CDC - Prescription Drugs for Preventing Malaria - Public Info Find Out Which Antimalarial Drug Is Recommended for You Antimalarial Warnings and Instructions Mefloquine Doxycycline Malarone Chloroquine (brand name Aralen) Hydroxy- chloroquine sulfate (brand name Plaquenil) Information for the Public Prescription Drugs for Preventing Malaria See Your Health Care Provider 4–6 weeks before travel if your trip is outside the United States or Canada. Find out what shots and prescriptions you or your family needs. Know Your Risk Malaria is a serious but preventable disease spread by the bite of an infected mosquito. Anyone, any age, can contract malaria. Enjoy your trip; follow the few simple precautions listed below to keep you and your family from getting malaria. Information about malaria risk and prevention is available at Toll-free Voice Information Service. Call 1-877-FYI-TRIP. Toll-free Fax Information Service. Call 1-888-232-3299 and listen to the instructions. Request document number 000005 for a directory of all available travel faxes. This Travelers' Health website. Identical malaria prevention information is provided at the CDC website and the toll-free Fax Information Service. Find Out Which Antimalarial Drug Is Recommended for You Drugs to prevent malaria, called antimalarials, are available only by prescription through a health care provider. Your health care provider will prescribe your antimalarial based on your travel itinerary and medical history. Some antimalarial drugs are more effective in some parts of the world than others. In addition, a medical condition may prevent you from taking certain drugs. Alternative drugs are available and are discussed below. Antimalarial Warnings and Instructions Overdosage of antimalarials can be fatal. Keep drugs in childproof containers out of the reach of children. Take antimalarials exactly on schedule without missing doses. Buy antimalarials in the United States before travel overseas. The quality of antimalarials sold outside of the United States may not be reliable. Your health care provider will prescribe one of the following antimalarials. Find the drug below; read the directions for use and side effects. If you have any questions about the drug recommended, call your health care provider or pharmacist. Travelers to malaria-risk areas in South America, Africa, the Indian subcontinent, Asia, and the South Pacific should take one of the following drugs: mefloquine, doxycycline, or Malarone.™ Mefloquine (brand name ) Directions for use: The adult dosage is 250 mg (one tablet) once a week. Take the first dose of mefloquine 1 week before arrival in **** the malaria-risk area. Take mefloquine once a week, on the same day of the week, while in the malaria-risk area. Take mefloquine once a week for 4 weeks after leaving the malaria-risk area. Mefloquine should be taken on a full stomach, for example, after dinner. Mefloquine side effects Mefloquine is usually well-tolerated; however, side effects can occur. The most commonly reported minor side effects include headache, nausea, dizziness, difficulty sleeping, anxiety, vivid dreams, and visual disturbances. Mefloquine has rarely been reported to cause serious side effects, such as seizures, depression, and psychosis. Mefloquine should be used with caution in persons with psychiatric disturbances. Minor side effects usually do not require stopping the drug. Travelers who have serious side effects should see a health care provider. Do NOT take mefloquine if you have Ever had an allergic reaction to mefloquine; Epilepsy or other seizure disorders; Active depression or a history of psychosis; Been diagnosed or treated for an irregular heartbeat. Alternatives for travelers who cannot or choose not to take mefloquine include doxycycline or Malarone.™ Doxycycline Directions for use: The adult dosage is 100 mg once a day. Take the first dose of doxycycline 1 or 2 days before arrival in the malaria-risk area. Take doxycycline once a day, at the same time each day, while in the malaria-risk area. Take doxycycline once a day for 4 weeks after leaving the malaria-risk area. Doxycycline side effects and warnings Taking doxycycline may cause travelers to sunburn faster than normal. To prevent sunburn, avoid midday sun, wear a high-SPF sunblock, wear long-sleeved shirts, long pants, and a hat. Take doxycycline on a full stomach to lessen nausea; do not lie down for 1 hour after taking the drug to prevent reflux of the drug (backing up into the esophagus). Women who use doxycycline may develop a vaginal yeast infection. Take an over-the-counter yeast medication with you on your trip for use if vaginal itching or discharge develops. Do not give doxycycline to children under the age of 8; teeth may become permanently stained. Do NOT take doxycycline if you are pregnant. Travelers to the borders of Thailand with Burma (Myanmar) and Cambodia, the western provinces of Cambodia, and in the eastern states of Burma (Myanmar) should read Malaria Information for Travelers to Southeast Asia. Mefloquine resistance has been reported in these areas and either doxycycline or Malarone™ would be the recommended antimalarial drug. Alternatives for travelers who cannot or choose not to take doxycycline include mefloquine or Malarone.