Malaria Prevention Medication
Various medications can be used to prevent malaria. Here is some information to help you in the complex process of deciding which drug is best for you.
DOXYCYCLINE
This medication will work in a large number of areas, and is the only effective drug for the Thai/Myanmar and Thai/Cambodia borders.
Taken 1 tablet per day starting 2 days prior to entering a malarious area, every day while there and for 28 days after leaving the malarious area.
Contraindicated in pregnancy or if under 8 years of age.
Side Effects:
A small number of people are more prone to sunburn. If so, take the medication with your evening meal, rather than in the morning, apply sunscreen and avoid sun exposure.
Some women develop thrush so thrush cream (Canestan) can be taken just in case.
Women should also be warned that it reduces the contraceptive effects of the pill for the first 2 weeks whilst taking it.
Nausea and vomiting occur occasionally and can be reduced by combining medication with a meal, remaining upright after dosage, and drinking lots of water.
This preparation will cost slightly over $1 per tablet.
MALARONE
Appears to be very safe, effective and to have few side effects, but is expensive ( about $7 - $8 per tablet).
Taken 1 tablet per day, starting 2 days prior to entering a malarious area, every day while there and for 7 days after leaving the malarious area.
Contraindicated in pregnancy.
Side effects: Almost none, but take after a meal to reduce any side effects (Gastrointestinal side effects are reported at higher doses used for treatment of malaria ie: 4 tabs/day for 3
days). Our clinic has this preparation available and because of the cost, can provide individual tablets....you do not have to buy a whole box if its not needed! ( they come in 12's)
LARIAM
This drug is usually well tolerated and can be used for long term prevention.
Taken 1 tablet per week, starting 1-2 weeks prior to entering a malarious area, continuing during and for 4 weeks after leaving the malarious area.
Adverse events can be predicted while you are still at home by taking one tablet daily for 3 days (or 3 doses a week apart), and adverse effects should be apparent after the 3 doses have been taken.
Contraindicated in epilepsy, depression, anxiety, psychotic illness.
Cautions: cardiac conduction defect, or if taking calcium channel or beta-blockers. Driving, diving and piloting may be difficult.
Side Effects: These have been exaggerated in the media, but include insomnia, nightmares, irritability, and depression. These can effect one in 200-500 in a disabling fashion. Psychosis does however occur in 1:12000. 2 Cases of psychosis have been reported in people taking it for the second time and the psychosis continued after cessation of the medication. This is disturbing information.
However, 97% of travellers are able to tolerate the drug without discontinuing it.
Alcohol, cannabis etc may exacerbate side effects, so are best avoided for 36 hours after a dose.
The dose may be halved and taken every 4 days to help reduce side effects, and it is very important to take with a meal and to be well HYDRATED.
Cost $8/tablet
CHLOROQUINE
Very inexpensive, but not used much either, mainly used for cental america.
Taken 2 tablets per week, starting 2 weeks prior to entering a malarious area, continuing during and for 4 weeks after leaving the malarious area.
Side effects: gastro intestinal, headaches, dizziness, blurred vision. Psoriasis is sometimes exacerbated.
In Long term use retinopathy is possible.
To reduce side effects take with meals or divide into twice weekly doses.
Caution: Concurrent intradermal Rabies vaccination not advised.
PROGUANIL
Taken in combination with Chloroquine in Chloroquine resistant areas, but this combination has considerably less efficacy than the newer drugs.
Taken 2 tabs per day, starting 2 days prior to entering the malarious area, continuing during and for 4 weeks after leaving the malarious area.
