Hi - Just curuious about everyone's experience about the necessity of taking anti-malarials. My husband and I are traveling to Thailand and Laos in December/January and we're debating whether we need to take anti-malarials and are worried about the side effects. We're going to Bangkok, Koh Chang then headed to Vientienne and Luang Prabang in Laos. Have looked at CDC website and talked to lots of people who've been. It doesn't sound like any of these places are really malaria zones, but just curious if anyone has heard differently.

I'd suggest that you start by going back to the cdc website. All of Laos is a malarial risk zone excfept for Vientienne. The only place in Thailand you are visiting that is malarial risk is Koh Chang.

Also, do read about anti-malarials. The two that are recommended for these areas of SE Asia are Malarone and Doxycycline. Given your brief time in malarial zones, Malarone would be a good choice as you only start it one to two days before entering the area and continue it just a week after leaving. However, the best anti-malarial for you depends on your individual situation. Armed with all of this information, you'll be ready to have an informed discussion with a travel med doc.

Ulitmately you have to choose what makes you feel secure.

However, double-check the side effects. We took Meflaquine on a July trip to Peru. One of the side effects is if you dream vividly, you will dream MORE vividly. So, I took half the dose for half the time. There was a party in my head every night until October.

We are going to Thailand and Angkor Wat in late Jan/early Feb. If it is a clear option, I am going to skip the anti malarials.

Check the CDC. They know best.

You took half the dose for half the time? So you'd get half a case of malaria? Or reduce your chances of getting it by half? I'm not a health care professional, but I'm not sure it works that way! Would recommend anyone check with their doctor before changing the prescribed dosages.

afields, your change in dose was very unwise. Talking an inadequate dose of an anti-malarial means you are not protected against malaria and can contribute to malarial resistance to that particular medication. If you have side effects from an anti-malarial, you should switch anti-malarials. So you took larium (Meflaquine) all that time, put up with the side effects, and didn't protect yourself from malaria...

There are a number of options for anti-malarials, the best one for you depends on where you are going, your particular health issues, and any side effects you might have. I'd highly recommend that you take a look at the cdc website www.cdc.gov/travel and read about malaria and anti-malarials. That way you will be well-informed before you visit a doctor before your next trip.

Just returned two weeks ago from Luang Prabang and Vientienne. My girlfriend experienced the psychological side effects of the malaria drugs last time she was in Thailand, so this time we decided against them.

I did sunset atop the mountain in Luang Prabang and my girlfriend went for a sunset jog with no bug bites to speak of. When we could, we avoided being outside at dusk, opting for massages or getting ready in our room for our nite adventures.

We had faith we'd be okay and it worked. Have fun and definatly do the waterfall tour in Luang Prabang, you get to feed wild bears and tigers.

I wanted to add some more info on anti-malarials.

As Larium is the anti-malarial with the most frequent and potnetially most severe side effects, a doctor prescribing larium to someone who has not taken it before has the person take three weekly doses before leaving for their trip, as most side effects show up within the first three doses. If you have intolerable side effects, they switch you to a different anti-malarial. Note that about one-third of people taking larium have psychologocal side effects, typically vivid dreams, but sometime severe depression, anxiety, paranoia or frank psychosis.

Note also that there is larium-resistant malarial in parts of SE Asia, notably around the Thai/Burma Thai/Cambodia and Thai/Laos borders. For that reason, most travel medicine docs will not prescribe Larium for anyone going to malarial risk areas in mainland SE Asia. The options for this part of the world are doxycycline and malarone.

Many parts of SE Asia are not malarial risk areas. For instance, only very small parts of Thailand are malarial risk, only small parts of Malaysia are malarial risk, and a good part of VN is low risk.

Even if you take anti-malarials, you should do everything you can to prevent mosquito bites as malaria is only one disease carried by mosquitos. Dengue is endemic in this part of the world, and the mosquitos that carry dengue (a different species than the ones that carry malaria) are active during the day. Also anti-malarials cannot guarantee you won't get malaria, they are typically effective in the 95-98% range.

howzit, I'm glad that you and your girldfriend did ok without anti-malarials, but that is never a good reason to recomend that to someone else. (Would you say to a friend, "I didn't wear my seat belt and didn't get into an accident, so I'd recommend that you not wear a seat belt, either?&quot And I certainly hope you did more than "have faith." I hope you were careful about applying effective insect repellants. It only take a single bite from an infected mosquito to get malaria.

Seat belts don't have psychological side effects.

ksblank, I know whatever choice you make will be right for you. Enjoy

It's Larium that is known for its psychological side effects. There is also some Larium resistant malaria in SEA, so it is not the best choice for SEA. Neither doxycycline nor Malarone have the incidence of side effects that Larium does, and both are well tolerated by most people, and they are both perfect choices for SEA.

It is very important to make a well educated decision along with your doctor as to whether or not you should take malarial prophylaxis, carry emergency standby treatment dosage should you have malaria suspicious symptoms and be more than 24 hours from competent medical help, or if you don't require either course at all and can count on DEET.

Dengue Fever is another very real threat, and is perhaps even more common. As there is no way to prevent Dengue other than to avoid mosquito bites, it is important to use appropriate repellent day and night when in SEA.

