Patient leaflets and SmPCs, drug interaction checker, official dosages and NHS pharmacy opening hours — all in one place.
Patient leaflets and SmPCs, drug interaction checker, official dosages and NHS pharmacy opening hours — all in one place.
The electronic medicines compendium (emc) no longer publishes a Summary of Product Characteristics for this product, which usually means it is no longer marketed in the UK. The patient leaflet below is kept for reference, but the product may not be available.
If you were prescribed this medicine, other products containing Atovaquone, Proguanil hydrochloride may still be available. Do not stop your treatment — ask your pharmacist or GP what to use instead.
FOR
Maloff Protect belongs to a group of medicines called antimalarials. It contains two active ingredients, atovaquone and proguanil hydrochloride. Maloff Protect is used to prevent malaria. It is available from the pharmacy for adults. It is not suitable for use in children or adolescents unless it has been prescribed for them by a doctor. If you are under 18 and you are visiting an area where there is malaria, talk to your doctor, nurse or pharmacist for advice. Malaria is spread by the bite of an infected mosquito, which passes the malaria parasite (Plasmodium falciparum) into the bloodstream. Maloff Protect prevents malaria by killing this parasite. IMPORTANT: You must get advice from a healthcare professional about which antimalarial medicine or medicines to take. You must ask your doctor, nurse or pharmacist if Maloff Protect is suitable for the part of the world that you are visiting. Getting advice for malaria is only one of the aspects to protect your health before your travel. Remember to seek a full travel consultation. If your travel plans change, you must seek updated travel advice. Protect yourself from malaria People of any age can get malaria. It is a serious disease, but it is preventable. As well as taking Maloff Protect, it is very important that you also take steps to avoid being bitten by mosquitoes. The bite avoidance measures listed below should be used in combination for maximum effectiveness. Use insect repellent on exposed areas of the skin. Wear clothing that covers most of the body, especially after sunset as this is the time when
mosquitoes are most active. Sleep in a room with screened windows and doors or under a mosquito net (it is preferable to sleep under a mosquito net treated with insecticide if possible). Close windows and doors at sunset, if they are not screened. Sleep in a room with air-conditioning or a fan, as mosquitoes are less active in cooler temperatures. Consider using an insecticide (mats, spray, plug-ins) to clear a room of insects or to stop 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 these symptoms, particularly within three months but even up to one year after returning home: a high temperature (fever) headache tiredness sweats and chills vomiting Tell your doctor that you have visited a malaria area.
2.
E MALOFF PROTECT
Do not take Maloff Protect if you: are allergic to atovaquone and/or proguanil hydrochloride or any of the ingredients of this medicine (listed in section 6) have kidney disease have liver disease Do not take Maloff Protect unless it has been prescribed for you by a doctor or other qualified prescriber if you:
are breastfeeding, pregnant or think you may be pregnant (see section 'Pregnancy and Breastfeeding') are under 18 years old or weigh less than 40 kg have ever had epilepsy, convulsions or fits suffer from depression have tuberculosis
Do not take Maloff Protect if you are already taking any of the following medicines:
etoposide, used to treat cancer metoclopramide, used to treat nausea and vomiting the antibiotics tetracycline, rifampicin or rifabutin indinavir, efavirenz, zidovudine or certain medicines called protease inhibitors, used to treat
human immunodeficiency virus (HIV) warfarin, other coumarin based anticoagulants, or new oral anticoagulants (NOACs) such as dabigatran etexilate, rivaroxaban, and apixaban
Talk to your doctor or pharmacist for advice. Warnings and precautions: If you are sick (vomit) within one hour of taking your Maloff Protect tablet, take another dose straight away. If you don't start vomiting until more than one hour after taking Maloff Protect, do not take another Maloff Protect tablet until your next dose is due, as it is likely that Maloff Protect will already be in your system It is very important to take the full course of Maloff Protect. If you have to take extra tablets due to sickness, you may need to get some more If you have been vomiting or have diarrhoea, it is especially important to use extra bite prevention, such as repellents and bed nets. The Maloff Protect you have taken may not be as effective because you may absorb less than you need Tell your doctor or pharmacist if you have taken any medicines to prevent or treat malaria before and they have not worked or if you have had an allergic reaction to them. Maloff Protect may not be suitable for you.
Other medicines and Maloff Protect Tell your doctor or pharmacist if you are taking, have recently taken or might take any other medicines. This includes medicines that you buy without a prescription. Do not take Maloff Protect if you are taking any of the medicines listed in the above section "Do not take Maloff Protect ".
