Details
Stereochemistry | ACHIRAL |
Molecular Formula | C22H19ClO3 |
Molecular Weight | 366.837 |
Optical Activity | UNSPECIFIED |
Defined Stereocenters | 2 / 2 |
E/Z Centers | 0 |
Charge | 0 |
SHOW SMILES / InChI
SMILES
OC1=C([C@H]2CC[C@@H](CC2)C3=CC=C(Cl)C=C3)C(=O)C4=C(C=CC=C4)C1=O
InChI
InChIKey=KUCQYCKVKVOKAY-CTYIDZIISA-N
InChI=1S/C22H19ClO3/c23-16-11-9-14(10-12-16)13-5-7-15(8-6-13)19-20(24)17-3-1-2-4-18(17)21(25)22(19)26/h1-4,9-13,15,26H,5-8H2/t13-,15-
Atovaquone is a chemical compound that belongs to the class of naphthoquinones; it is manufactured in the US in the liquid form, or oral suspension, under the brand name Mepron. Meron is used for the treatment or prevention of Pneumocystis carinii pneumonia in patients who are intolerant to trimethoprim-sulfamethoxazole (TMP-SMX). Also indicated for the acute oral treatment of mild to moderate PCP in patients who are intolerant to TMP-SMX. The mechanism of action against Pneumocystis jiroveci has not been fully elucidated. In Plasmodium species, the site of action appears to be the cytochrome bc1 complex (Complex III). Several metabolic enzymes are linked to the mitochondrial electron transport chain via ubiquinone. Inhibition of electron transport by atovaquone results in indirect inhibition of these enzymes. The ultimate metabolic effects of such blockade may include inhibition of nucleic acid and adenosine triphosphate (ATP) synthesis. Several laboratories, using different in vitro methodologies, have shown the IC50 (50% inhibitory concentration) of atovaquone against P. jiroveci to be 0.1 to 3.0 mcg/mL.
Approval Year
Targets
Primary Target | Pharmacology | Condition | Potency |
---|---|---|---|
Target ID: CHEMBL1777 Sources: https://www.ncbi.nlm.nih.gov/pubmed/12791689 |
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Target ID: Q08210 Gene ID: 3885966.0 Gene Symbol: NA Target Organism: Plasmodium falciparum (isolate 3D7) Sources: https://www.ncbi.nlm.nih.gov/pubmed/7726490 |
Conditions
Condition | Modality | Targets | Highest Phase | Product |
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Curative | MEPRON Approved Use1.1 Prevention of Pneumocystis jiroveci Pneumonia. MEPRON® suspension is indicated for the prevention of Pneumocystis jiroveci pneumonia (PCP) in adults and adolescents (aged 13 years and older) who cannot tolerate trimethoprimsulfamethoxazole (TMP-SMX). 1.2 Treatment of Mild-to-Moderate Pneumocystis jiroveci Pneumonia
MEPRON suspension is indicated for the acute oral treatment of mild-to-mod Launch Date1992 |
Cmax
Value | Dose | Co-administered | Analyte | Population |
---|---|---|---|---|
8.8 μg/mL |
500 mg 1 times / day multiple, oral dose: 500 mg route of administration: Oral experiment type: MULTIPLE co-administered: |
ATOVAQUONE plasma | Homo sapiens population: UNHEALTHY age: UNKNOWN sex: UNKNOWN food status: FASTED |
|
15.1 μg/mL |
500 mg 1 times / day multiple, oral dose: 500 mg route of administration: Oral experiment type: MULTIPLE co-administered: |
ATOVAQUONE plasma | Homo sapiens population: UNHEALTHY age: UNKNOWN sex: UNKNOWN food status: FED |
|
15.1 μg/mL |
500 mg 1 times / day steady-state, oral dose: 500 mg route of administration: Oral experiment type: STEADY-STATE co-administered: |
ATOVAQUONE plasma | Homo sapiens population: UNKNOWN age: UNKNOWN sex: UNKNOWN food status: FED |
|
15.3 μg/mL |
750 mg 1 times / day steady-state, oral dose: 750 mg route of administration: Oral experiment type: STEADY-STATE co-administered: |
ATOVAQUONE plasma | Homo sapiens population: UNKNOWN age: UNKNOWN sex: UNKNOWN food status: FED |
|
16.8 μg/mL |
1000 mg 1 times / day steady-state, oral dose: 1000 mg route of administration: Oral experiment type: STEADY-STATE co-administered: |
ATOVAQUONE plasma | Homo sapiens population: UNKNOWN age: UNKNOWN sex: UNKNOWN food status: FED |
|
24 μg/mL |
750 mg 2 times / day steady-state, oral dose: 750 mg route of administration: Oral experiment type: STEADY-STATE co-administered: |
ATOVAQUONE plasma | Homo sapiens population: UNHEALTHY age: UNKNOWN sex: UNKNOWN food status: UNKNOWN |
AUC
Value | Dose | Co-administered | Analyte | Population |
---|---|---|---|---|
169 μg × h/mL |
500 mg 1 times / day multiple, oral dose: 500 mg route of administration: Oral experiment type: MULTIPLE co-administered: |
