Anti-Malarial Medication

Be aware of the risk – Your risk depends on the location, season of travel, length of stay, activities and type of accommodation.

Prevent yourself from being bitten – For example by using DEET-based mosquito repellents, wearing appropriate clothing and using mosquito nets.

Medication – You should take antimalarial medication if appropriate for the area. No antimalarials are 100% effective but taking them in combination with mosquito bite avoidance measures will give substantial protection against malaria.

Seek emergency medical care – If you develop a fever of 38°C [100°F] or higher more than one week after being in a malaria risk area, or if you develop any symptoms suggestive of malaria within a year of return. 

Malaria tablets are antiparasitic medications which prevent you from becoming infected with malaria. However they do not provide complete protection, and you will need another treatment if you catch malaria.

Malaria tablets work by:

• stopping the parasite from multiplying in red blood cells enabling your immune system to fight the infection before you develop symptoms
• preventing the parasite from developing in the liver and infecting red blood cells

You usually start taking anti-malaria tablets a few days before you enter an area where malaria is present and continue taking them for the duration of your trip, and then for a short time when you have returned to a malaria-free zone.

There are several different malaria tablets available. Which one you’ll need to take may depend on:

• where you are travelling to
• how your body responds to the medication
• your current health status

MASTA offers the following anti-malaria tablets:

Doxycycline

Doxycycline is an antibiotic that can be taken to prevent malaria. The treatment course is usually started 1 to 2 days before entering an at-risk area and continued until 4 weeks after you leave. Doxycycline is a prescription-only medication, so you will need to complete our online questionnaire for a doctor’s approval to receive it.

Atovaquone and Proguanil

Atovaquone and Proguanil tablets should be started 1 to 2 days before travelling to an area which has malaria and continued throughout your stay, until 7 days after you have returned to a malaria-free zone. It is a prescription-only medication, so you will need to complete our questionnaire for a doctor’s approval to receive it.

How to take doxycycline to prevent malaria

The usual dose of doxycycline for malaria is one 100mg tablet daily from 1 to 2 days before travelling to an area where you may contract malaria, until 4 weeks after you return.

• swallow them whole with plenty of water
• take them around the same time each day, in an upright position (such as sitting or standing, not lying down) to prevent the medication from irritating your stomach
• avoid lying down for at least 30 minutes after taking doxycycline to allow the tablet to swiftly move through your digestive system and avoid irritation
• take them with food or milk if they upset your stomach

Doxycycline tablets increase your risk of photosensitivity, making your skin more sensitive to sunlight. You should reduce sun exposure and use high-SPF sun cream.

How to take Atovaquone and Proguanil

The usual dose for of Atovaquone and Proguanil for adults to prevent malaria is 1 tablet once per day, taken with food or a milky drink where possible. Each tablet contains 250mg of atovaquone and 100mg of proguanil hydrochloride.

• start taking atovaquone and proguanil tablets, 1 to 2 days before travelling to an at-risk area
• take the medication as instructed every day during your trip
• continue taking it for 7 days after you have returned to a no-to-low-risk area

What happens if I miss a dose?

If you forget a dose of malaria tablets, take it as soon as you remember. Then take your next tablet at the correct time.

Do not take a double dose to make up for a forgotten dose, take your next dose at the usual time.

As with all medications, there is the risk of experiencing side effects when taking malaria tablets. However, not everyone will experience them.

Common doxycycline side effects (may affect up to 1 in 10 people) include:

• feeling sick (nausea)
• being sick (vomiting)
• worsening of a disease called lupus
• pericarditis (inflammation of the heart)
• rashes (especially after sun exposure)
• headache
• allergic reaction

Uncommon doxycycline side effects (may affect 1 in 100 people) include:

• vaginal infection
• heartburn

Very common atovaquone and proguanil side effects (affecting more than 1 in 10 people) include:

• headache
• feeling sick (nausea)
• being sick (vomiting)
• stomach pain
• diarrhoea

Common atovaquone and proguanil side effects (may affect up to 1 in 10 people) include:

• sleeping problems (insomnia)
• dizziness
• strange dreams
• loss of appetite
• depression
• fever
• rash, this may be itchy
• cough

Uncommon atovaquone and proguanil side effects (may affect 1 in 100 people) include:

• an unusual feeling that your heart is beating faster (palpitations)
• anxiety
• hair loss
• itchy, bumpy rash known as hives
• redness and swelling of the mouth
• low sodium levels in the blood

Malaria tablets may not be suitable for everyone.

