Larium
 

http://www.salon.com/ent/tv/review/2005/05/25/lo_svu/

Yes, it is still a matter of debate...yes, you need to get the advice of your doctor.

But apparently it IS true that the US military no longer prescribes larium because of the serious side effects--SOME OF WHICH PERSIST LONG AFTER STOPPING THIS DRUG.

Actually, I could never understand the argument that taking a drug once a week was an advantage anyway.

Not sure if you mean Lariam, but I'm happy with it. And sorry, I can better live with a weekly date than a daily. So apparently opinions can be quite different.

Mitch

After taking Larium before, during, and after our trip to Kenya & Tanzania, my liver function numbers were quite abnormal, according to my doctor said upon an exam after our return. In a year, those numbers returned to where they were before our trip. Your use of this drug should depend entirely on what your personal physician tells you, not based on the experience of others who may post here.

I'm glad I have bought my Malarone!

Though it should be noted that some local personal physicians are not exactly up to speed on the latest trends in tropical medicine... when I asked my Dr about the possible side effects of larium for our safari she said she had no idea there were any...luckily I had brought a bunch of info I had gotten on the subject and was able to talk her into perscribing malarone..we had no side effects at all and I would take malarone again, no problem. Being an educated patient has advantages too!

A very small percentage of Lariam users suffer serious side effects. I have no doubt that a lot of travel related and “soldier life” related disorders are blamed on Lariam. As it is the only anti-malarial that’s both effective and reasonably priced it’s definitely worth the small risk – at least for me. Of course, if you have some specific health problems or take medicines that are dangerous to combine with Lariam you shouldn’t take it – but that’s something your doctor should tell you.

On my first trip to Kenya my doctor advised me to take Malarone. It was only a two-week trip and she thought I shouldn’t risk ruining my trip with “nightmares”. I’ve always had nightmares quite regularly but I didn’t want to become psychotic. On my second trip I decided to try Lariam – not throwing away money unnecessarily makes it easier to return to Kenya - and I had no problems whatsoever. And this year I took Lariam again. One night I felt like hundreds of rats where entering through the net-covered window behind my head. I was almost asleep and there WAS a rat in the room (only one), so I don’t think it had anything to do with taking Lariam. Maybe I get one side effect from Lariam and that is euphoria.

I’ve no idea when I’ll be able to return to Africa, but as I have some Lariam pills I feel like I’m on my way. I bought them for less than half the original price from someone on a travel forum who had 19 pills left over. He lived in Stockholm and I was going there anyway, so we arranged to make the transaction outside an underground station.

If the US military spends its money on Malarone instead of on making war that’s all very well, but if anyone tries to have Lariam banned I’ll scream, “DON’T TOUCH MY PILLS!!!”
>:O

I was on the Kenya trip with Thyra and Justin and I took Malarone. My friend took Lariam and by the time we got home, I felt that she was in the early stage of Alzheimers! She wasn't nearly as difficult on our previous trip, when no malaria pills were necessary. She didn't have nightmares, but was forgetful and difficult. When I thought about it later, I realized it could have been the side-effects of Lariam. At any rate, my insurance covered the cost of my anti-malaria medicine so cost didn't matter. Maybe people don't realize their insurance will cover this stuff. (And maybe some insurance won't)

Hi Retiredatlast,
I’ve diagnosed your friend: She was showing the side effects of having to leave Kenya. The symptoms are very easily recognised.

good one Nyamera--Kenya withdrawal syndrome.

I have taken Larium before for a trip to the Amazon. For me, it was absolutely horrible! I had the worst dreams i have ever had...absolutely miserable to the point of almost being frightening. I am going on safari in august and don't care what cost or inconvenience another brand is...i refuse to take larium again to the point that i would probably just not go to a place that you need it if in fact i had to take the larium again....but thats just my experience.

I just got back from 12 days in Kenya. I took Malarone & have had no side effects at all. Still taking it for 6 more days Would highly recommend it. It was expensive but worth it.

Why don't people use Doxycycline? Just curious because that is what we always take.

Scout52 -

Not being a specialist in tropical meds, my guess would be that doxy is an antibiotic and not specific for malaria. Yes, it is often prescribed for those who cannot for any variety of reasons be on a Lariam or Malarone protocol.

Besides, doxy often causes sun sensitivity, so you've got to protect yourself with some SPF; women often find they have discharge problems.

... and, you've got to take doxy for 1-month after returning from the infected area.

We've heard from posters who feel the 1-a-week Lariam (regardless possible psychotic reactions, sleeplessness, and other strange happenings) is better then taking 1-a-day pill as Malarone (with minimal, if any, side-effects)... and then there is the doxy that you have to take forever (or so it seems).