ATOVAQUONE plasma | Homo sapiens population: UNHEALTHY age: UNKNOWN sex: UNKNOWN food status: FASTED |
|
280 μg × h/mL |
500 mg 1 times / day multiple, oral dose: 500 mg route of administration: Oral experiment type: MULTIPLE co-administered: |
ATOVAQUONE plasma | Homo sapiens population: UNHEALTHY age: UNKNOWN sex: UNKNOWN food status: FED |
|
324 μg × h/mL |
750 mg single, oral dose: 750 mg route of administration: Oral experiment type: SINGLE co-administered: |
ATOVAQUONE plasma | Homo sapiens population: HEALTHY age: UNKNOWN sex: UNKNOWN food status: FASTED |
|
801 μg × h/mL |
750 mg single, oral dose: 750 mg route of administration: Oral experiment type: SINGLE co-administered: |
ATOVAQUONE plasma | Homo sapiens population: HEALTHY age: UNKNOWN sex: UNKNOWN food status: FED |
Funbound
Value | Dose | Co-administered | Analyte | Population |
---|---|---|---|---|
0.1% |
500 mg 1 times / day multiple, oral dose: 500 mg route of administration: Oral experiment type: MULTIPLE co-administered: |
ATOVAQUONE plasma | Homo sapiens population: UNHEALTHY age: UNKNOWN sex: UNKNOWN food status: FASTED |
|
0.1% |
500 mg 1 times / day multiple, oral dose: 500 mg route of administration: Oral experiment type: MULTIPLE co-administered: |
ATOVAQUONE plasma | Homo sapiens population: UNHEALTHY age: UNKNOWN sex: UNKNOWN food status: FED |
|
0.1% |
750 mg single, oral dose: 750 mg route of administration: Oral experiment type: SINGLE co-administered: |
ATOVAQUONE plasma | Homo sapiens population: HEALTHY age: UNKNOWN sex: UNKNOWN food status: FASTED |
|
0.1% |
750 mg single, oral dose: 750 mg route of administration: Oral experiment type: SINGLE co-administered: |
ATOVAQUONE plasma | Homo sapiens population: HEALTHY age: UNKNOWN sex: UNKNOWN food status: FED |
|
0.1% |
500 mg 1 times / day steady-state, oral dose: 500 mg route of administration: Oral experiment type: STEADY-STATE co-administered: |
ATOVAQUONE plasma | Homo sapiens population: UNKNOWN age: UNKNOWN sex: UNKNOWN food status: FED |
|
0.1% |
750 mg 1 times / day steady-state, oral dose: 750 mg route of administration: Oral experiment type: STEADY-STATE co-administered: |
ATOVAQUONE plasma | Homo sapiens population: UNKNOWN age: UNKNOWN sex: UNKNOWN food status: FED |
|
0.1% |
1000 mg 1 times / day steady-state, oral dose: 1000 mg route of administration: Oral experiment type: STEADY-STATE co-administered: |
ATOVAQUONE plasma | Homo sapiens population: UNKNOWN age: UNKNOWN sex: UNKNOWN food status: FED |
|
0.1% |
750 mg 2 times / day steady-state, oral dose: 750 mg route of administration: Oral experiment type: STEADY-STATE co-administered: |
ATOVAQUONE plasma | Homo sapiens population: UNHEALTHY age: UNKNOWN sex: UNKNOWN food status: UNKNOWN |
Doses
Dose | Population | Adverse events |
---|---|---|
1000 mg 2 times / day multiple, oral Highest studied dose Dose: 1000 mg, 2 times / day Route: oral Route: multiple Dose: 1000 mg, 2 times / day Sources: Page: p.559 |
unhealthy n = 6 Health Status: unhealthy Condition: HIV inection Population Size: 6 Sources: Page: p.559 |
|
31500 mg single, oral Overdose Dose: 31500 mg Route: oral Route: single Dose: 31500 mg Co-administed with:: dapsone Sources: Page: p.16 |
unhealthy Health Status: unhealthy Condition: Pneumocystis carinii pneumonia Sources: Page: p.16 |
Other AEs: Methemoglobinemia, Rash... Other AEs: Methemoglobinemia Sources: Page: p.16Rash |
1500 mg 1 times / day multiple, oral Recommended Dose: 1500 mg, 1 times / day Route: oral Route: multiple Dose: 1500 mg, 1 times / day Sources: Page: p.12 |
unhealthy n = 175 Health Status: unhealthy Condition: Pneumocystis carinii pneumonia Population Size: 175 Sources: Page: p.12 |
Disc. AE: Rash, Diarrhea... AEs leading to discontinuation/dose reduction: Rash (grade 1-2, 6%) Sources: Page: p.12Diarrhea (4%) Nausea (3%) |
1500 mg 1 times / day multiple, oral Recommended Dose: 1500 mg, 1 times / day Route: oral Route: multiple Dose: 1500 mg, 1 times / day Sources: Page: p.12 |
unhealthy n = 203 Health Status: unhealthy Condition: Pneumocystis carinii pneumonia Population Size: 203 Sources: Page: p.12 |
Disc. AE: Rash... AEs leading to discontinuation/dose reduction: Rash (4%) Sources: Page: p.12 |
1500 mg 1 times / day multiple, oral Recommended Dose: 1500 mg, 1 times / day Route: oral Route: multiple Dose: 1500 mg, 1 times / day Sources: Page: p.13 |
