Malarone, Lariam, Doxycycline, or Paludrine: Which pills or tablets to take to protect against malaria?

Which antimalarials, tablets, and pills are available?

• Antimalarials are also called malaria prophylaxis. The most suitable antimalarial for you depends, among other things, on your destination and the duration of your trip.
• Different types of malaria are prevalent in different areas, and in some areas, mosquitoes are resistant to certain antimalarials.

What is paludrine, or proguanil hydrochloride?

• Paludrine contains proguanil and is still used in areas where mosquitoes are not yet resistant.
• The most common side effects, if they occur at all, are mild: nausea, diarrhea, abdominal pain, shortness of breath, vomiting, headache, etc. See also the website of the Centers for Disease Control and Prevention for the most recent information!
• As far as we know, Paludrine can be used during pregnancy and breastfeeding.

What is nivaquine or chloroquine?

• Nivaquine works on the basis of chloroquine and suppresses malaria, not preventing it. This means it could still flare up after your return.
• There is a fair amount of resistance to this drug in Southeast Asia and Africa; seek proper advice beforehand based on your destination(s).
• The most common side effects are mild, although things like hair loss, dizziness, rash, etc. are also regularly attributed to Nivaquine use.
• You should not use it if you have psoriasis!
• You should generally take the weekly dose of chloroquine on the day of departure to the malaria-affected area and again the following day. Then, switch to the weekly dose once a week. Continue until four weeks after leaving the malaria-affected area. Take the tablets during or after meals.
• You can also start taking the pills one or two weeks in advance. In that case, you don't need to take two doses on two consecutive days as described above. Continue taking them until four weeks after leaving the malaria-affected area.
• Suitable for pregnant women and children, although pregnant women are advised against traveling to malaria-affected areas. The consequences of treatment once you have malaria can be risky for both the mother and the unborn child.

What is Lariam or mefloquine?

• Travelers attribute unusual side effects to Lariam, such as unusual dreams, panic attacks, and depression. However, most travelers experience no side effects, or at least no more so than they would with other antimalarial drugs. Experts disagree on the risk of these side effects; studies vary from 1 in 10,000 to 1 in 140. Many travelers also become accustomed to certain side effects over time. It's important that you make your own decision in this regard (and/or in consultation with your doctor and travel doctor).
• The most common side effects are mild: nausea, diarrhea, dizziness, sleep problems, and balance problems (these usually resolve after one or more weeks; 70% of symptoms are caused by the first three pills).
• People with epilepsy, (severe) depression, or other psychiatric disorders, people taking beta blockers, or who have heart problems should generally not use this medication to prevent malaria (check with your doctor). Children under 15 kg (33 lbs) are also advised against it.
• Lariam is the most affordable anti-malarial medication on the market in the Netherlands.
• You take it once a week. It is recommended to start at home three weeks in advance to determine if you are hypersensitive. Continue for four weeks after leaving the malaria-affected area. Resistance to Lariam occurs occasionally (though it can vary). This was/is the case at the Thai border with Myanmar, Cambodia, and western Cambodia.
• If you are going diving, it is not recommended to use Lariam. This is because it can cause dizziness and balance problems.
• Pharmacy can make Lariam capsules for young children.

Pregnancy, breastfeeding, and Lariam?

• Lariam should not be used during the first three months of pregnancy.
• It is not recommended to become pregnant for three months after the last dose of Lariam, and breastfeeding is also not recommended.

What is Malarone, or the combination of atavaquone and proguanil?

• Malarone is a fairly expensive drug, especially because you have to take it daily: around 40 euros for 12 tablets. After a week or two, Lariam becomes more affordable, and the longer you go, the greater the price difference.
• Studies have shown that Malarone is approximately 98% effective in preventing malaria, which is equivalent to Lariam or doxycycline.
• Malarone has fewer side effects than other antimalarials; however, headaches or stomach problems may occur.
• You should take Malarone at the same time every day with food or a dairy drink. Start 1 day before departure and continue for up to 7 days after leaving a malaria-affected area.
• Pregnancy & breastfeeding: Malarone cannot be used during pregnancy, and breastfeeding is also not recommended.
• Not recommended for those sensitive to atovaquone or proguanil.