REMEMBER to tell your doctor or pharmacist if you start taking any other medicines while you're taking Maloff Protect. Maloff Protect with food and drink Take Maloff Protect with food or a milky drink, where possible. This will increase the amount of Maloff Protect your body can absorb, and make your treatment more effective. It is best if you swallow the tablets whole and do not crush them. Pregnancy and breastfeeding If you are pregnant, think you may be pregnant or intend to get pregnant, or you are breastfeeding, do not take Maloff Protect unless your doctor tells you to. Pregnant women have an increased risk of developing severe malaria and a higher risk of fatality compared to non-pregnant women. Seek advice from your doctor or pharmacist if you are pregnant or breastfeeding and need to take an antimalarial. Driving and using machines Maloff Protect makes some people feel dizzy. If you feel dizzy, do not drive, use machines or take part in activities where you may put yourself or others at risk.
3.
MALOFF PROTECT
Always take this medicine exactly as described in this leaflet or as your doctor, nurse or pharmacist has told you. Check with your doctor or pharmacist if you are not sure. Take Maloff Protect with food or a milky drink, where possible as this helps your body absorb the active ingredients. It is best to take Maloff Protect at the same time each day. Adults: Take one tablet once a day, as described below.
Start taking Maloff Protect one to two days before travelling to an area which has malaria. Continue taking it every day during your stay. Take Maloff Protect for another seven days after your return to a malaria-free area. Take the full course of Maloff Protect for maximum protection. Stopping early puts you at risk of getting malaria, as it takes seven days to ensure that any parasites that may be in your blood after a bite from an infected mosquito are killed.
Maloff Protect is only available without a prescription for adults. It is not suitable for use in children or adolescents unless it has been prescribed for them by a doctor. If you are under 18 and you are visiting an area where there is malaria, talk to your doctor, nurse or pharmacist for advice. If you take more Maloff Protect than you should Contact a doctor or pharmacist for advice. If possible, show them the Maloff Protect pack. If you forget to take Maloff Protect It is important that you take the full course of Maloff Protect. If you forget to take a dose, take your next dose as soon as you remember. Then continue your treatment as before. Do not take a double dose (two doses at the same time) to make up for a missed dose. Only take an additional dose if you are sick (vomit) within one hour of taking Maloff Protect. See "Warnings and precautions" overleaf. Don't stop taking Maloff Protect unless your doctor or pharmacist tells you to. The only exception is if you experience one of the serious side effects listed in section 4 below. Talk to your doctor or pharmacist if you need any advice. If you have any further questions on the use of this product, ask your doctor or pharmacist.
4.
Like all medicines, Maloff Protect can cause side effects, although not everybody gets them. IMPORTANT: If any side effect causes you to stop taking Maloff Protect, or if you vomit or have diarrhoea whilst taking Maloff Protect, you should continue to protect yourself against malaria as much as possible. Information on how to protect yourself from malaria is provided in section one of this leaflet. The bite avoidance measures listed in section one should be used in combination for maximum effectiveness.
Look out for the following severe reactions. They have occurred in a small number of people, but their exact frequency is unknown. Stop taking Maloff Protect and contact a doctor immediately if you notice any of the following symptoms: Severe allergic reactions – signs include: o rash and itching o sudden wheezing, tightness of the chest or throat, or difficulty breathing o swollen eyelids, face, lips, tongue or other part of the body Severe skin reactions: o 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) o severe widespread rash with blisters and peeling skin, particularly occurring around the mouth, nose, eyes and genitals (Stevens-Johnson syndrome) Most of the following side effects reported have been mild and have not lasted very long. Very common: may affect more than 1 in 10 people headache feeling sick and being sick (nausea and vomiting) stomach pain diarrhoea Common: may affect up to 1 in 10 people 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: may affect up to 1 to 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: may affect up to 1 in 1,000 people 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. pancytopenia (a decrease in all types of blood cells) inflammation of the liver (hepatitis) blockage of the bile ducts (cholestasis) 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 (seizures) 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) Reporting of side effects 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 the Yellow Card Scheme Website: www.mhra.gov.uk/yellowcard. By reporting side effects, you can help provide more information on the safety of this medicine.
5.
MALOFF PROTECT Keep this medicine out of the sight and reach of children. Do not use this medicine after the expiry date which is stated on the carton and the blister after EXP. The expiry date refers to the last day of that month. This medicine does not require any special storage conditions. Do not throw away any medicines via wastewater or household waste. Ask your pharmacist how to throw away medicines you no longer use. These measures will help protect the environment.
6.
