Azithromycin + Atovaquone = Precautionary

Effect on Concentration

Azithromycin
Decrease
Applies within class?
No
Atovaquone
Unknown
Applies within class?
No

Pharmacologic Effects

Azithromycin
Effect
N/A
Applies within class?
No
Atovaquone
Effect
N/A
Applies within class?
No

Interaction History

N/A

Last Updated 22-May-2020

Summary

Atovaquone consistently decreased azithromycin exposure in HIV-infected children. Clinical consequence is indeterminate.

Sources

Pharmacokinetics of Azithromycin Administered Alone and With Atovaquone in Human Immunodeficiency Virus-Infected Children. The ACTG 254 Team ^

Study Design

o evaluate if atovaquone (ATQ) interacts pharmacokinetically with azithromycin (AZ) in human immunodeficiency virus-infected children, 10 subjects (ages, 4 to 13 years) were randomized in a crossover study to receive AZ (5 mg/kg/day) alone (ALONE) or AZ (5 mg/kg/day) and ATQ (30 mg/kg/day) simultaneously (SIM) prior to receiving AZ and ATQ staggered by 12 h.

Study Results

Despite a lack of significant difference in the mean AZ pharmacokinetic parameters, the steady-state values of AZs area under the concentration-time curve from 0 to 24 h and maximum concentration in serum were consistently lower (n 7 of 7) for the SIM regimen than they were for the ALONE regimen.

Study Conclusions

A larger study will be required to determine if ATQ affects AZ pharmacokinetics and efficacy in a clinically significant manner.

References

Ngo LY. Pharmacokinetics of azithromycin administered alone and with atovaquone in human immunodeficiency virus-infected children. the actg 254 team. Antimicrob Agents Chemother. 1999; 6: 1516-9.