Cost, of course, comes into play - doxy is the least expensive, in fact, cheap. However, when planning a vacation some people completely forget about anything other then air, hotel, food, tours and Visas and then they find out about inoculations and meds. Personally, in the scheme of things and the costs for a safari, regardless whether budget - moderate - expensive - the expense for your meds is most important.

So it's an individual decision made between you (your pocket) and your medical professional.

I met a couple of German women in the airport in Bangkok and we started chatting. They were friends on their way to Vietnam for vacation. One said that she had taken Larium on a trip somewhere the year before and is suffering permanent liver damage from it. I refuse to take Larium. I took Malarone while in Ghana for two weeks and didn't have any major problems. Happy Travels!

The US Army doctors we worked with (different ones for each trip) both basically said no Larium because of the potential side effects. We were given the choice between Malarone and Doxycycline, with a recommendation for doxy because "considering where you are going, having an antibiotic already in your system can't be a bad thing". We didn't notice any sun sensitivity problems, but we went to Africa from Nevada, Alice Springs, Australia, and Riyadh, Saudi Arabia. Maybe the effects are a lot worse for people who don't already live in intensely sunny climates. Taking the meds for a month afterward is a hassle, but you just have to remember to do so. On the other hand, any acne you have tends to clear up nicely!

Good to see you're following the advice of doctors, Scout 52, but your puzzlement about why more don't use doxy is unwarranted. It all depends on the individual and the medical advice they get...everybody can react differently to different drugs. I've a friend who always uses doxy and he doesn't have problems with it...it could well be that sun-sensitivity doesn't come into play for people who live in sunny climes like us. But I've always used Lariam because it is among the most effective, and I don't have any problems with it. In fact, the minimum prescription course I can get is 8 tablets, so for a two-week safari (about the most I can afford), I'm taking pills two weeks before I leave and four weeks after I return, longer than necessary but that doesn't bother me and I'm not wasting any pills. I can understand why the US or any other military force for that matter would steer clear of Lariam (they have enough trouble keeping their people on an even keel anyway), but it works for me and most people who use it.

I've taken doxycycline before and did not have the wierd dreams like Lariam (aka mefloquine), but doxy seems to kill certain good flora and fauna in my digestive tract and puts me in a terrible state during and after a trip. This is why I prefer Malarone. Of course, your mileage may vary. :-)

I took Larium before my recent trip to Africa and it made me go absolutely crazy. Like being on speed times ten. It took several days (and tranquilizers) to get it out of my system. In talking to the many people we met during our trip, only Americans seem to still be taking Larium. The Europeans and particularly South Africans stopped taking it years ago because of the horrible side effects. The camp managers at one of our safari camps told us stories of people running through the camp in the middle of the night (not a good idea in a bush camp) because they were having Larium related psychotic episodes. I have heard good things about both Malarone and the doxycycline. The other thing that many locals recommended is lots of gin and tonic! My favorite remedy.

I was under the impression that doxycycline was less effective than Malarone.

We actually took doxy with zero problems last time (I, with olive skin, did get a bit of a sunburn). Was thinking of asking for Malarone this time. But then again, had no probs with doxy and really didn't encounter mosquitoes except on Zanzibar.

The strange thing is my doctor just prescribed the antimalarial as if there were only ONE choice. Perhaps that's the case with my HMO.

Leely -

If you belong to an HMO, your physician can probably prescribe any of the anti-malarials. It's whether you have a drug plan thru the HMO that will deterimine what they will pay.

I'm on a 3-tiered program, where generics like doxcy is $10; and now that Lariam is now offered as a generic (mefloquine) and would cost the same; the Malarone is the 2nd-tier (approved brand meds) and should be $25, but this last script cost $35... all better then full retail of around $100. 3rd-tier (non-approved brand meds) runs $50.

Regardless, as Kavey's thread re her dad's recent bout with malaria - do take your meds whatever the cost.

To ddgattina and all others that question Larium.
All the advise was very helpful. My husband and I are spending two weeks in South Africa in October, driving from Joburg to Cape Town. We don't expect to be in any of the malaria areas. Our primary doctor, when we asked, told us that it really was not necessary to take anything. We read some of the talk on line here and had just about decided not to take anything.
But a visit yesterday to our cardiologist (spelling?) changed that, he told us that we should take the anti-malarials. We are elderly and have some minor heart problems, so we do take his advise. He didn't seem to know the difference between Larium and Malarone, but gave us a prescription for Malarone. Don't doctors usually read up on these meds? Our drugstore didn't have Malarone in stock and needed to order it - good thing we planned early. We're expat New Englanders living in Georgia, so I guess southerners don't usually travel to Africa. Although I hear of a lot of church groups going into the bush; I wonder if they take anti-malarials.
The final decision for us is to take the meds and prevent problems. Malaria would not be fun for us at this stage in our lives.
Have a great trip. - Joan

Hi Joan,
If you are under a doctors care for other conditions, you do need to follow that doctor's advice, BUT also ask hard questions, because as you say, some doctors don't do much travel medicine, so they don't know or keep up on tropical medicine. (Which does change over time.) Especially in an area where people don't travel to exotic locales very frequently. But I have been sometimes shocked by the recommendations of lazy doctors who don't keep up with the times --even doctors who specialize in travel medicine. A few years ago (the first year malarone was approved in the US) I had an argument with one who insisted lariam was the best choice, even when I told him that I had such bad nightmares and sleep disruption that I stopped taking the larium on a trip to India!! He finally relented and gave me prescriptions for both.