What Maloff Protect contains 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 What Maloff Protect looks like and contents of the pack Maloff Protect tablets are pinkish brown to brown coloured, circular, biconvex bevelled edge filmcoated tablets with '404' debossed on one side and 'G' debossed on the other side. Maloff Protect tablets are supplied in PVC/PVDC (clear) and hard tempered PVC/PVDCAluminium foil blisters containing 12 tablets. Pack size: 24 or 36 tablets Marketing Authorisation Holder Glenmark Pharmaceuticals Europe Limited Laxmi House, 2 B Draycott Avenue, Kenton, Middlesex, HA3 0BU, United Kingdom Manufacturer Glenmark Pharmaceuticals Europe Limited. Building 2, Croxley Green Business Park, Croxley Green, Hertfordshire, WD18 8YA, United Kingdom Glenmark Pharmaceuticals s.r.o. Hvězdova 1716/2b, 140 78 Prague 4, Czech Republic
This leaflet was last revised in October 2024
The active substance in MaloffProtect is atovaquone, proguanil hydrochloride.
This leaflet reproduces the patient information leaflet approved for MaloffProtect, as published on the electronic medicines compendium (emc). The version printed inside your medicine’s packaging is the one that applies to you.
Whether a medicine is available over the counter or on prescription only depends on its licence. Check the leaflet, or ask your pharmacist — they can tell you straight away.
The text above reproduces the patient information leaflet approved for this medicine, restructured for easier reading.
It is indicated for:
• Chemoprophylaxis of Plasmodium falciparum (P. Falciparum) malaria in adults.
Because Maloff Protect is effective against drug sensitive and drug resistant P. falciparum it is especially recommended for chemoprophylaxis of P. falciparum malaria where the pathogen may be resistant to other antimalarials.
Official guidelines and local information on the prevalence of resistance to antimalarial drugs should be taken into consideration. Official guidelines will normally include World Health Organisation (WHO) and public health authorities' guidelines.
Method of administration
The daily dose should be taken with food or a milky drink (to ensure maximum absorption) at the same time each day.
The tablets should preferably not be crushed.
If patients are unable to tolerate food, Maloff Protect should be administered, but systemic exposure of atovaquone will be reduced. In the event of vomiting within one hour of dosing a repeat dose should be taken.
Posology
Chemoprophylaxis
Chemoprophylaxis should:
• commence one to two days prior to entering a malaria-endemic area, continue during the period of the stay,
• continue for seven days after leaving the area.
In residents (semi-immune subjects) of endemic areas, the safety and effectiveness of
Maloff Protect has been established in studies of up to 12 weeks.
In non-immune subjects, the average duration of exposure in clinical studies was 27 days.
Dosage in adults
One Maloff Protect tablet daily.
Maloff Protect tablets are not recommended for malaria chemoprophylaxis in persons under 40 kg bodyweight.
Dosage in the elderly
A pharmacokinetic study indicates that no dosage adjustments are needed in the elderly (see Section 5.2).
• Hypersensitivity to the active substances or to any of the excipients listed in section 6.1
• Patients with diagnosed renal impairment of any severity
• Patients with diagnosed hepatic impairment of any severity.
• Maloff Protect is contraindicated for use in children and adolescents
Persons taking Maloff Protect for chemoprophylaxis of malaria should be advised to take a repeat dose if they vomit within one hour of dosing. In the event of diarrhoea, normal dosing should be continued. Absorption of atovaquone may be reduced in patients with diarrhoea or vomiting, but diarrhoea or vomiting was not associated with reduced efficacy in clinical trials of Maloff Protect for malaria chemoprophylaxis. However, as with other antimalarial agents, subjects with diarrhoea or vomiting should be advised to continue with malaria prevention measures by complying with personal protection measures (repellents, bed nets).
Occasionally, severe allergic reactions (including anaphylaxis) have been reported in patients taking Maloff Protect. If patients experience an allergic reaction (see section 4.8) Maloff Protect should be discontinued promptly and appropriate treatment initiated.
Maloff Protect should not be used unless advised by a doctor or other qualified prescriber:
• In patients who are taking etoposide. (see section 4.5)
• In patients who are taking rifampicin or rifabutin (see section 4.5)
• In patients taking metoclopramide (see section 4.5)
• In patients taking warfarin or other oral anticoagulant (see section 4.5)
• In patients who are taking tetracycline (see section 4.5)
• In patients who are taking indinavir, efavirenz, zidovudine or boosted protease inhibitors (see section 4.5)
• In patients with a history of depression or seizures
• In patients with tuberculosis
• Patients who are pregnant, planning to become pregnant or breastfeeding. Pregnant women have an increased risk of developing severe malaria and a higher risk of fatality compared to non-pregnant women.