unhealthy n = 203 Health Status: unhealthy Condition: Pneumocystis carinii pneumonia Population Size: 203 Sources: Page: p.13 |
Disc. AE: Vomiting, ALT increased... AEs leading to discontinuation/dose reduction: Vomiting (<1%) Sources: Page: p.13ALT increased (2%) Aspartate aminotransferase increase (2%) |
1500 mg 1 times / day multiple, oral Recommended Dose: 1500 mg, 1 times / day Route: oral Route: multiple Dose: 1500 mg, 1 times / day Sources: Page: p.15 |
unhealthy n = 73 Health Status: unhealthy Condition: Pneumocystis carinii pneumonia Population Size: 73 Sources: Page: p.15 |
Disc. AE: Creatinine increased, Blood urea nitrogen increased... AEs leading to discontinuation/dose reduction: Creatinine increased (1%) Sources: Page: p.15Blood urea nitrogen increased (1%) Amylase increased (1%) |
AEs
AE | Significance | Dose | Population |
---|---|---|---|
Methemoglobinemia | 31500 mg single, oral Overdose Dose: 31500 mg Route: oral Route: single Dose: 31500 mg Co-administed with:: dapsone Sources: Page: p.16 |
unhealthy Health Status: unhealthy Condition: Pneumocystis carinii pneumonia Sources: Page: p.16 |
|
Rash | 31500 mg single, oral Overdose Dose: 31500 mg Route: oral Route: single Dose: 31500 mg Co-administed with:: dapsone Sources: Page: p.16 |
unhealthy Health Status: unhealthy Condition: Pneumocystis carinii pneumonia Sources: Page: p.16 |
|
Nausea | 3% Disc. AE |
1500 mg 1 times / day multiple, oral Recommended Dose: 1500 mg, 1 times / day Route: oral Route: multiple Dose: 1500 mg, 1 times / day Sources: Page: p.12 |
unhealthy n = 175 Health Status: unhealthy Condition: Pneumocystis carinii pneumonia Population Size: 175 Sources: Page: p.12 |
Diarrhea | 4% Disc. AE |
1500 mg 1 times / day multiple, oral Recommended Dose: 1500 mg, 1 times / day Route: oral Route: multiple Dose: 1500 mg, 1 times / day Sources: Page: p.12 |
unhealthy n = 175 Health Status: unhealthy Condition: Pneumocystis carinii pneumonia Population Size: 175 Sources: Page: p.12 |
Rash | grade 1-2, 6% Disc. AE |
1500 mg 1 times / day multiple, oral Recommended Dose: 1500 mg, 1 times / day Route: oral Route: multiple Dose: 1500 mg, 1 times / day Sources: Page: p.12 |
unhealthy n = 175 Health Status: unhealthy Condition: Pneumocystis carinii pneumonia Population Size: 175 Sources: Page: p.12 |
Rash | 4% Disc. AE |
1500 mg 1 times / day multiple, oral Recommended Dose: 1500 mg, 1 times / day Route: oral Route: multiple Dose: 1500 mg, 1 times / day Sources: Page: p.12 |
unhealthy n = 203 Health Status: unhealthy Condition: Pneumocystis carinii pneumonia Population Size: 203 Sources: Page: p.12 |
ALT increased | 2% Disc. AE |
1500 mg 1 times / day multiple, oral Recommended Dose: 1500 mg, 1 times / day Route: oral Route: multiple Dose: 1500 mg, 1 times / day Sources: Page: p.13 |
unhealthy n = 203 Health Status: unhealthy Condition: Pneumocystis carinii pneumonia Population Size: 203 Sources: Page: p.13 |
Aspartate aminotransferase increase | 2% Disc. AE |
1500 mg 1 times / day multiple, oral Recommended Dose: 1500 mg, 1 times / day Route: oral Route: multiple Dose: 1500 mg, 1 times / day Sources: Page: p.13 |
unhealthy n = 203 Health Status: unhealthy Condition: Pneumocystis carinii pneumonia Population Size: 203 Sources: Page: p.13 |
Vomiting | <1% Disc. AE |
1500 mg 1 times / day multiple, oral Recommended Dose: 1500 mg, 1 times / day Route: oral Route: multiple Dose: 1500 mg, 1 times / day Sources: Page: p.13 |
unhealthy n = 203 Health Status: unhealthy Condition: Pneumocystis carinii pneumonia Population Size: 203 Sources: Page: p.13 |
Amylase increased | 1% Disc. AE |
1500 mg 1 times / day multiple, oral Recommended Dose: 1500 mg, 1 times / day Route: oral Route: multiple Dose: 1500 mg, 1 times / day Sources: Page: p.15 |
unhealthy n = 73 Health Status: unhealthy Condition: Pneumocystis carinii pneumonia Population Size: 73 Sources: Page: p.15 |
Blood urea nitrogen increased | 1% Disc. AE |
1500 mg 1 times / day multiple, oral Recommended Dose: 1500 mg, 1 times / day Route: oral Route: multiple Dose: 1500 mg, 1 times / day Sources: Page: p.15 |
unhealthy n = 73 Health Status: unhealthy Condition: Pneumocystis carinii pneumonia Population Size: 73 Sources: Page: p.15 |
Creatinine increased | 1% Disc. AE |