Thanks for all the Malaria information. My husband bought "Jungle Juice" and "Sawyer" clothing insect repelent at REI yesterday.

I know Larium (thankfully) is not the drug of choice for SEA. The side effect of doxycycline is sun-sensitivity. I am already fair skinned with all skin cancer risk factors.

Anyone have experience with Malarone?

My husband bought "Jungle Juice" (98% deet) and "Sawyer" clothing insect repelent at REI yesterday.

Jungle Juice and other 100% deet preparations are not meant for application to skin. You want a repellant that contains 24-50% deet.

Many people on this board have reported on using malarone. It is the anti-malarial with the fewest side effects. I've taken it a number of times with no side effects at all. Some people do get stomach upset from malarone. It is also the most convenient anti-malarial as you start taking it one or two days before entering the malarial risk area and continue it for just one week after leaving the malarial risk area.

Let me note that neither doxycycline nor malarone have psychological side effects, only larium, which is not recommended for this part of the world has psychological side effects.

The malarial risk areas I will be going to are Cambodia and Laos, and the travel clinic I went to recommended Malarone. I got a prescription for that, and went to REI to get "Jungle Juice Plus Insect Repellent" which is only 17.5% DEET, but contains other ingredients for repelling flies, gnats, etc., along with repelling mosquitos and is meant for applying to the skin.

pebbles, it sounds like you are all set!

Thanks for the Jungle Juice REPELLENT advise.

Thanks also for Malarone advice. I already knew from the CDC website that Larium was not recommended for Angkor Wat. I am personally GRATEFUL for this. I would never want to repeat Larium's side effects!

Anyone have any experience with Malarone's side effects?

Do a search here on this board. Many people who post here have taken malarone. I've taken it a number of times and never had any side effects. I can think of one Fodor regular who had stomach upset with it, and switched to doxycycline.

I know everyone's got an opinion on this, so you're just going to have to go with what feels most comfortable for you. But...I'll throw my two cents in too:

We just got back from a trip to Cambodia & Thailand a couple weeks back and did a lot of research on here and through both our travel doctors. We went uber-prepared.

We sprayed all our clothing with permethrin prior to leaving and, when there, wore DEET every day (I highly recommed using Ultrathon by 3M--it has next-to-no-smell and isn't sticky and thick like other DEET repellents)...this all in combination with a hearty prescription of Malarone.

Let me speak first to the Malarone. In a nutshell: it was no fun taking--yes, I will agree with most here, it has very few side-effects in comparison to other anti-malarials, for sure. But, it made us both feel an ever-present slight nausea and (pardon me for being so blunt) total constipation the entire time we were on it. I these symptoms were a direct result of the medication since the first day we were allowed to stop taking it, we felt 150% better and never had those side-effects again for the rest of our trip.

Secondly, the DEET and Permethrin one-two punch is a pretty powerful combo. We were in some areas where you could see clouds of mosquitos in Cambodia and not one bit us the entire time. When the odd mosquito somehow managed to land on our skin, they were dead on contact. It's actually quite freaky...and I don't wanna know what goes into that Ultrathon, but whatever it is, it works. In fact, the only place I got bitten was in Phi Phi Island at the tail-end of our trip when I unwisely thought I didn't have to wear the Ultrathon anymore...and paid the price. So definitely wear the DEET and try out the Ulrathon...if you have to put a chemical lotion on every day, it might as well be something that doesn't smell and doesn't feel like a burden to wear.

This all being said, in my humble opinion, you'd be foolish not to take anti-malarials. In the most basic terms: the risk of getting malaria far outweighs a little constipation. We're actually going back (to Laos & Vietnam) next year and as much as I'm not looking forward to taking the Malarone again, I've accepted that it's just a fact of going there.

Just thought you should know an honest opinion about what it could be like taking the Malarone route. Please, though, spray your clothes and get very strong DEET...it really makes all the difference in avoiding mosquitoes almost completely.

Good luck!

Filmwill,

Thanks for the frank discussion on Malarone. I realize a little constipation and nausea are nothing compared to Malaria, but I find the side effects to be unappealing. (I'm sure I deserve a lecture, here.)

Where did you get the "Ultrathon by 3M?"

My husband is going to the Travel Doc tomorrow. I've armed him with all of the advice from this thread.

Thanks.

Definitely no lectures...to each their own!

On Ultrathon's website, they list the following stores:

http://solutions.3m.com/wps/portal/3...ome/WhereToBuy

We got it at Adventure 16 (a local Southern California outdoors store) but, judging from the stores 3M lists on their website, it looks like you can find it almost anywhere.

Good luck!

If you you don't like the possibility of constipation from Malarone, you might want to consider doxycycline. People seem to avoid it because you have to take it for 4 weeks after leaving the area, but I had virtually no side effects with it (a little nausea ONCE when I took it on an empty stomach). It does increase sensitivity to sun and since I'm light anyway, I wore lots of sunscreen every day. But the doxy was not a problem at all - and quite inexpensive besides. (As I remember, I believe it can cause yeast infections in women, but I've taken it twice, once for a trip to Africa and earlier this year for Thailand, Laos, and Cambodia - and no problems either time.)

I read that you need anti malarials for Chiang Mai also. Call me stupid, but I believe I used to be on doxycycline for acne. Is this one and the same? Or is doxycycline used in many forms?