Atovaquone/Proguanil Hydrochloride 250 mg/100 mg film-coated tablets

• Keep this leaflet. You may need to read it again.
• If you have any further questions, ask your doctor or pharmacist.
• This medicine has been prescribed for you. Do not pass it on to others. It may harm them, even if their symptoms are the same as yours.
• If you get any side effects, talk to your doctor or pharmacist. This includes any possible side effects not listed in this leaflet. See section 4.

1. What Atovaquone/Proguanil Hydrochloride is and what it is used for
2. What you need to know before you take Atovaquone/Proguanil Hydrochloride
3. How to take Atovaquone/Proguanil Hydrochloride
4. Possible side effects
5 How to store Atovaquone/Proguanil Hydrochloride
6. Contents of the pack and other information

People of any age can get malaria. It is a serious disease, but is preventable. As well as taking Atovaquone/Proguanil Hydrochloride 250 mg/100 mg Film-coated tablets, it is very important that you also take steps to avoid being bitten by mosquitoes.

• Use insect repellent on exposed areas of the skin.
• Wear light coloured clothing that covers most of the body, especially after sunset as this is the time when mosquitoes are most active.
• Sleep in a screened room or under a mosquito net impregnated with insecticide.
• Close windows and doors at sunset, if they are not screened.
• Consider using an insecticide (mats, spray, plug-ins) to clear a room of insects or to deter mosquitoes from entering the room.

If you need further advice, talk to your doctor or pharmacist

It is still possible to get malaria after taking the necessary precautions. Some types of malaria infection take a long time to cause symptoms, so the illness may not start until several days, weeks or even months after returning from abroad.

See a doctor immediately if you get symptoms such as high temperature, headache, shivering and tiredness after returning home.

• if you are allergic to Atovaquone and/or proguanil hydrochloride or any of the ingredients of this medicine (listed in section 6).
• for preventing malaria, if you have severe kidney disease.

When preventing malaria:

• if you are sick (vomit) within 1 hour of taking your Atovaquone/Proguanil Hydrochloride 250 mg/100 mg Film-coated tablet, take another dose straight away
• it is important to take the full course of Atovaquone/Proguanil Hydrochloride 250 mg/100 mg Film-coated tablets. If you have to take extra tablets due to sickness, you may need another prescription.
• if you have been vomiting, it is especially important to use extra protection, such as repellents and bednets. Atovaquone/Proguanil Hydrochloride 250 mg/100 mg Film-coated tablets may not be as effective, as the amount absorbed will be reduced.

When treating malaria:

• if you have vomiting and diarrhoea tell your doctor, you will need regular blood tests. Atovaquone/Proguanil Hydrochloride 250 mg/100 mg Film-coated tablets will not be as effective, as the amount absorbed will be reduced. The tests will check whether the malaria parasite is being cleared from your blood.
• if you have severe kidney disease, your doctor may want to prescribe a different medicine
• if you get a certain type of infection whilst being treated with Atovaquone/Proguanil Hydrochloride 250 mg/100 mg Film-coated tablets, your doctor may prescribe another type of medicine instead of Atovaquone/Proguanil Hydrochloride 250 mg/100 mg Film-coated tablets
• if the malaria is treated but then comes back repeatedly or if the malaria is caused by a certain type of parasite, your doctor may prescribe another medicine to be taken as well as Atovaquone/Proguanil Hydrochloride 250 mg/100 mg Film-coated tablets

Tell your doctor or pharmacist if you are taking, have recently taken or might take any other medicines.

Some medicines can affect the way Atovaquone/Proguanil Hydrochloride 250 mg/100 mg Film-coated tablets works, or Atovaquone/Proguanil Hydrochloride 250 mg/100 mg Film-coated tablets themselves can strengthen or weaken the effectiveness of other medicines taken at the same time. These include:

• metoclopramide, used to treat nausea and vomiting
• the antibiotics tetracycline, rifampicin and rifabutin
• efavirenz or certain highly active protease-inhibitors used to treat HIV
• indinavir, used to treat HIV
• warfarin and other medicines that stop blood clotting
• etoposide used to treat cancer.

Tell your doctor if you are taking any of these. Your doctor may decide that Atovaquone/Proguanil Hydrochloride 250 mg/100 mg Film-coated tablets aren’t suitable for you, or that you need extra check ups while you’re taking it.

REMEMBER to tell your doctor if you start taking any other medicines while you’re taking Atovaquone/Proguanil Hydrochloride 250 mg/100 mg Film-coated tablets.