What is doxycycline?

• This antibiotic is not yet registered as an antimalarial in the Netherlands, but it is frequently prescribed in England, for example, and is also available locally in some areas.
• Doxycycline is mainly used in areas where resistance to other malaria tablets is high (Southeast Asia). Doxycycline is very inexpensive (cheaper than Lariam, let alone Malarone).
• When combined with doxycycline, the contraceptive pill may be less effective! Furthermore, some people experience sun sensitivity or gastrointestinal complaints.
• Start taking it on the day of departure and continue taking it for up to four weeks after leaving the malaria-affected area. It's best to test a week beforehand to ensure you don't experience any side effects.
• Not suitable for children under 8 years of age.
• Doxycycline cannot be used during pregnancy and breastfeeding.
• Currently, it is not recommended to take it for longer than three months without a doctor's supervision.

What is tafenoquine?

• Available since 2018 for the prevention and treatment of all types of malaria, usually under the brand name 'Krintafel'.
• In the treatment of malaria, it is always used in combination with another malaria medication (usually chloroquine) to combat the malaria parasite.
• Tafenoquine disrupts the growth of P. vivax in the liver, allowing the drug to prevent malaria relapses.
• Common side effects include vomiting, dizziness, and headache.

What are the other antimalarial medications and tablets?

• Fansidar: is no longer prescribed to prevent malaria, partly due to its severe side effects. It is still used as a treatment for malaria.
• Maloprim: is also a backup drug due to its side effects.
• Halofantrine: is no longer widely used due to side effects.
• Quinine: is used as a treatment.

Are there any new antimalarial drugs or malaria vaccines on the horizon?

New drugs are being extensively researched and are sometimes already available locally.

• Mosquirix. This vaccine targets malaria tropicana and is intended for young children. It has been in use since 2022 in several countries with high malaria infection rates. It has limited effectiveness, resulting in approximately 30% fewer hospitalizations.
• R21/Matrix-M: the first WHO-approved effective malaria vaccine, used in africa since 2023.
• Qinghao su (Artemisinin) is also a natural product. The discovery of this substance and its effects earned a Nobel Prize in 2015. Artemisinin is the active ingredient in the aforementioned sweet wormwood and can now also be chemically produced. Derived active ingredients include: arteflene, artemether, and artesunate (malaria medication, not prophylaxis). Misuse has led to the development of high local resistance to Artemisinin among malaria parasites.

Note:

• In some countries, you can also buy antimalarials over the counter. However, these may be of inferior quality and carry certain risks. The packaging may also list different active ingredients than those actually contained in the product. See the Centers for Disease Control and Prevention website for the most recent information!

What should you do if you're staying in a malaria area for a long time?

Two options

• Continue taking malaria pills
  • especially Lariam, which is suitable for a longer period provided you don't have any side effects.
  • Laria can be expensive, however.
• Stop taking the malaria tablets
  • If you do this, you should try to avoid getting bitten as much as possible in areas where malaria is prevalent.
  • It's also best to check beforehand where a doctor or hospital is located nearby.
  • Know what to do in the event of a malaria attack
  • Even if you've been in a malaria area for a long time, you don't become immune to malaria. You always run a risk of contracting it.
  • Keep an eye on vaccine developments, in some African countries a recognized vaccine is already available for children

Read more on Malaria

• Malaria: what is it, how dangerous is it, how do you get it, and how to prevent Malaria?
• See the websites of the World Health Organization, the Malaria Foundation International, or the Center for Disease Control and Prevention for the most up-to-date information on malaria and malaria prevention.