Atovaquone (Mepron) demonstrates significant efficacy in lipid-lowering therapy but may also induce various adverse reactions.

I. Adverse Reactions of Atovaquone (Mepron)

1. Serious Adverse Reactions

1.1 Rhabdomyolysis

(1) Manifestations include muscle pain, weakness, marked elevation of creatine kinase, and increased myoglobin in blood and urine.

(2) In severe cases, it may lead to critical complications such as acute kidney injury.

If any of the above symptoms occur, discontinue the drug immediately and seek medical attention.

1.2 Hepatic Impairment

(1) May cause hepatitis, jaundice, and marked elevation of hepatic enzymes such as AST and ALT.

(2) If AST or ALT persistently exceeds 2.5 times the upper limit of normal or reaches above 100 units, the drug must be discontinued immediately.

Liver function should be monitored regularly during treatment.

1.3 Pancreatitis

(1) Manifested as severe abdominal pain, nausea, vomiting, accompanied by elevated amylase and lipase.

(2) If pancreatitis is suspected, discontinue the drug immediately and initiate medical intervention.

2. Common Adverse Reactions

(1) Hepatic system: Elevated liver enzymes (AST, ALT, γ‑GTP, etc.), occasional hepatomegaly.

(2) Skin reactions: Rash, pruritus, urticaria; alopecia, photosensitivity reaction or erythema multiforme in a few patients.

(3) Gastrointestinal system: Nausea, vomiting, constipation, diarrhea, anorexia, epigastric discomfort, etc.

(4) Renal system: Elevated blood urea nitrogen and creatinine, indicating abnormal renal function.

(5) Musculoskeletal system: Elevated creatine kinase, muscle spasm, stiffness.

(6) Hematological system: Anemia, abnormal leukocytes, abnormal platelets, etc.

(7) Nervous system: Headache, dizziness, fatigue.

(8) Biliary system: Cholelithiasis, cholecystitis.

(9) Others: Positive antinuclear antibody, general malaise, palpitations, edema, taste disturbance, limb numbness, etc.

II. Methods to Alleviate Adverse Reactions of Atovaquone

1. Preventive Measures Before Administration

(1) Comprehensive evaluation: Before treatment, hepatic and renal function and lipid levels should be examined to ensure eligibility for medication.

(2) Starting with low dose: For patients with hepatic or renal dysfunction, the elderly, or high‑risk populations, initiate treatment at the lowest dose (53.3 mg daily).

2. Monitoring and Dose Adjustment During Treatment

(1) Hepatic function: Recheck monthly for the first 3 months, then every 3 months thereafter.

(2) Renal function: Monitor serum creatinine regularly.

(3) Creatine kinase: Test promptly if muscular symptoms occur.

(4) Dose adjustment: Reduce the dose or extend the dosing interval as needed based on test results and symptoms.

3. Management of Adverse Reactions

(1) Mild gastrointestinal reactions: Administration after meals is recommended to reduce gastrointestinal irritation.

If symptoms persist, consult a physician to adjust the timing or dose.

(2) Muscular discomfort: If muscle pain or weakness occurs, measure creatine kinase immediately; discontinue the drug and seek medical advice if necessary.

(3) Rash or allergic reaction: Mild rash may be observed. If it worsens or is accompanied by systemic symptoms, discontinue immediately and seek medical help.

(4) Elevated liver enzymes: Close observation is acceptable for mild elevation; discontinue the drug and recheck liver function for marked elevation.

(5) Renal dysfunction: If elevated creatinine is found, reduce or discontinue the dose according to severity, and investigate whether it is related to rhabdomyolysis.

4. Management of Drug Interactions

(1) Concomitant use with statins: Increased risk; start with low dose and closely monitor renal function and creatine kinase.

(2) Concomitant use with anticoagulants: Monitor coagulation function and adjust anticoagulant dose.

(3) Concomitant use with sulfonylurea antidiabetic agents: Watch for hypoglycemia and monitor blood glucose.

(4) Concomitant use with anion‑exchange resins: Administer at least 1 hour apart or more than 4–6 hours apart.

(5) Concomitant use with cyclosporine: Alert for worsening renal function; monitor renal function regularly.

5. Precautions for Special Populations

(1) Elderly patients: Start with low dose and closely monitor hepatic and renal function.

(2) Patients with hepatic or renal insufficiency: Strictly adjust dose or contraindicate according to guidelines.

(3) Pregnant and lactating women: Contraindicated.

III. Storage Conditions for Atovaquone

1. Storage Requirements

(1) Temperature: Store at room temperature; avoid excessive heat or freezing.

(2) Light protection: Protect from light after opening to prevent discoloration or degradation due to light exposure.

(3) Moisture protection: Avoid humidity after opening; store in a dry place.

2. Packaging and Administration Precautions

(1) PTP package instructions: Remove the tablet from the PTP sheet before administration.

Do not swallow the package directly to avoid esophageal injury.

(2) Shelf life: 3 years. Do not use after the expiration date.

3. Management After Opening

(1) Use as soon as possible after opening to avoid prolonged exposure to air.

(2) Discontinue use if tablets show discoloration, abnormal odor, or deformation.