Take Atovaquone/Proguanil Hydrochloride 250 mg/100 mg Film-coated tablets with food or a milky drink, where possible. This will increase the amount of Atovaquone/Proguanil Hydrochloride 250 mg/100 mg Film-coated tablets your body can absorb, and make your treatment more effective.

The tablets should preferably not be crushed.

If you are pregnant or if you have the intention to get pregnant, do not take Atovaquone/Proguanil Hydrochloride 250 mg/100 mg Film-coated tablets unless your doctor recommends it.

Ask your doctor or pharmacist for advice before taking Atovaquone/Proguanil Hydrochloride 250 mg/100 mg Film-coated tablets.

Do not breast feed while taking Atovaquone/Proguanil Hydrochloride 250 mg/100 mg Film-coated tablets, as the ingredients of Atovaquone/Proguanil Hydrochloride 250 mg/100 mg Film-coated tablets may pass into breast milk and may harm your baby.

If you feel dizzy, do not drive. Atovaquone/Proguanil Hydrochloride 250 mg/100 mg Film-coated tablets make some people feel dizzy. If this happens to you, do not drive, use machines or take part in activities where you may put yourself or others at risk.

The usual dose for adults and adolescents weighing more than 40 kg is 1 tablet once a day, taken as below.

For children, talk to your doctor.

Atovaquone/Proguanil Hydrochloride 250 mg/100 mg Film-coated tablets is not recommended for preventing malaria in children, or in adults or adolescents who weigh less than 40 kg.

There may be a different type of Atovaquone/Proguanil Hydrochloride 250 mg/100 mg Film-coated tablets available for children in your country.

To prevent malaria in adults:

• start taking Atovaquone/Proguanil Hydrochloride 250 mg/100 mg Film-coated tablets 1 to 2 days before travelling to an area which has malaria
• continue taking it every day during your stay and then continue taking it for another 7 days after your return to a malaria-free area. Take the full course of Atovaquone/Proguanil Hydrochloride 250 mg/100 mg Film-coated tablets for maximum protection. Stopping early puts you at risk of getting malaria, as it takes 7 days to ensure that any parasites that may be in your blood following a bite from an infected mosquito are killed.

The usual dose for adults is 4 tablets once a day for 3 days.

For children weighing 11 kg or more:

• ≥11 to <20 kg – 1 tablet once a day for 3 days
• ≥ 21 to <30 kg – 2 tablets once a day for 3 days
• ≥ 31 to <40 kg – 3 tablets once a day for 3 days
• Over 40 kg – dose as for adults.

Atovaquone/Proguanil Hydrochloride 250 mg/100 mg Film-coated tablets is not recommended for treating malaria in children who weigh less than 11 kg.

For children who weigh less than 11 kg talk to your doctor. There may be a different type of Atovaquone/Proguanil Hydrochloride 250 mg/100 mg Film-coated tablet available in your country

Contact a doctor or pharmacist for advice. If possible show them the Atovaquone/Proguanil Hydrochloride 250 mg/100 mg Film-coated tablets pack.

It is very important that you take the full course of Atovaquone/Proguanil Hydrochloride 250 mg/100 mg Film-coated tablets. If you forget to take a dose, don’t worry. Just take your next dose as soon as you remember. Then continue your treatment as before. Don’t take a double dose to make up for a missed dose.

Keep taking Atovaquone/Proguanil Hydrochloride for 7 days after you return to a malaria-free area. Take the full course of Atovaquone/Proguanil Hydrochloride for maximum protection. Stopping early puts you at risk of getting malaria, as it takes 7 days to ensure that any parasites that may be in your blood following a bite from an infected mosquito are killed.

Please talk to your doctor or pharmacist if you need any advice.

Severe skin reactions:

• skin rash, which may blister and looks like small targets (central dark spots, surrounded by paler area with a dark ring around the edge) (erythema multiforme)
• severe widespread rash with blisters and peeling skin, particularly occurring around the mouth, nose, eyes and genitals (Stevens-Johnson syndrome). If you notice any of these symptoms contact a doctor urgently.

Most of the other side effects reported have been mild and have not lasted very long.