The safety and effectiveness of Maloff Protect has not been established for chemoprophylaxis of malaria in patients who weigh less than 40 kg.
Travellers should be reminded the need of receiving a full travel consultation if they have not already done so to undertake an overall risk assessment-based package of travel health advice. Malaria prophylaxis is only one of the aspects of pre-travel advice.
The maximum duration of travel for which Maloff Protect can be supplied without prescription is 12 weeks (93 tablets). For longer durations of travel, advice should be sought from a doctor or other qualified prescriber.
Concomitant administration of rifampicin or rifabutin with Maloff Protect is not recommended as it is known to reduce plasma concentrations of atovaquone levels by approximately 50% and 34%, respectively (see section 4.4).
Concomitant treatment with metoclopramide has been associated with a significant decrease (about 50%) in plasma concentrations of atovaquone.
When given with efavirenz or boosted protease-inhibitors, atovaquone concentrations have been observed to decrease by as much as 75%. This combination should be avoided whenever possible (see section 4.4).
Proguanil may potentiate the effect of warfarin and other coumarin based anticoagulants which may lead to an increase in risk of haemorrhage. The mechanism of this potential drug interaction has not been established. Caution is advised when initiating or withdrawing malaria prophylaxis with atovaquone proguanil in patients on continuous treatment with oralanticoagulants. The dose of oral anticoagulant may need to be adjusted during Maloff
Protect use or after its withdrawal, based on INR results. Concomitant treatment with warfarin, other coumarin-based anticoagulants, or NOACs such as dabigatran etexilate, rivaroxaban, and apixaban should be undertaken with caution. (see section 4.4) Apixaban and rivaroxaban are substrates of CYP3A4 and p-glycoprotein, whilst dabigatran is a substrate of p-glycoprotein. Atovaquone may produce minor inhibition of CYP3A4, but the effect of proguanil on this enzyme is unknown. Neither atovaquone nor proguanil inhibits p-glycoprotein.
Concomitant treatment with tetracycline has been associated with decreases in plasma concentrations (AUC) of atovaquone. (see section 4.4)
Concomitant administration of atovaquone and indinavir results in a decrease in the minimum concentration after dosing (Cmin) of indinavir (23% decrease; 90% CI 8-35%). (see section 4.4)
The co-administration of atovaquone at doses of 45 mg/kg/day in children (n=9) with acute lymphoblastic leukaemia for chemoprophylaxis of pneumocystis pneumonia (PCP) was found to increase the AUC of etoposide and its metabolite etoposide catechol by a median of 8.6% (P=0.055) and 28.4% (P=0.031) (respectively compared to the co-administration of etoposide and sulfamethoxazole-trimethoprim). Caution should be advised in patients receiving concomitant therapy with etoposide (see section 4.4).
Pharmacokinetic data have shown that atovaquone appears to decrease the rate of metabolism of zidovudine to its glucuronide metabolite (steady state AUC of zidovudine was increased by 33% and peak plasma concentration of the glucuronide was decreased by 19%). At zidovudine dosages of 500 or 600 mg/day it would seem unlikely that a concomitant course of Maloff Protect would result in an increased incidence of adverse reactions attributable to higher plasma concentrations of zidovudine.
Proguanil is primarily metabolised by CYP2C19. However, potential pharmacokinetic interactions with other substrates, inhibitors (e.g. moclobemide, fluvoxamine) or inducers (e.g. artemisinin, carbamazepine) of CYP2C19 are unknown (see section 5.2).
Atovaquone is highly protein bound (>99%) but does not displace other highly protein bound drugs in vitro, indicating significant drug interactions arising from displacement are unlikely.
Pregnancy
The safety of atovaquone and proguanil hydrochloride when administered concurrently for use in human pregnancy has not been established and the potential risk is unknown.
Animal studies showed no evidence for teratogenicity of the combination. The individual components have shown no effects on parturition or pre- and post-natal development. Maternal toxicity was seen in pregnant rabbits during a teratogenicity study (see section 5.3).
The proguanil component of Maloff Protect acts by inhibiting parasitic dihydrofolate reductase. There are no clinical data indicating that folate supplementation diminishes drug efficacy.
Lactation
The atovaquone concentrations in milk, in a rat study, were 30% of the concurrent atovaquone concentrations in maternal plasma. It is not known whether atovaquone is excreted in human milk.
Proguanil is excreted in human milk in small quantities.
Maloff Protect should not be used by women who are breastfeeding unless advised by a doctor or other qualified prescriber.
