) see also Malarial misconceptions: http://www.hc-sc.gc.ca/pphb-dgspsp/publicat/ccdr-rmtc/00vol26/26s2/26s2n_e.html or copy
Chloroquine: Minor side effects such as stomach upset and blurred vision occur frequently. These can lessened by taking tablets with food, or taking half the dose on 2 occasions each week. They are safe in pregnant women and children in correct doses. Pruritus (itch) in dark skin individuals is common. . If you have had generalised psoriasis, chloroquine and other chloroquine-like drugs, including primaquine, quinidine and proguanil should be avoided. Retinal changes including eye damage and blindness may occur after prolonged use but on the usual 300mg per week dose it would take 6-7 years.
Malarone: - a combination of atovaquone and proguanil in a single tablet, is a new addition for malaria prevention. Its use has been approved for treatment and prevention of malaria (TGA-Australia) since November 2001. It is particularly useful where malaria is resistant to chloroquine and mefloquine (Larium). On evidence to date, it appears to be very safe and effective, but is expensive.
For prevention of malaria, Malarone is taken once a day, starting 1 day before entering malarial risk area and continuing for 1 week after leaving the malarious area. It should be taken with food or milk. This regime is simple and suited to business & frequent travellers. Nb. When Malarone is used for malaria prevention, side effects are uncommon . However, nausea, vomiting, abdominal pain, and diarrhoea occur when higher doses of the drug are used for treatment. Convulsions and rash have rarely been reported.
Doxycycline: It is an alternative to mefloquine for short-term travellers. Doxycycline at 100 mg/day is approved for a period of up to 8 weeks only (NHMRC 1994) but is probably safe for longer use. Side Effects include thrush, stomach & bowel upsets, (particularly if medication is taken on an empty stomach) and sunlight sensitivity. The exaggerated sunburn reaction may be minimised by avoidance of sunlight, using sunscreen and taking the drug in the evening. Drinking copious quantities of water after swallowing the drug is recommended to reduce heartburn. Using Doxycycline may make the Contraceptive pill unreliable. The Therapeutic guidelines 2002 states that: "A second form of contraception is not necessary, but may be offered." & "Women who develop breakthrough bleeding might consider using barrier methods for the duration of antibiotic therapy". Discuss this matter with your doctor.
Mefloquine: Side-effects ('Lariam') Minor side effects such as nausea, vomiting, heartburn and loose stools occur in about 20% of users, but this is no more frequent than with other antimalarials and usually subside with continued use. Taking ½ tab twice a week with food, and drinking copious water with medication will help reduce these.
Unfortunately mefloquine frequently produces annoying
adverse neurological effects such as insomnia, vivid dreams, dizziness, mental clouding,
anxiety and coordination problems. These are sufficient to interfere with daily activities
in up to 10% of users and are probably aggravated by use of alcohol and cannabis.
Disabling side effects sufficient to recommend the cessation of mefloquine occur in 0.5%
of users. However despite this, some 5 - 10% of users will stop the drug. Consequently
any person requiring a clear mind and good co-ordination should not use mefloquine.
This may involve travellers to high altitude and definitely those contemplating aqualung
(scuba) diving. Other contra indications include persons with a history of seizures, neuro-psychiatric disorder, the first 3 months of pregnancy and those with cardiac
conduction problems. Women are advised to use contraceptives during and for 3 months after
administration of mefloquine.
Mefloquine is probably best commenced 3 -4 weeks before
entering a malarious area as it takes this long to build up to satisfactory blood levels.
(half life of 21 days). Also this provides time to detect those travellers that
develop unacceptable side-effects and thus enable a change in medication.
Commencing 1 or 2 weeks before departure is
not adequate.
A recent report involving soldiers taking mefloquine 250mg daily for 3 days to enable a
quick build up in blood levels was surprisingly well tolerated.
US authorities are prepared to use mefloquine for up to 2 years continuously in Peace
Corps Volunteers overseas.
Serious neuropsychological side effects can occur when mefloquine is used in high doses.
(click important note
)
see also Malarial misconceptions:
http://www.hc-sc.gc.ca/pphb-dgspsp/publicat/ccdr-rmtc/00vol26/26s2/26s2n_e.html or
copy
Proguanil:
One of the safest antimalarial drugs. Mouth ulcers is an annoying complication in up to
37% of travellers. (when taken with Chloroquine). Proguanil is taken 2 tabs daily,
starting 1 day before entering malarial area and continuing for 4 weeks after
leaving the area.
Chloroquine is taken 2 tabs weekly…. Confusing your tablets could be deadly.
Contrarily to WHO recommendations,
Australian travel physicians mostly limit the use of Chloraquine + Proguanil,
to travellers unable to take mefloquine or doxycycline.