Very common: affects more than 1 user in 10

• headache
• feeling sick and being sick (nausea and vomiting)
• stomach pain
• diarrhoea

Common: affects 1 to 10 users in 100

• dizziness
• sleeping problems (insomnia)
• strange dreams
• depression
• loss of appetite
• fever
• rash
• cough
• allergic reactions
• itching (pruritus)

Common side effects, which may show up in your blood tests are:

• reduced numbers of red blood cells (anaemia) which can cause tiredness, headaches and shortness of breath
• reduced numbers of white blood cells (neutropenia) which may make you more likely to catch infections
• low levels of sodium in the blood (hyponatraemia)
• an increase in liver enzymes.

Uncommon: affects 1 to 10 users in 1,000

These may affect up to 1 in 100 people:

• anxiety
• an unusual awareness of abnormal beating of the heart (palpitations) swelling and redness of the mouth
• red swollen patches on the skin (hives)
• hair loss.

Uncommon side effects that may show up in your blood tests:

• an increase in amylase (an enzyme produced in the pancreas).

Rare: affects 1 to 10 users in 10,000

• seeing or hearing things that are not there (hallucinations)

Other side effects: Other side effects have occurred in a small number of people but their exact frequency is unknown.

• Inflammation of the liver (hepatitis)
• blockage of the bile ducts (cholestatis)
• increase in heart rate (tachycardia)
• inflammation of the blood vessels (vasculitis) which may be visible as red or purple raised spots on the skin but can affect other parts of the body
• fits (seizure)
• panic attacks, crying
• nightmares
• severe mental health problem in which the person loses contact with reality and is unable to think and judge clearly
• mouth ulcers
• blisters
• peeling skin
• increased sensitivity of the skin to sunlight
• effects on your stomach (gastric intolerance).

Other side effects that may show up in your blood tests:

• Adecrease in all types of blood cells (pancytopenia).

If you get any side effects, talk to your doctor or pharmacist. This includes any possible side effects not listed in this leaflet. You can also report side effects directly via Yellow Card Scheme at: www.mhra.gov.uk/yellowcard. By reporting side effects you can help provide more information on the safety of this medicine.

The active substances are atovaquone and proguanil hydrochloride.

Each tablet contains 250 mg atovaquone and 100 mg proguanil hydrochloride.

The other ingredients are:

Core

Poloxamer 188 , Microcrystalline Cellulose, Low-substituted Hydroxypropyl Cellulose, Povidone K30, Sodium Starch Glycolate Type A, Silica Colloidal anhydrous, Magnesium Stearate

Coating

Hypromellose, Titanium Dioxide (E171), Iron Oxide Red (E172), Macrogol 400, Macrogol 8000

Atovaquone/Proguanil Hydrochloride 250 mg/100 mg Film-coated tablets are Pinkish brown to brown coloured, circular, biconvex beveled edge Film-coated tablets with ‘404’ debossed on one side and ‘G’ debossed on the other side.

Atovaquone/Proguanil Hydrochloride 250 mg/100 mg Film-coated are supplied in PVC/PVDC (clear) and hard tempered PVC/PVDC-Aluminium foil blister packs containing 12 tablets

Pack size: 12, 24, 36, 60

Not all pack sizes may be marketed.

This medicinal product is authorised in the Member States under the following names:

Denmark Atovaquon/Proguanilhydrochlorid Glenmark 250 mg /100 mg Filmovertrukne tabletter

Germany Atovaquon/Proguanilhydrochlorid Glenmark 250 mg /100 mg Filmtabletten

France Atovaquone/Proguanil Alfasigma 250 mg /100 mg comprimé pelliculé

United Kingdom Atovaquone/Proguanil Hydrochloride 250 mg /100 mg Film-coated tablets

The Netherlands Atovaquon/Proguanilhydrochloride Glenmark 250 mg /100 mg Filmomhulde Tabletten

Belgium Atovaquone/Proguanil Glenmark 250mg/100mg filmomhulde tabletten/comprimés pellicullés/Filmtabletten

Sweden Atovakvon / Proguanil Glenmark 250/100 mg filmdragerade tabletter

Spain Malaway 250 mg/100 mg Comprimidos recubiertos con película

Ireland Atovaquone/Proguanil Hydrochloride 250 mg /100 mg Film-coated tablets

Poland Falcimar

Iceland Atóvakón/Prógúanílhýdróklóríð Glenmark 250mg/100mg filmuhúðaðar töflur

Norway Atovakon/proguanil Glenmark

Austria Atovaquon/Proguanil-Hydrochlorid Glenmark 250 mg/100 mg Filmtabletten

Finland Atovaquone/Proguanil Glenmark 250 mg/100 mg kalvopäällysteinen tabletti