Hello All

I am actually a pharmacist and have been using mefloquine (Larium) for more than 10 years without any problems.
It has had a lot of unjust bad publicity but it is still what I recommend first-line. The serious side-effects of Larium only effect 1 in 10,000 people so the odds are very good.

Also, the malaria parasite is increasing it's resistance to Malarone but resistance to Larium is almost non-existant. Also in the UK we are getting more reports of hair-loss due to the side-effect of Malarone.

Either way, including doxycycline, malaria prophylaxis is very important and should not be ignored.

Thanks Africa. It’s nice to hear something positive about my favourite pill – LariAm. I definitely prefer weird dreams to hair-loss.

Sorry "Lariam", I hate brand names!!!!

>>but resistance to Larium is almost non-existant<<

Certainly not so in Southeast Asia, where Lariam has losts its usefulness. Malarone is what is highly recommended here and it seems to be working just fine. Doxy if Malarone can't be taken though this has its own set of issues.

You certainly don't want to be the 1/10,000 who encounter serious side-effects of Larium. For some, restless sleep or lots of wierd dreams in color is more than they wish to deal with. And just hope no one in your family has psychological problems... you're a likely candidate for issues with Lariam.

None of the meds available/recommended as a preventative against Malaria are a guarantee, they are not an inoculation -so along with repellents and covering up during mossie biting time your chances are improved.

That is why each individual has to discuss their particular health history with their physician and/or a tropical disease specialist; then make a decision.

Hi Sandi

I am refering to resistance in Africa, where the plasmodium falciparum parasite is increasing resistance to Malarone. Also with mefloquine, we recommend initiation of prophylaxis 2 weeks before departure. Therefore, there is still the time to change medication if need be. Most people would expereince side-effects after the first tablet and the effects are reversible.

The 1 in 10,000 figure is reassuring and not a stat I've seen before. Guess it took a pharmacist to deliver those facts.

Had not heard of the hair loss problem. Thanks for the alert.

I have taken Doxycycline for malaria prevention in South America. Is it equally good in Africa, or would Larium be more commonly used? I don't have a physician here in Califoria who is "up" on the latest in malaria prevention... Thanks, Sharon

Hi stamiya:
Here is the CDC site for East Africa/malaria drugs.
http://www.cdc.gov/travel/regionalma...htm#prevention

It does not show what Africa indicates British studies are showing, i.e. resistence to malarone nor hair loss---(Africa, not suggesting your info is incorrect: Brit studies could be ahead of U.S., or the CDC unwilling to put it on the public website yet, etc.)

Obviously, an individual's personal health situation may affect his/her choice of malaria drug. From the CDC site you will see that sun sensitivity and potential yeast infections for women are possible side effects of doxycycline.

The "tropical disease" specialist that we went to for our shots did not "push" one anti-malarial over another--merely laid out the potential side effects.

I took lariam 10 years ago for a trip to Costa Rico without any problem. I switched to malarone for my Africa trip, despite its extra expense, because of the potential side effect of nightmares. Even though I had not had a problem in the past, I chose this--why? OK, let's see, I'll be in a canvas tent in the serengeti and I may hear a lion roar, or hear an animal walking outside the tent. I will have a very good reason to have nightmares--I decided that I did not want to imagine, real or otherwise, that the malaria drug was causing them.
My SO and our 3rd traveling companion are both taking Lariam.

Any ideas about the effects of Larium on newly pregnant women??

Regarding the latest information, eg hair-loss with Malarone etc....you will not find this from travel websites or embassy websites. You will only find this information from the manufacturers (e.g. GSK) aimed at health care professionals.

Regarding dermatological side effects of Malarone, the company now states "Skin/hypersensitivity: Allergic reactions: including rash, urticaria, angioedema and isolated reports of anaphylaxis. Hair loss."

Regarding the use of antimalarials in pregnancy, none of them are currently 100% safe due to a lack of data and studies. If pregnant or planning to become pregnant, Lariam should be AVOIDED as it has the least amount of safety data.

Malarone has safety evidence, but only from animal studies. When healthcare professionals recommend antimalarials in pregnancy, the advice is always geared towards the safety of the mother and you will always see the statement "The use of ....... in pregnancy should only be considered if the expected benefit to the mother outweighs any potential risk to the foetus." I hope this helps.

