MALARONE

MALARONE is an FDA-registered drug product whose active ingredient is ATOVAQUONE AND PROGUANIL HYDROCHLORIDE. It is labelled by GlaxoSmithKline LLC taken by oral and marketed as a human prescription drug product. Identifiers on file: NDC 0173-0675, application NDA021078, label effective 20260610. It is one of 4 FDA drug label records sharing the active ingredient ATOVAQUONE AND PROGUANIL HYDROCHLORIDE. This page reproduces the FDA-approved label text so you can check what a product is, who makes it and how it is supplied before discussing it with a pharmacist or prescriber.

Across FDA labelling, products containing ATOVAQUONE AND PROGUANIL HYDROCHLORIDE are most often described in connection with: falciparum malaria, prophylaxis plasmodium, including areas, chloroquine resistance, reported treatment, acute uncomplicated, malarone indicated, shown effective. Wording differs between labels, and the full indications section on this page takes precedence when it is present.

1 INDICATIONS AND USAGE MALARONE is an antimalarial indicated for: • prophylaxis of Plasmodium falciparum (P. falciparum) malaria, including in areas where chloroquine resistance has been reported. ( 1.1 ) • treatment of acute, uncomplicated P. falciparum malaria. ( 1.2 ) 1.1 Prevention of Malaria MALARONE is indicated for the prophylaxis of Plasmodium falciparum (P. falciparum) malaria, including in areas where chloroquine resistance has been reported. 1.2 Treatment of Malaria MALARONE is indicated for the treatment of acute, uncomplicated P. falciparum malaria. MALARONE has 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.

2 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. MALARONE may be crushed and mixed with condensed milk just prior to administration to patients who may have difficulty swallowing tablets. • MALARONE should be taken with food or a milky drink. Prophylaxis ( 2.1 ) : • Start prophylaxis 1 or 2 days before entering a malaria‑endemic area and continue daily during the stay and for 7 days after return. • Adults: One adult strength tablet per day. • Pediatric Patients: Dosage based on body weight (see Table 1 ). Treatment ( 2.2 ) : • Adults: Four adult strength tablets as a single daily dose for 3 days. • Pediatric Patients: Dosage based on body weight (see Table 2 ). Renal Impairment ( 2.3 ) : • Do not use for prophylaxis of malaria in patients with severe renal impairment. • Use with caution for treatment of malaria in patients with severe renal impairment. 2.1 Prevention of Malaria Start prophylactic treatment with MALARONE 1 or 2 days before entering a malaria‑endemic area and continue daily during the stay and for 7 days after return. Adults One MALARONE tablet (adult strength = 250 mg atovaquone/100 mg proguanil hydrochloride) per day. Pediatric Patients The dosage for prevention of malaria in pediatric patients is based upon body weight ( Table 1 ). Table 1. Dosage for Prevention of Malaria in Pediatric Patients Weight (kg) Atovaquone/ Proguanil HCl Total Daily Dose Dosage Regimen 11-20 62.5 mg/25 mg 1 MALARONE pediatric tablet daily 21-30 125 mg/50 mg 2 MALARONE pediatric tablets as a single daily dose 31-40 187.5 mg/75 mg 3 MALARONE pediatric tablets as a single daily dose >40 250 mg/100 mg 1 MALARONE tablet (adult strength) as a single daily dose 2.2 Treatment of Acute Malaria Adults Four MALARONE tablets (adult strength; total daily dose 1 g atovaquone/400 mg proguanil hydrochloride) as a single daily dose for 3 consecutive days. Pediatric Patients The dosage for treatment of acute malaria in pediatric patients is based upon body weight ( Table 2 ). Table 2. Dosage for Treatment of Acute Malaria in Pediatric Patients Weight (kg) Atovaquone/ Proguanil HCl Total Daily Dose Dosage Regimen 5-8 125 mg/50 mg 2 MALARONE pediatric tablets daily for 3 consecutive days 9-10 187.5 mg/75 mg 3 MALARONE pediatric tablets daily for 3 consecutive days 11-20 250 mg/100 mg 1 MALARONE tablet (adult strength) daily for 3 consecutive days 21-30 500 mg/200 mg 2 MALARONE tablets (adult strength) as a single daily dose for 3 consecutive days 31-40 750 mg/300 mg 3 MALARONE tablets (adult strength) as a single daily dose for 3 consecutive days >40 1 g/400 mg 4 MALARONE tablets (adult strength) as a single daily dose for 3 consecutive days 2.3 Renal Impairment Do not use MALARONE for malaria prophylaxis in patients with severe renal impairment (creatinine clearance <30 mL/min) [see Contraindications ( 4 )] . Use with caution for the treatment of malaria in patients with severe renal impairment, only if the benefits of the 3-day treatment regimen outweigh the potential risks associated with increased drug exposure. No dosage adjustments are needed in patients with mild (creatinine clearance 50 to 80 mL/min) or moderate (creatinine clearance 30 to 50 mL/min) renal impairment. [See Clinical Pharmacology ( 12.3 ).]