1500 mg 1 times / day multiple, oral Recommended Dose: 1500 mg, 1 times / day Route: oral Route: multiple Dose: 1500 mg, 1 times / day Sources: Page: p.15 |
unhealthy n = 73 Health Status: unhealthy Condition: Pneumocystis carinii pneumonia Population Size: 73 Sources: Page: p.15 |
Overview
CYP3A4 | CYP2C9 | CYP2D6 | hERG |
---|---|---|---|
Drug as perpetrator
Target | Modality | Activity | Metabolite | Clinical evidence |
---|---|---|---|---|
no | ||||
no | ||||
Sources: https://pubmed.ncbi.nlm.nih.gov/25218605/ |
no | |||
no | ||||
Sources: https://pubmed.ncbi.nlm.nih.gov/25218605/ |
no | |||
no | ||||
weak | ||||
yes [IC50 0.23 uM] | ||||
yes [IC50 6.8 uM] | ||||
yes | ||||
yes | ||||
Sources: https://pubmed.ncbi.nlm.nih.gov/25218605/ |
yes | |||
Sources: https://pubmed.ncbi.nlm.nih.gov/25218605/ |
yes |
Drug as victim
Target | Modality | Activity | Metabolite | Clinical evidence |
---|---|---|---|---|
yes |
PubMed
Title | Date | PubMed |
---|---|---|
Efficacy of a hydroxynaphthoquinone, 566C80, in experimental Pneumocystis carinii pneumonitis. | 1990 Feb |
|
Remarkable in vitro and in vivo activities of the hydroxynaphthoquinone 566C80 against tachyzoites and tissue cysts of Toxoplasma gondii. | 1991 Feb |
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Evaluation of the effect of drugs on the cyst form of Toxoplasma gondii. | 1991 Jul |
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In vitro and in vivo activities of the hydroxynaphthoquinone 566C80 against the cyst form of Toxoplasma gondii. | 1992 Feb |
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The activity of atovaquone (566C80) in murine toxoplasmosis is markedly augmented when used in combination with pyrimethamine or sulfadiazine. | 1993 Feb |
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In vitro model to assess effect of antimicrobial agents on Encephalitozoon cuniculi. | 1994 Oct |
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New drug developments for opportunistic infections in immunosuppressed patients: Pneumocystis carinii. | 1995 Nov 24 |
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Evaluation of the activities of rifabutin combined with atovaquone or low-dose of cotrimoxazole for prevention of pneumocystosis and toxoplasmosis in a dual infection rat model. | 1996 Sep-Oct |
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Atovaquone suspension compared with aerosolized pentamidine for prevention of Pneumocystis carinii pneumonia in human immunodeficiency virus-infected subjects intolerant of trimethoprim or sulfonamides. | 1999 Aug |
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Evaluation of the efficacy of atovaquone alone or in combination with azithromycin against acute murine toxoplasmosis. | 2000 Apr |
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Atovaquone-proguanil versus chloroquine-proguanil for malaria prophylaxis in non-immune travellers: a randomised, double-blind study. Malarone International Study Team. | 2000 Dec 2 |
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Effects of atovaquone and diospyrin-based drugs on the cellular ATP of Pneumocystis carinii f. sp. carinii. | 2000 Mar |
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Plasmodium falciparum: the effects of atovaquone resistance on respiration. | 2001 Aug |
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Application of higher throughput screening (HTS) inhibition assays to evaluate the interaction of antiparasitic drugs with cytochrome P450s. | 2001 Jan |
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Atovaquone nanosuspensions show excellent therapeutic effect in a new murine model of reactivated toxoplasmosis. | 2001 Jun |
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Efficacy of atovaquone combined with clindamycin against murine infection with a cystogenic (Me49) strain of Toxoplasma gondii. | 2002 Dec |
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Combined effect of atovaquone and pyrrolidine dithiocarbamate in the treatment of acute murine toxoplasmosis. | 2004 Jun |
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Prediction of genotoxicity of chemical compounds by statistical learning methods. | 2005 Jun |
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Acute hepatitis and atovaquone/proguanil. | 2005 Sep-Oct |
