling.

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Contraindications/Precautions
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Contraindicated in: Hypersensitivity; Lactation: May appear in breast milk.

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Use Cautiously in: Decreased hepatic, renal, or cardiac function (dosage modification may be necessary); GI disorders (absorption may be limited); OB: Safety not established; Pedi: Safety not established.

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Interactions
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Drug-Drug: May interact with drugs that are highly bound to plasma proteins (does not appear to interact with phenytoin).

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Drug-Food: Food enhances absorption.

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Route/Dosage
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Treatment
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PO (Adults): 750 mg twice daily for 21 days.

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PO (Children): 40 mg/kg/day (unlabeled).

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Prevention
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PO (Adults and Adolescents 13–16 yr): 1500 mg once daily.

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Availability
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Suspension: 750 mg/5 mL.

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