Atovaquone and proguanil interfere with two different pathways involved in the biosynthesis of pyrimidines required for nucleic acid replication. The mechanism of action of atovaquone against P. falciparum is via inhibition of mitochondrial electron transport, and collapse of mitochondrial membrane potential. One mechanism of action of proguanil, via its metabolite cycloguanil, is inhibition of dihydrofolate reductase, which disrupts deoxythymidylate synthesis. Proguanil also has antimalarial and is able to potentiate the ability of atovaquone to collapse mitochondrial membrane potential in malaria parasites. This latter mechanism may explain the synergy seen when atovaquone and proguanil are used in combination.
This medicinal substance has been classified in the anatomical therapeutic chemical (ATC) classification according to its main therapeutic use as follows:
| ATC code | Group title | Classification |
|---|---|---|
| P01BB51 | Proguanil and atovaquone | P Antiparasitic products, insecticides and repellents → P01 Antiprotozoals → P01B Antimalarials → P01BB Biguanides |
Competent medicine agencies globally have authorized commercialization of this active ingredient according to these medication package inserts (MPIs):
| Title | Information Source | Document Type | |
|---|---|---|---|
| MALARONE Film-coated tablet | Medicines & Healthcare Products Regulatory Agency (GB) | MPI, EU: SmPC | |
| MALARONE PAEDIATRIC Film-coated tablet | Medicines & Healthcare Products Regulatory Agency (GB) | MPI, EU: SmPC |
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