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In vitro atovaquone/proguanil susceptibility and characterization of the cytochrome b gene of Plasmodium falciparum from different endemic regions of Thailand. | 2008 Jan 28 |
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Novel HIV-1 protease inhibitors (PIs) containing a bicyclic P2 functional moiety, tetrahydropyrano-tetrahydrofuran, that are potent against multi-PI-resistant HIV-1 variants. | 2011 Apr |
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Identification and validation of tetracyclic benzothiazepines as Plasmodium falciparum cytochrome bc1 inhibitors. | 2011 Dec 23 |
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Sensitivity of Plasmodium vivax to chloroquine, mefloquine, artemisinin and atovaquone in north-western Thailand. | 2011 Oct |
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Drug screen targeted at Plasmodium liver stages identifies a potent multistage antimalarial drug. | 2012 Apr 15 |
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Targeting the ERAD pathway via inhibition of signal peptide peptidase for antiparasitic therapeutic design. | 2012 Dec 26 |
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Characterization of Plasmodium liver stage inhibition by halofuginone. | 2012 May |
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A SYBR Green 1-based in vitro test of susceptibility of Ghanaian Plasmodium falciparum clinical isolates to a panel of anti-malarial drugs. | 2013 Dec 17 |
|
Quinolin-4(1H)-imines are potent antiplasmodial drugs targeting the liver stage of malaria. | 2013 Jun 13 |
|
Design, synthesis and biological evaluation of WC-9 analogs as antiparasitic agents. | 2013 Nov |
|
FDA-approved drugs and other compounds tested as inhibitors of human glutathione transferase P1-1. | 2013 Sep 5 |
|
In vitro and in vivo combination of cepharanthine with anti-malarial drugs. | 2014 Mar 12 |
Patents
Sample Use Guides
Dosage for the Prevention of P. jiroveci Pneumonia:
1,500 mg (10 mL) once daily administered with food.
Dosage for the Treatment of Mild-to-Moderate P. jiroveci Pneumonia
The recommended oral dosage is 750 mg (5 mL) twice daily (total daily dose = 1,500 mg) administered with food for 21 days.
Route of Administration:
Oral
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Classification Tree | Code System | Code | ||
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NCI_THESAURUS |
C277
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FDA ORPHAN DRUG |
48890
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FDA ORPHAN DRUG |
66692
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FDA ORPHAN DRUG |
48990
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NDF-RT |
N0000175482
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WHO-ATC |
P01AX06
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FDA ORPHAN DRUG |
66792
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LIVERTOX |
NBK548592
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NDF-RT |
N0000175485
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ATOVAQUONE
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60212
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7083
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C28838
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m2127
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DB01117
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CHEMBL1450
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6914
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Atovaquone
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Y883P1Z2LT
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D053626
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100000086636
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Atovaquone and Proquanil
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95233-18-4
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575568
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EE-53
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759582
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258
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SUB05602MIG
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DTXSID7022629
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ACTIVE MOIETY