Dizziness has been reported. Patients should be warned that if affected they should not drive, operate machinery or take part in activities where this may put themselves or others at risk.
In clinical trials of atovaquone/proguanil in the treatment of malaria the most commonly reported adverse reactions were abdominal pain, headache, anorexia, nausea, vomiting, diarrhoea and coughing.
In clinical trials of atovaquone/proguanil for chemoprophylaxis of malaria, the most commonly reported adverse reactions were headache, abdominal pain and diarrhoea.
The following table provides a summary of adverse reactions that have been reported to have a suspected (at least possible) causal relationship to treatment with atovaquone/proguanil, in clinical trials and spontaneous post-marketing reports. The following convention is used for the classification of frequency:
very common (≥ 1/10); common (≥ 1/100 to <1/10); uncommon (≥ 1/1,000 to <1/100); rare (≥ 1/10,000 to <1/1,000); not known (cannot be estimated from the available data)
There are limited long term safety data in children. In particular, the long-term effects of Maloff Protect on growth, puberty and general development have not been studied.
System Organ Class
Very Common
Common
Uncommon
Rare
Not known2
Blood and lymphatic disorders
Anaemia
Neutropenia1
Pancytopenia in patients with severe renal impairment3
Immune system disorders
Allergic reactions
Angioedema3
Anaphylaxis (see section 4.4)
Vasculitis3
Metabolism and nutrition disorders
Hyponatraemia1
Anorexia
Elevated amylase levels1
Psychiatric disorders
Abnormal dreams
Depression
Anxiety
Hallucinations (observed from spontaneous post marketing reports)
Panic attack
Crying
Nightmares
Psychotic disorder
Nervous system disorders
Headache
Insomnia
Dizziness
Seizure
Cardiac disorders
Palpitations
Tachycardia
Gastrointestinal disorders
Nausea1
Vomiting
Diarrhoea
Abdominal pain
Stomatitis
Gastric intolerance3
Oral ulceration3
Hepatobiliary disorders
Elevated liver enzymes1,4
Hepatitis
Cholestasis3
Skin and subcutaneous tissue disorders
Pruritus
Rash
Hair loss
Urticaria
Stevens-Johnson syndrome
Erythema multiforme
Blister2
Skin exfoliation
Photosensitivity reactions
General disorders and administration site conditions
Fever
Respiratory, thoracic and mediastinal disorders
Cough
1. Frequency taken from atovaquone label. Patients participating in clinical trials with atovaquone have received higher doses and have often had complications of advanced Human Immunodeficiency Virus (HIV) disease. Therefore, the causal relationship between the adverse experiences and atovaquone is difficult to evaluate. These events may have been seen at a lower frequency or not at all in clinical trials with atovaquone/proguanil.
2. Observed from post-marketing spontaneous reports. The frequency is unknown.
3. Observed with proguanil.
4. Clinical trial data for atovaquone/proguanil indicated that abnormalities in liver function tests were reversible and not associated with untoward clinical events.
Reporting of suspected adverse reactions
Reporting suspected adverse reactions after authorisation of the medicinal product is important. It allows continued monitoring of the benefit/risk balance of the medicinal product. Healthcare professionals are asked to report any suspected adverse reactions via the national reporting system listed in the Yellow Card Scheme Website: www.mhra.gov.uk/yellowcard.
There is insufficient experience to predict the consequences or suggest specific management of Maloff Protect overdose. However, in the reported cases of atovaquone overdose, the observed effects were consistent with known undesirable effects of the drug. If overdose occurs, the patient should be monitored and standard supportive treatment applied.
Medicines sold in Romania with the same active substance: Cunoscut în România ca
⚠ Same active substance, but a different pharmaceutical form (for example a gel instead of a tablet). Not interchangeable — ask a pharmacist.
Same active substance. The strength, the form and whether you need a prescription can differ. Always ask a pharmacist before you switch. Romanian medicines in the UK →
Medicines sold in Poland with the same active substance: W Polsce znany jako
⚠ Same active substance, but a different pharmaceutical form (for example a gel instead of a tablet). Not interchangeable — ask a pharmacist.
Same active substance. The strength, the form and whether you need a prescription can differ. Always ask a pharmacist before you switch. Polish medicines in the UK →
Ask anything about MaloffProtect. The assistant answers only from this leaflet — if the leaflet does not cover it, it will say so. It does not give medical advice.
Answers come from the patient leaflet published on the electronic medicines compendium (emc). They are not medical advice. Ask a pharmacist or your GP if you are unsure. For urgent help call NHS 111, or 999 in an emergency.
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