Does Larium still work if I take one half of the pill in the morning, and the other half in about 12 hours? Or do I necessarily need to take the whole pill at once? I am still at home, and took the pill by halfs with 6 hours interval. Did not have any nightmares, only felt dizzy and horrible headacke.

Lariam will still be effective if the tablet is broken, as it is a normal-release formulation. So it is fine to take half a tablet 12 hours apart. Ideally Lariam should be taken after a meal with plenty of water. This may actually reduce some of the side-effects as it will aid its absorption from the stomach.

Mefloquine (Lariam) is highly "protein-bound". This means it binds to proteins like albumin in the blood. The protein molecules hold onto the Lariam molecules and transport them around the body (like a bus).

Sometimes when you use other drugs that are protein-bound, the Lariam molecules will compete for seats on the protein 'bus'. Or you may have a low protein count in the blood (not enough buses).

It is the Lariam molecules that don't get a seat on the 'bus' that can cause problems and go whereever they want thus causing side-effects.

Africa, don't know where you get your statistics from... 1 in 10,000 seems very low!

A clinical study in October 2001 in the peer-reviewed Clinical Infectious Diseases journal showed 29 percent of travelers taking Lariam complained of neuropsychiatric side effects and that 5 percent were so bothered they quit taking the drug altogether. The "randomized controlled trial" was done among 976 travelers in the field.

Hi Pumbavu

I take apart RCTs everyday as part of my work. You'll be suprised how many RCTs are poorly designed.

I am familiar with the study by Overbosch et al., and that study stated that none of the neuropsychiatric events were serious and therefore did not require medical intervention. I am talking about serious adverse events (1 in 10,000) which would be worse than getting malaria.

In this study 14% of the Malarone cohort also experienced neuropsychiatric effects, which is high for a drug that is meant to be free of such side-effects. Also a large number of the study team was made up of GSK employees (the manufacturers of Malarone).

Wouldn’t you need a big test group were half of the people were given Lariam and half sugar pills to do a more accurate study? There’re websites about Lariam that can provoke neuropsychiatric side effects …

Africa, I hope you’re not working for Roche …

Starting the Lariam 2-week prior is what we've always done - whether traveling with my partner or with a friend. None of us ever had any side-effects during this time. However, within the 3rd and 4th weeks, the weird dreams and restless sleep started with all of us and continued through the 3 to 4 weeks after returning home and for some weeks after... Lariam does have a longlife in the system. So even the 2-week prior, may not show any indication.

For us, these side-effects weren't all so terrible, rather funny when we compared dreams the next day. But for some individuals, even the restlessness and dreams can be disconcerting. So I and others were relieved when Malarone came on the market. Absolutely no side-effects from anyone who took the Malarone and we still all have our hair, no one has lost any or gone bald.

All information is good to have, and what you've provided has to be included, but again, the individual has to decide based on information available and discussion with their own physician or tropical disease specialist taking into considering their own health history.

Hi Nyamera

I should work for Roche and get paid more money, but I work for the NHS in the UK. So I spend my days looking at clinical evidence for new drugs and the economics behind their use, then writing reports on the data.

The antimalrials don't fall into this category as they are mainly obtained by private prescription in most of the UK. Although saying that, certain London areas like Southwark and Lambeth are now providing NHS prescriptions for antimalarials. Many travellers from these parts can not afford or will not buy antimalarials and are returing from holiday with malaria. As the rates are so high, the authorities have decided it is cheaper to prevent than treat.

Also Sandi your advice is very sound, and by no means is Lariam an angel, but it is no devil either. The same applies to Malarone as well.

Africa,
I was hoping you could fix me a PR job at Roche so that I could start planning my next trip.

Nyamera.......you've given me a good idea...

I am actually off to TZ on the 11th Feb (12 days!!!!) and then I'll be back there in mid-Novemeber.

"Serious side-effects" of 1/10,000 actually doesn't sound very good to me. Especially when you consider that generally speaking all side-effects for all drugs are under-reported. Are the hair loss reports anecdotal or documented by authorities at this point? (Funny: more older people get to travel for a variety of reasons...kind of makes me wonder if this is just a time of life issue, ha ha. "Yikes, I'm losing hair! Must be the malarone!"

Also the "non-serious side-effects", like sleep disturbances can actually be a big negative whether you are travelling for business or pleasure.

Too bad about the resistance problem, THAT is really bad news. I suppose we'll be hearing more about this over time.