Doxycycline warnings

Do not take doxycycline if you are:

• allergic to any of its ingredients
• pregnant or trying to become pregnant
• breastfeeding

You should tell your doctor before taking doxycycline if you:

• are going to be exposed to strong light including sunbeds
• have liver or kidney problems
• have myasthenia gravis, a disease that affects certain muscles
• have porphyria (a rare blood pigment disease)
• systemic lupus erythematosus, an allergic condition that causes joint pain, skin rashes and fever
• think you may have syphilis
• have or get diarrhoea with antibiotics
• are taking oral retinoids

Doxycycline and other medications

Before taking doxycycline, you must tell your doctor about any other medications you are taking, including those that are prescription-only, over-the-counter, or herbal.

The following medications can lower the effectiveness of doxycycline:

• antacids used to treat indigestion
• epilepsy medications including carbamazepine, phenytoin and barbiturates

Doxycycline can affect how the following medications work:

• warfarin or coumarins for preventing blood clots
• oral contraceptive pill
• penicillin antibiotics
• ciclosporin, used to affect how the immune system works

Doxycycline and the contraceptive pill

Doxycycline doesn’t stop the oral contraceptive pill from working but it can make it less effective if you experience sickness or diarrhoea for more than 24 hours.

If you are concerned, speak to your doctor before taking doxycycline or follow the instructions about what to do in the patient information leaflet provided with your contraceptive pill.

Atovaquone and Proguanil warnings

Do not take atovaquone and proguanil if you are allergic to any of its ingredients.

Before taking atovaquone and proguanil, tell your doctor if you have a severe kidney disease.

Other medications and atovaquone and proguanil

Some medications can affect how atovaquone and proguanil works or may affect the effectiveness of other medications. It is important to tell your doctor if you are taking any prescription, over the counter or herbal medications before taking atovaquone and proguanil, particularly:

• metoclopramide
• tetracycline, rifampicin or rifabutin
• efavirenz
• warfarin
• etoposide

Atovaquone and proguanil in pregnancy and breastfeeding

You must not take atovaquone and proguanil if you are or suspect you may be pregnant unless your doctor recommends it. Atovaquone and proguanil must not be taken if you are breastfeeding, unless no other alternative is available, because the active ingredients may pass into your milk and harm your baby.

Are malaria tablets available on the NHS?

No, malaria tablets are not available on the NHS. You can pay for a supply of tablets in one of our travel clinics or for a private prescription either from an online travel service, like this or from a GP. The cost of a private prescription can vary for malaria tablets.

Can you get malaria tablets over the counter?

Yes, a type of malaria tablet called chloroquine is available over the counter without a prescription from most pharmacies, but this may not be suitable for all travel destinations

Is doxycycline or atovaquone and proguanil better for malaria?

Doxycycline and atovaquone and proguanil are both effective at preventing malaria but doxycycline is available at a cheaper cost but you must continue to take doxycycline for 4 weeks after leaving the malaria risk are..

Atovaquone and proguanil is more expensive but you only need to take the tablets for 7 days after leaving the malaria risk area.

Can I drink alcohol while taking malaria tablets?

Whether you can drink alcohol while taking malaria tablets will depend on which type of medication you are taking. You should read the patient information leaflet before starting your medication. If you’re taking:

• doxycycline – alcohol should be avoided while taking doxycycline as it can stop the tablet from working as it should
• atovaquone and proguanil – alcohol in moderation should be fine with this medication but it is important to avoid large amounts, especially if you experience side effects

If I get malaria, will I have it for the rest of my life?

No, malaria is not a lifelong condition, and if it is diagnosed and treated promptly the infection will go away. Sometimes malaria can come back, if it does, you will need to be treated again.

Do all mosquitoes transmit malaria?

No, only female Anopheles mosquitoes can transmit malaria from one person to another.