Malarone

What does it do?

Malarone is a combination drug, containing Atovaquone (250mg) and Proguanil (100mg), and each component stops the P.falciparum parasite from reproducing in the blood. It is used as a preventative method against malaria from bites from mosquitoes infected with this parasite.
Stronger doses of the drug are used to treat uncomplicated malaria from the same parasite.

Who is at risk of malaria?

Malaria is a tropical disease carried by mosquitoes in infected areas, and is common in areas such as Southern Asia, Africa, and South America. Before travelling to these climates, it is important to check the malaria risk for the specific location and time of year you are visiting. Consult the NHS Fit for Travel website or consult a travel medicine professional for more advice.

People who previously built up immunity by living in malaria areas can lose that immunity over time. The recommended tablets for an area can change from time-to-time.

Children and women who are pregnant or breastfeeding are at increased risks, including severe and fatal malaria.

See a doctor immediately if you get flu-like symptoms such as a high temperature, headache, body aches, shivering and tiredness after leaving a malaria risk area for up to one year, as this may indicate a malaria infection.

Why Malarone?

Malarone is one of a choice of anti-malarial drugs that can be prescribed but is particularly effective in high-risk areas where resistance to chloroquine, which targets the same P.falciparum parasite, is prevalent. Its simple dosage means it is suitable for last-minute holidays and trips of shorter duration.
The Fit for Travel website has details of recommended malaria tablets (and other travel health advice) for each destination.

How to take Malarone

After consultation with a doctor, detailing the specifics of your trip, your Malarone prescription needs to be started one to two days before entering an area with malaria risk. Take one tablet every day during your stay and for seven days after leaving the area.

Take the tablet at the same time once a day with food or a milky drink. For the medication to be effective, and to prevent resistance, the whole course of tablets must be completed.

If you forget to take a dose just take your next dose as soon as you remember. Then continue your treatment as before.

How to take Malarone
After consultation with a doctor, detailing the specifics of your trip, your Malarone prescription needs to be started one to two days before entering an area with malaria risk. Take one tablet every day during your stay and for seven days after leaving the area.

Take the tablet at the same time once a day with food or a milky drink. For the medication to be effective, and to prevent resistance, the whole course of tablets must be completed.

If you forget to take a dose just take your next dose as soon as you remember. Then continue your treatment as before.

How effective is it?
No anti-malarial medication is 100% effective and preventative measures should be taken to decrease the risk of being bitten in high-risk areas. Cover exposed skin, especially during and after dusk, use an insect repellent and mosquito nets at night.

What are the side effects of Malarone?
All medication affects patients individually, with some possible side effects being more common than others. Malarone is very well tolerated compared with other antimalarials. A full list of side effects can be found in the manufacturer’s patient information leaflet (PDF) supplied with Malarone tablets.

Common side effects (affecting more than 1 in 10 people) include headaches, nausea, vomiting, diarrhoea and abdominal pain. These side effects can often be alleviated by taking Malarone with food or a milky drink.

Less common side effects (affecting up to 1 in 10 people) include loss of appetite, coughing, dizziness, fever, rash or itching, insomnia, or abnormal dreams, and anaemia.

Uncommon side effects (affecting up to 1 in 100 people) include anxiety, palpitations, swelling and redness of the mouth, hair loss, and hives. Other rare side effects are listed in the patient information leaflet.

What should I do if I experience side effects from Malarone?
Try to persevere with the medication.
Take it regularly as directed, with food or a milky drink.
Stick to plain, bland food stuffs.
You can treat nuisance side effects with commonly used medicines. Headache can be treated with paracetamol for example. For nausea/vomiting, try an anti-sickness medication such as promethazine.
Do not stop taking your malaria prophylaxis unless you can possible help it.
If you are sick (vomit) within 1 hour of taking your Malarone tablet, take another dose straight away.
If you feel dizzy, do not drive or operate machinery.
If you are worried you have had a serious side effect from Malarone you must report this to your doctor.
Adverse reactions should be reported on the Yellow Card Scheme.
Allergic reactions after taking Malarone
If you have any symptoms or signs suggestive of an acute allergic reaction (anaphylaxis), you must get medical help immediately.

Symptoms/signs of an acute allergic reaction include:

Difficulty breathing, tight chest, wheezing.
Swelling of the face, eyelids, lips, tongue, or other parts of the body.
Skin rash – urticaria/hives. Usually treated with anti-histamine.
Confusion, collapse, unconsciousness.
For more information see NHS – Anaphylaxis.

Who should not take Malarone?

During a Dr Fox online consultation, you will be required to complete an assessment questionnaire to determine your suitability for anti-malarial medication. You should not take Malarone without further consultation with your GP if you:

Are allergic to atovaquone or proguanil
Are pregnant or breastfeeding or intend to be during your trip or two months after
Have been diagnosed with liver disease or severe kidney disease
Have epilepsy or seizures
Are currently taking:
warfarin and other medicines to thin the blood
metoclopramide, used to treat nausea and vomiting
the antibiotics, tetracycline, rifampicin, or rifabutin
efavirenz or certain highly active protease-inhibitors used to treat HIV
etoposide used to treat cancer
If you start taking any other medicines whilst taking Malarone speak to your doctor or pharmacist.

Malarone Adult tablets are recommended for preventing malaria in people over 40kg. Malarone Paediatric tablets are available for children from 11kg on prescription from GPs, or from specially trained pharmacists.

Dr Fox can only prescribe medicine to adults (18 years or over). Further information about malaria tablets for children.