4 CONTRAINDICATIONS • MALARONE is contraindicated in individuals with known hypersensitivity reactions to atovaquone or proguanil hydrochloride or any component of the formulation [see Warnings and Precautions ( 5.4 ), Adverse Reactions ( 6.2 )] . • MALARONE is contraindicated for prophylaxis of P. falciparum malaria in patients with severe renal impairment (creatinine clearance <30 mL/min) because of pancytopenia in patients with severe renal impairment treated with proguanil [see Use in Specific Populations ( 8.6 ), Clinical Pharmacology ( 12.3 )] . • Known serious hypersensitivity reactions to atovaquone or proguanil hydrochloride or any component of the formulation. ( 4 ) • Prophylaxis of P. falciparum malaria in patients with severe renal impairment (creatinine clearance <30 mL/min). ( 4 )

6 ADVERSE REACTIONS The following clinically significant adverse reactions are discussed in another section of the labeling: • Vomiting and Diarrhea [see Warnings and Precautions ( 5.1 )]. • Hepatotoxicity [see Warnings and Precautions ( 5.3 )]. • Severe Cutaneous Adverse Reactions [see Warnings and Precautions ( 5.4 )]. • Prophylaxis: Common adverse reactions (≥4%) in adults were diarrhea, dreams, oral ulcers, and headache; these events occurred in a similar or lower proportion of subjects receiving MALARONE than an active comparator. Common adverse reactions (≥5%) in pediatric patients included abdominal pain, headache, cough, and vomiting. ( 6.1 ) • Treatment: Common adverse reactions (≥5%) in adolescents and adults were abdominal pain, nausea, vomiting, headache, diarrhea, asthenia, anorexia, and dizziness. Common adverse reactions (≥6%) in pediatric patients included vomiting, pruritus, and diarrhea. ( 6.1 ) To report SUSPECTED ADVERSE REACTIONS, contact GlaxoSmithKline at 1-888-825-5249 or FDA at 1-800-FDA-1088 or www.fda.gov/medwatch . 6.1 Clinical Trials Experience Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared with rates in the clinical trials of another drug and may not reflect the rates observed in practice. Because MALARONE contains atovaquone and proguanil hydrochloride, the type and severity of adverse reactions associated with each of the compounds may be expected. The lower prophylactic doses of MALARONE were better tolerated than the higher treatment doses. Prophylaxis of P. falciparum Malaria In 3 clinical trials (2 of which were placebo‑controlled) 381 adults (mean age: 31 years) received MALARONE for the prophylaxis of malaria; the majority of adults were black (90%) and 79% were male. In a clinical trial for the prophylaxis of malaria, 125 pediatric patients (mean age: 9 years) received MALARONE; all subjects were black and 52% were male. Adverse experiences reported in adults and pediatric patients considered attributable to therapy occurred in similar proportions of subjects receiving MALARONE or placebo in all studies. Prophylaxis with MALARONE was discontinued prematurely due to a treatment‑related adverse experience in 3 of 381 (0.8%) adults and 0 of 125 pediatric patients. In a placebo‑controlled study of malaria prophylaxis with MALARONE involving 330 pediatric patients (aged 4 to 14 years) in Gabon, a malaria‑endemic area, the safety profile of MALARONE was consistent with that observed in the earlier prophylactic studies in adults and pediatric patients. The most common treatment‑emergent adverse events with MALARONE were abdominal pain (13%), headache (13%), and cough (10%). Abdominal pain (13% vs. 8%) and vomiting (5% vs. 3%) were reported more often with MALARONE than with placebo. No patient withdrew from the study due to an adverse experience with MALARONE. No routine laboratory data were obtained during this study. Non‑immune travelers visiting a malaria‑endemic area received MALARONE (n = 1,004) for prophylaxis of malaria in 2 active-controlled clinical trials. In one study (n = 493), the mean age of subjects was 33 years and 53% were male; 90% of subjects were white, 6% of subjects were black, and the remaining were of other racial/ethnic groups. In the other study (n = 511), the mean age of subjects was 36 years and 51% were female; the majority of subjects (97%) were white. Adverse experiences occurred in a similar or lower proportion of subjects receiving MALARONE than an active comparator ( Table 3 ). Fewer neuropsychiatric adverse experiences occurred in subjects who received MALARONE than mefloquine. Fewer gastrointestinal adverse experiences occurred in subjects receiving MALARONE than chloroquine/proguanil. Compared with active comparator drugs, subjects receiving MALARONE had fewer adverse experiences overall that were attributed to prophylactic therapy ( Table 3 ). Prophylaxis with MALARONE was discontinued prematurely due to a treatment‑related adverse