What to know about malaria pills for travel

You can contract malaria when a mosquito with a parasite infection bites you. Certain regions across the globe have high rates of malaria.

The risk of contracting malaria in the United States is very low. Most of these cases are the result of people traveling back to the U.S. after visiting high risk areas. Some high risk areas include Africa and Central and South America, although these are constantly changing.

If you are traveling to a high risk region, there are medications you can take to prevent catching malaria if an infected mosquito bites you.

These medications work best in combination with other protective measures like insect repellent sprays and using a mosquito-proof net over your bed at night.

Several types of antimalarial medications are available. Examples include:

Mefloquine

Mefloquine (Lariam) is a highly effective medication that can prevent malaria.

The Centers for Disease Control and Prevention (CDC) recommends a dose of 250 milligrams (mg) per week for adults of mefloquine. For children who weigh less than 9 kilograms (kg), the dose is 4.6 mg per kg of their weight weekly.  

Doctors recommend taking mefloquine 1–2 weeks before you are due for travel and continue taking them 4 weeks after leaving.

Like other medications, there are side effects you may experience while taking mefloquine. These include:

• changes in vision
• dizziness
• hearing loss
• anxiety
• tremors
• loss of balance
• suicidal thoughts
• aggression
• changes in heart rate

If you or someone you know is considering suicide or self-harm, please seek support:

• Call or text the 988 Suicide and Crisis Lifeline 24 hours a day at 988.
• Text “HOME” to the Crisis Textline at 741741.
• Not in the U.S.? Find a helpline in your country with Befrienders Worldwide.
• Call 911 or your local emergency number if you feel it’s an emergency.

While you wait for help to arrive, stay with someone and remove any weapons or substances that can cause harm. You are not alone.

Chloroquine

Chloroquine (Aralen) is an antimalarial medication that is effective in treating and preventing malaria caused by certain strains of malaria-causing parasites. You can take chloroquine as an oral tablet.

If you are traveling to the following places, a doctor may recommend you take a course of chloroquine:

• Mexico
• areas of Central America west of the Panama Canal
• the Caribbean
• East Asia
• certain countries in the Middle East, such as Yemen

Doctors typically recommend taking 500 mg on a weekly basis. The amount may differ depending on your weight. They may calculate your dosage as 5 mg per 1 kg of your weight.

You should begin chloroquine 2 weeks before you travel and continue for up to 8 weeks after you return from the high risk area.

Chloroquine has few side effects, especially if you take it as a doctor prescribes.

Common side effects of chloroquine can include:

• nausea
• vomiting
• diarrhea
• loss of appetite
• headache
• lower back pain
• itchy throat  

Higher doses can cause severe side effects, such as:

• reduced vision
• paranoia
• double vision
• hallucinations
• suicidal thoughts

If you are experiencing any severe symptoms, you should seek medical help immediately.

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Doxycycline

Doxycycline (Periostat) is an antibiotic medication that you can take to prevent malaria for up to 4 months. It is highly effective at preventing malaria. An older study from 2011 noted that doxycycline is nearly 100 % effective in preventing the disease.

Typically, a doctor will prescribe 100 mg of doxycycline daily for adults, which you start 1–2 days before you leave for travel to a high risk location.

For children ages 8 years or older, 2.2 mg per kg of body weight daily is the standard recommendation. Typically, you’ll continue to take the medication for 4 weeks after you return home. It is important to complete the dosage that your doctor prescribes.

As with all medications, taking doxycycline comes with the risk of side effects. These include:

• nausea
• light sensitivity
• abdominal pain
• diarrhea
• rashes upon sunlight exposure
• irregular heart rate
• migraine
• vaginal yeast infections
• tooth discoloration

Atovaquone-Proguanil (Malarone)

Atovaquone-Proguanil is a combination of medications effective in preventing malaria. It is particularly effective against the Plasmodium falciparum strain, which is usually resistant to other medications.  

For adults, the effective dose is 1 tablet per day, which you begin 1–2 days before traveling to a high risk area. For children weighing between 5–8 kg, they should take half of a pediatric tablet daily. As a child gains weight, their dosage will gradually increase. Always follow the instructions of a doctor when taking medication they prescribe.

Common side effects of this medication include:

• vomiting
• headaches
• abdominal pain
• nausea

According to the CDC, you can reduce the risk of experiencing side effects by taking your tablets with food.

When should you speak with a doctor?

If you are traveling abroad, it is a good idea to speak with a doctor or visit a travel clinic beforehand. A healthcare professional can inform you about any medications or vaccinations you may need to stay safe while traveling.

According to the International Association for Medical Assistance to Travellers, consider getting an appointment 6 weeks before you are due to travel. This will allow time if you need extra vaccinations that require boosters, which may be a few weeks apart.  

Summary

If you are traveling abroad, for example, to Africa or the Caribbean, you may need to receive a prescription for preventive antimalarial medication. Various medications are available, each with different doses and possible side effects.

If you think you may need antimalarial medication, speak with a doctor or travel nurse. They can advise on which type of antimalarial medication is suitable for you. They will also provide instructions for dosage and when to take your tablets. It is important to follow them to avoid an overdose and ensure that the medication is effective.

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