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Proguanil (chlorguanide, chloroguanide) is a prophylactic antimalarial drug. When taken, it is converted to the active metabolite cycloguanil. Proguanil is effective against sporozoites. Proguanil hydrochloride is marketed as Paludrine by AstraZeneca.
It has been used for malarial prophylaxis in children with sickle cell disease living in malaria-endemic areas for many years.
It is on the World Health Organization's List of Essential Medicines, a list of the most important medication needed in a basic health system.
Malarone has fewer side effects than mefloquine, but can be more expensive because it is taken daily.
Proguanil is taken with atovaquone for chloroquine-resistant and multidrug resistant strains of P. falciparum and P. vivax. Proguanil combined with atovaquone is sold under the tradename Malarone (GlaxoSmithKline).
General precautions regarding proguanil involve watching out for feelings of sullenness and anxiety to a level outside the ordinary, when taking it over a period of several months. These may come on gradually and may not be immediately attributable to anything in particular.
The active metabolite of the proguanil is cycloguanil, which binds to the DHFR enzyme of the parasite and inhibts the folic acid metabolism. The mechanism for the cyclisation of the proguanil to cycloguanil has been recently explored by Bharatam et al.
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- Crowther AF, Levi AA (1953). "Proguanil, the isolation of a metabolite with high antimalarial activity". Br J Pharmacol Chemother 8 (1): 93–97. doi:10.1111/j.1476-5381.1953.tb00758.x. PMC 1509229. PMID 13066702.
- "WHO Model List of EssentialMedicines" (PDF). World Health Organization. October 2013. Retrieved 22 April 2014.
- Sutherland CJ, Laundy M, Price N et al. (November 2008). "Mutations in the Plasmodium falciparum cytochrome b gene are associated with delayed parasite recrudescence in malaria patients treated with atovaquone-proguanill". Malar. J. 7 (1): 240. doi:10.1186/1475-2875-7-240. PMC 2640403. PMID 19021900.
- Payen C, Monnin L, Pulce C, Descotes J (December 2008). "Bone marrow aplasia following acute poisoning with chloroquine-proguanil". Clin Toxicol (Phila) 46 (10): 1085–7. doi:10.1080/15563650601182925. PMID 19065311.