experience in 7 of 1,004 travelers. Table 3. Adverse Reactions in Active-Controlled Clinical Trials of MALARONE for Prophylaxis of P. falciparum Malaria a Adverse experiences that started while receiving active study drug. b Mean duration of dosing based on recommended dosing regimens. Adverse Experience Percent of Subjects with Adverse Experiences a (Percent of Subjects with Adverse Experiences Attributable to Therapy) Study 1 Study 2 MALARONE n = 493 (28 days) b Mefloquine n = 483 (53 days) b MALARONE n = 511 (26 days) b Chloroquine plus Proguanil n = 511 (49 days) b 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) Anxiety 1 (<1) 5 (4) <1 (<1) 1 (<1) Any adverse experience 64 (30) 69 (42) 58 (22) 66 (28) Any 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, MALARONE (n = 110) was compared with chloroquine/proguanil (n = 111) for the prophylaxis of malaria in 221 non-immune pediatric patients (aged 2 to 17 years). The mean duration of exposure was 23 days for MALARONE, 46 days for chloroquine, and 43 days for proguanil, reflecting the different recommended dosage regimens for these products. Fewer patients treated with MALARONE 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 MALARONE or chloroquine/proguanil, respectively. Two patients discontinued prophylaxis with chloroquine/proguanil due to adverse events, while none of those receiving MALARONE discontinued due to adverse events. Treatment of Acute, Uncomplicated P. falciparum Malaria In 7 controlled trials, 436 adolescents and adults received MALARONE for treatment of acute, uncomplicated P. falciparum malaria. The range of mean ages of subjects was 26 to 29 years; 79% of subjects were male. In these studies, 48% of subjects were classified as other racial/ethnic groups, primarily Asian; 42% of subjects were black and the remaining subjects were white. 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 (0.9%) adolescents and adults treated with MALARONE. In 2 controlled trials, 116 pediatric patients (weighing 11 to 40 kg) (mean age: 7 years) received MALARONE for the treatment of malaria. The majority of subjects were black (72%); 28% were of other racial/ethnic groups, primarily Asian. 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 MALARONE 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 MALARONE, 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 MALARONE for the treatment of uncomplicated P. falciparum malaria, only diarrhea (6%) occurred in ≥5% of patients as an adverse experience attributable to MALARONE. 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 patients with malaria being treated with MALARONE. The frequency of these abnormalities varied substantially across trials of treatment and were not observed in the randomized portions of the prophylaxis trials. One active-controlled trial evaluated the treatment of malaria in Thai adults (n = 182); the mean age of subjects was 26 years (range: 15 to 63 years); 80% of subjects were male. Early elevations of ALT and AST occurred more frequently in patients treated with MALARONE (n = 91) compared with patients treated with an active control, mefloquine (n = 91). On Day 7, rates of elevated ALT and AST with MALARONE and mefloquine (for patients who had normal baseline levels of these clinical laboratory parameters) were ALT 26.7% vs. 15.6%; AST 16.9% vs. 8.6%, respectively. By Day 14 of this 28‑day study, the frequency of transaminase elevations equalized across the 2 groups. 6.2 Postmarketing Experience The following reactions have been identified during postapproval use of MALARONE. Because these reactions are reported voluntarily from a population of uncertain size, it is not always possible to reliably estimate their frequency or establish a causal relationship to drug exposure. These adverse reactions have been chosen for inclusion due to a combination of their seriousness, frequency of reporting, or potential causal relationship to MALARONE. Blood and Lymphatic System Disorders Neutropenia and anemia. Pancytopenia in patients with severe renal impairment treated with proguanil [see Contraindications ( 4 )] . Immune System Disorders Allergic reactions including anaphylaxis, angioedema, urticaria, and vasculitis. Nervous System Disorders Seizures and psychiatric adverse reactions, such as hallucinations, depression, anxiety, panic attacks, crying, nightmares, and psychotic disorders. Gastrointestinal Disorders Stomatitis. Hepatobiliary Disorders Elevated liver laboratory tests, hepatitis, cholestasis, and hepatic failure requiring transplant has been reported. Skin and Subcutaneous Tissue Disorders Photosensitivity, rash, erythema multiforme (EM), Stevens‑Johnson syndrome (SJS), and drug reaction with eosinophilia and systemic symptoms (DRESS) .

