Antimalarial medicine for prevention
If you are travelling to an area with a risk of malaria, your doctor will recommend you take antimalarial tablets to prevent you from becoming infected. The antimalarial tablets that you are prescribed will be based on the following factors:
- where you are going
- medical history, including any drug allergies
- relevant family medical history
- current medicines
- any problems with antimalarial medicines in the past
- your age
- whether you are pregnant
Sometimes, you need to take a short trial course of antimalarial tablets before you go. This is to check that you do not experience any side effects or reactions. If you do, alternative antimalarials can be prescribed before you leave.
If you are planning to go away for more than six months, you are considered a long-term traveller.
When travelling to areas where there is a risk of malaria, always consider taking antimalarial medicine. If you are travelling to different places, you may only need to take antimalarials for part of your trip.
Discuss your options at a specialist travel health clinic or your GP surgery as soon as possible.
Antimalarial medicine for treatment
With prompt diagnosis and treatment, most people make a full recovery from malaria. If you have been diagnosed with malaria, your treatment must start as soon as possible.
Malaria can be treated using the same antimalarial medicines taken to prevent malaria. However, if you have taken a preventive anti-malarial medicine, your doctor should not give you the same one to treat your malaria. Therefore, it is important you tell your doctor what tablets you took to prevent malaria.
The antimalarial medicine that you are prescribed and the length of your treatment depend on:
- the type of malaria you have
- how bad your symptoms are
- where you caught malaria
- if you took antimalarial tablets
- whether you are pregnant
- your age
Your doctor will check the most recent advice and recommend the right treatment for you. They may recommend a combination of different medicines to overcome strains of malaria that have become drug-resistant.
Often, antimalarial treatment is given as tablets or capsules. If you are very ill, you will be admitted to hospital and treatment is usually given through a drip into a vein in your arm.
Treatment for malaria can leave you feeling very weak and tired for several weeks.
Emergency standby treatment
This is a course of medicine that can be taken for malaria symptoms if you cannot reach a doctor while you are travelling overseas.
Research has shown that emergency standby treatment is often used incorrectly. It should only be considered for travellers who are going to be in very remote areas away from medical help.
It is not a substitute for taking the right malaria prevention tablets. Your doctor should get advice from a travel health specialist before prescribing emergency standby treatment.
Types of antimalarial drugs
There are five medicines used to prevent malaria.
Atovaquone plus proguanil (also known as Malarone)
- Prevention: the adult dose is one adult-strength tablet a day. Child dosage is also once a day, but the amount depends on the child's weight. It should be started just one or two days before your trip, taken all the time that you are in a risk area and for seven days after you get back.
- Recommendations: lack of research means that this drug is not usually recommended for pregnant or breastfeeding women. It is also not advised for people with severe kidney problems.
- Possible side effects: intestinal upset, headaches, skin rash and mouth ulcers.
- Other factors: it is more expensive than other antimalarials so may be more suitable for use on short trips.
Chloroquine (also known as Avloclor tablets and Nivaquine syrup)
- Prevention: the adult dosage is two tablets taken once a week. Child dosage is also once a week but the amount depends on the child's weight. Nivaquine is available in a syrup for small children. It must be started one week before you travel, taken all the time you are in a risk area and for four weeks after you return.
- Recommendations: it is not recommended for people with liver or kidney problems, psoriasis or epilepsy.
- Possible side effects: bitter taste, nausea (which may be reduced by taking tablets after food), headache, skin itching in people of African descent and eye problems after years of continuous use.
- Other factors: chloroquine is one of the oldest antimalarial medicines and many strains of malaria are now resistant to it.
Doxycycline (also known as Vibramycin-D)
- Prevention: the dose is 100mg daily as a tablet or capsule. You should start the tablets two days before you travel, and take them all the time you are in a risk region and for four weeks after you return.
- Recommendations: it is not suitable for pregnant or breastfeeding women, children under 12 (because of the risk of permanent tooth discolouration), people who are sensitive to tetracycline antibiotics or people with liver problems.
- Possible side effects: sunburn due to light sensitivity, stomach upset, heartburn and thrush. It should always be taken with food, preferably when standing or sitting. Doxycycline initially reduces the effectiveness of combined hormone contraceptives, such as the pill or patches.
- Other factors: if you take doxycycline for acne, this will provide protection against malaria, as long as you are taking an adequate dose (ask your GP). Doxycycline is relatively cheap.
Mefloquine (also known as Lariam)
- Prevention: the adult dose is one tablet weekly. Child dosage is also once a week but the amount will depend on the child's weight. It should be started three weeks before you go and taken all the time you are in the risk region and for four weeks after you get back.
- Recommendations: it is not recommended if you have epilepsy, seizures, depression or psychiatric problems, or if a close relative has any of these conditions. It is not usually recommended for people with severe heart or liver problems.
- Possible side effects: dizziness, headache, sleep disturbances (insomnia and vivid dreams) and psychiatric reactions (anxiety, depression, panic attacks and hallucinations). It is very important to tell your doctor about any previous psychiatric problems, including mild depression. You should not take this medication if you have a seizure disorder.
- Other factors: if you have not taken mefloquine before, it is recommended that you do a three-week trial before you travel to see if you develop any side effects.
Proguanil (also known as Paludrine)
- Prevention: the adult dosage is two proguanil tablets each day (usually taken with two tablets of chloroquine once a week, on the same day each week). Child dosage is also proguanil daily and chloroquine once a week, but the amount will depend on the child's weight. You should start taking it one week before travel and continue all the time you are in a risk area and for four weeks after you return.
- Recommendations: proguanil should be used with caution if you are taking a medicine to prevent blood clots (an anticoagulant, such as warfarin) or if you have kidney problems.
- Possible side effects: mouth ulcers, diarrhoea, nausea and anorexia.
- Other factors: the major disadvantage of taking proguanil and chloroquine is that resistance has developed in many areas, so the drugs are no longer effective.
Taking antimalarials during pregnancy
If you are pregnant, avoid travelling to areas where there is a risk of malaria. Pregnant women have an increased risk of developing severe malaria and it is more dangerous for them and their baby.
If you feel you must travel to malaria risk areas while pregnant, it is important to take the right antimalarial medicine. Some of the drugs used to prevent and treat malaria are unsuitable as they may cause side effects for you and your baby.
- Chloroquine and proguanil are safe to use at any stage of your pregnancy without harm to you or your baby. It is recommended that you take a 5mg folic acid supplement while you are taking proguanil. Chloroquine alone or the combination with proguanil does not offer enough protection in many regions, including Africa.
- Mefloquine (Larium) is not usually prescribed in pregnancy. However, if travel is unavoidable, it can be considered for countries with a high risk of malaria.
- Doxycycline is never recommended for pregnant or breastfeeding women in Ireland as it could harm the baby.
- Atovaquone and proguanil (Malarone) is generally not recommended as there is only limited research on use of this drug in pregnancy. If the risk of malaria is high, it can be taken if mefloquine is not suitable.