The other issue that you brought up is iimportant too-- there are malarial areas in South Africa, but if you are definitely NOT going to any of these, you don't need anti-malarials. Some doctors just make decisions by country rather by region and this can lead to overmedication. You might want to call the cardiologist again and be very specific about your itinerary, armed with the info that shows these areas are not malarial. That said, there IS still a very very very small risk that a malarial mosquito could travel (perhaps in a plane?), get to Joburg or Capetown and bite you. I met a man who had never been out of the northeast US in his life who contracted malaria somehow. Because no one suspected malaria it went on so long he got liver damage. They finally figured out that he had been working around the docks in Philadelphia, and a mosquito probably made the trip in on one of the ships! He was the only case.
So weird things can happen. Perhaps your cardiologist is just super-cautious--talk it over with him/her.

That said, if you do need to take an antimalarial, I think that your doctor's recommendation for malarone is a good one and probably the safest. It has very few side effects compared to the other options (most people have no side effects on malarone) and it is definitely more effective than doxycycline. It is far more common for people to get malaria while taking doxy than while taking malarone. (Not saying doxy is bad...I'm just saying that it is not as effective as malarone. If you have no health problems AND are religious about insect repellant and covering up at dusk, it is probably sufficient.)

In addition I completely disagree that "having an antibiotic in your system is a good thing". That is quite silly. Antibiotics DO (emphatically DO) have side effects (as other posters have noted...they kill of beneficial flora in the intestinal tract, and that can have longer ranging effects, including on your natural immunity to disease. AND having antibiotics in your system when you don't need them fosters resistant pathogens generally. I hope the docs who said this were kidding (and in fairness to them, it sounds like they might have been.)

Have a wonderful trip Joan!!

Coincidentally, I watched a rerun on "Law & Order SVU" tonight which was about US soldiers who took malaria medicine & became psychotic. The prosecutor is going after the US Army for murder.

Sunshine, check out the link in the post that started this thread. The Salon article is by the reporter who investigated and wrote the original news reports that provided the premise for this episode. The reporter says that the episode was accurate in its description ot the problems the US military experienced with lariam, but of course SVU made the reporter the bad guy, when in fact they led the charge in exposing the severe problems experienced with larium. The scary but true part is about the long-term effects the drug can have on the brain.

Will do. Thanks!

Would like to hear more about antimalarial drugs.

If we stay in Nairobi and Kigali - de we need preventative medicines like Lariam?

Check the www.cdc.gov site for recommended Malaria meds.

You'll find mention of
-Malarone, the newest specifically for malaria and with least number of reported side-effect; maybe tummy problems if not taken with food, dairy preferrably, which usually disappear in a day or two. Protocol is to start taking these 2-days before entering infected area, daily and for 7-days thereafter. Cost is high at between $90-$125/person for the full number of pills needed (unless your insurance picks up some of the price.)

-Lariam - the one pill which this topic relates to. Has been shown for its side-effects of insomnia, wierd dreams, psychotic episodes, etc. though some people have none of these (small number don't); taken 1 tab a week starting 2-weeks prior arriving at infected area, then weekly (same day each week) and the 4-weeks after return. If availabile in generic, but cost will probably be $4-$9/pill, depending and whether your drug plan will pick up the cost.

-doxycycline - an antibiotic rather than specifically for malaris, recommended to those who for health reasons can't take the others. Has been reported that users have sun sensitivity so using an SPF on exposed skin is recommended, women can have thrush (discharge problems) and these have to be taken for 30-days after returning from infected area. Cost is the cheapest, but not necessarily the most effective.

Remember - these are just preventatives, not an inoculation. You'll have to remember to wear long pants, long sleeves and socks during mossie biting time - dusk to dawn, apply repellent on exposed skin (back of neck, hands).

But you must discuss your options with a professional - your personal physician who hopefully has a background in tropical diseases and knows your medical history or visit a Travel Clinic though prices here will be very high. With whomever you choose, go prepared with the cdc info and your questions so a proper script can be written.

Don't fool around when it comes to malaria - it's a nasty disease with over a million deaths a year.