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 one effective drug for the difficult 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 it’s not needed – they come in packs of 12.

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 affect 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 about $8/tablet.