™ Malarone™ Malarone is a new antimalarial drug in the United States. Malarone is a combination of two drugs (atovaquone and proguanil) and is an effective alternative for travelers who cannot or choose not to take doxycycline or mefloquine. and is an effective alternative for travelers who cannot or choose not to take mefloquine or doxycycline. Directions for use: The adult dosage is 1 adult tablet (250 mg atovaquone/100 mg proguanil) once a day. Take the first dose of Malarone 1 to 2 days before travel to the malaria-risk area. Take Malarone once a day while in the malaria-risk area. Take Malarone once a day for 7 days after leaving the malaria-risk area. Take the dose at the same time each day with food or milk. Malarone Side Effects and Warnings Although side effects are rare, abdominal pain, nausea, vomiting, and headache can occur. Malarone should not be taken by patients with severe renal impairment. Pregnant women or women breast-feeding infants weighing less than 11 kg (24 lbs) should NOT take Malarone to prevent malaria. Infants weighing less than 11 kg (24 lbs) should NOT be given Malarone. Travelers to malaria-risk areas in Mexico, Haiti, the Dominican Republic, and certain countries in Central America, the Middle East, and Eastern Europe should take chloroquine or hydroxychloroquine sulfate as their antimalarial drug. Chloroquine (brand name Aralen®) Directions for use: The adult dosage is 500 mg chloroquine phosphate once a week. Take the first dose of chloroquine 1 week before arrival in the malaria-risk area. Take chloroquine once a week, on the same day of the week, while in the malaria-risk area. Take chloroquine once a week for 4 weeks after leaving the malaria-risk area. Chloroquine should be taken on a full stomach to minimize nausea. Chloroquine side effects Although side effects are rare, nausea and vomiting, headache, dizziness, blurred vision, and itching can occur. Chloroquine may worsen the symptoms of psoriasis. Hydroxychloroquine sulfate (brand name Plaquenil®) Directions for use: The adult dosage is 400 mg once a week. Take the first dose of hydroxychloroquine sulfate 1 week before arrival in the malaria-risk area. Take hydroxychloroquine sulfate once a week, on the same day of the week, while in the malaria-risk area. Take hydroxychloroquine sulfate once a week for 4 weeks after leaving the malaria-risk area. Take hydroxychloroquine sulfate on a full stomach, for example, after dinner, to minimize nausea. Hydroxychloroquine sulfate may be better tolerated than chloroquine. Hydroxychloroquine sulfate side effects Although side effects are rare, nausea and vomiting, headache, dizziness, blurred vision, and itching have been reported. Hydroxychloroquine sulfate may worsen the symptoms of psoriasis. Prevent Insect Bites Protect yourself from mosquito bites. Wear long-sleeved shirts and long pants; apply insect repellent to exposed skin. Mosquitoes that transmit malaria bite between dusk and dawn. Use insect repellents that contain DEET. When using repellent with DEET, follow these precautions: Always use according to label directions. Use only when outdoors and wash skin after coming indoors. Do not breathe in, swallow, or get into the eyes. Do not put on wounds or broken skin. The concentration of DEET varies among repellents. Repellents with DEET concentrations of 30% to 35% are quite effective, and the effect should last about 4 hours. Travelers who will not be staying in well-screened or air-conditioned rooms should use a pyrethroid-containing flying-insect spray in living and sleeping areas during evening and nighttime hours. In addition, travelers should take additional precautions, including sleeping under mosquito netting (bed nets). Bed nets sprayed with the insecticide permethrin are more effective. In the United States, permethrin is available as a spray or liquid to treat clothes and bed nets. Bed nets may be purchased that have already been treated with permethrin. Permethrin or another insecticide, deltamethrin, may be purchased overseas to treat nets and clothes. For more information, please see the Insect Protection section. Know the Signs and Symptoms of Malaria Malaria can occur despite taking antimalarials. Malaria causes a flu-like illness; symptoms include fever, shaking chills, headache, muscle aches, and tiredness. Nausea, vomiting, and diarrhea may also occur. Malaria symptoms will occur at least seven to nine days after being bitten by an infected mosquito. Fever in the first week of travel in a malaria-risk area is unlikely to be malaria; however, ill travelers should still seek immediate medical care. Although malaria is unlikely to be the cause, any fever should be promptly evaluated. If you or your child becomes ill with a fever or flu-like illness while traveling in a malaria-risk area and up to 1 year after returning home, seek immediate medical care. Tell your health care provider where you have been traveling. For more information on malaria, see the Diseases section and read the following: Malaria: General Information Preventing Malaria in Pregnant Women (Information for the Public) Preventing Malaria in Infants and Children (Information for the Public) *Use of trade names is for identification purposes only and does not imply endorsement by the Public Health Service or by the U.S. Department of Health and Human Services.