FDA lists 4 drug label records with ATOVAQUONE AND PROGUANIL HYDROCHLORIDE as the active ingredient. The most common dosage forms and the manufacturers with the most records are summarised below; strengths, pack sizes and inactive ingredients can still differ between apparently similar products.

4 FDA recall record(s) match this product name or manufacturer. A match means the firm or product name appears in the enforcement report; confirm lot numbers and dates against the official FDA notice before acting.

What is MALARONE used for?
1 INDICATIONS AND USAGE MALARONE is an antimalarial indicated for: • prophylaxis of Plasmodium falciparum (P. falciparum) malaria, including in areas where chloroquine resistance has been reported. ( 1.1 ) • treatment of acute, uncomplicated P. falciparum malaria. ( 1.2 ) 1.1 Prevention of Malaria MALARONE is indicated for the prophylaxis of Plasmodium falciparum (P. falciparum) malaria, …

Who makes MALARONE?
GlaxoSmithKline LLC is the labeler of record for MALARONE. 4 FDA label records share the active ingredient ATOVAQUONE AND PROGUANIL HYDROCHLORIDE, so generic and branded versions may come from different companies; the manufacturer named on your pack is the one that matters for any enquiry.

What form does MALARONE come in?
administered by oral. Strengths and pack sizes vary by label, so compare the NDC on your pack with the identifier listed on this page.

Is MALARONE prescription or over-the-counter?
The FDA label for this product is recorded as human prescription drug. Marketing status can differ between strengths and countries, so check the dispensing rules where you live.

Are there other products containing ATOVAQUONE AND PROGUANIL HYDROCHLORIDE?
Yes. 4 FDA drug label records list ATOVAQUONE AND PROGUANIL HYDROCHLORIDE as the active ingredient. Products with the same active ingredient can usually be substituted only when a prescriber or pharmacist confirms it is appropriate.

Has MALARONE been recalled?
4 FDA recall record(s) match this product name or manufacturer. Review the recall and safety notices section on this page and confirm lot numbers against the official FDA enforcement report.

Where does this information come from?
All content is reproduced from FDA Structured Product Labelling data via openFDA. It is provided for identification and reference only and is not medical advice.