Malaria tablets?
 

Hi everyone,

Me and my husband are travelling to India and the Maldives in 2 weeks. I went to my GP and I was also told that North India (Delhi, Jaipur, Agra) and Kerala is in a no malaria risk area.

I can't decide whether to take malaria tablets... We're staying for 7 nights in the north and then for further 5 nights in Kerala. We're not staying on the coast but are staying near Munnar and in Allepey. We will be taking a lot of repellents and long sleeves/trousers.

Your views please.

Thanks.
Katerina

Hmmm...not easy to say. I guess this is a case of "better safe than sorry". I have taken Malarone a couple of times and at least it didn't have any side effects on me...but they were very expensive. But they say the most important thing is to cover up at dawn and dusk when this mosquito is active. Have a great trip to the Maldives by the way....I went there with my wife a couple of years back and it was beautiful. You can see some pictures in my trip report http://gardkarlsen.com/sun_island_index.htm

Regards
Gard
http://gardkarlsen.com - trip reports and pictures

I live in India and have never taken anti-malaria meds. The risks of actually getting malaria at this time of the year are negligible, especially in North India. You'll do fine with long sleeves/trousers and insect repellent.

Also, you need to weigh in the potential side effects of the drugs themselves.

Many thanks for your replies.

Gard, I have seen your website and taken notes from it many times before! :-) Especially before planning our trip to Thailand last year. You're well travelled; I'll be referring to your website again when planning our trip to Peru. (hopefully soon!)

Thanks Sharon1306 for the reassurance; I've been reading several government websites and they mostly advise that North India and Kerala are safe without malaria tablets...

We'll have to give it some further thought... I'd rather avoid taking the tablets but as Gard points out it is better to be safe than sorry!

Thanks again.
Katerina

Kacenka, good for you for reading the governement websites! Both the US www.cdc.gov/travel and UK www.fitfortravel.scot.nhs.uk have excellent websites. The guidelines for antimalarials for travel in India have recently changed, and the areas you are visiting are considered lower risk areas (but not no risk). If you have particular health problems you are concerned about, do talk with your doctor, Some people have medical conditions that would make any type of malaria a life-threatening situation, so for those people a physician might recommend anti-malarials in lower risk areas.

Sharon, the situation for someone living in a malarial risk area is very different from that of a person visiting. The visitor has no resistance to malaria, while someone living in the area for a long period of time does have resistance. What is right for you isn't necessarily right for a visitor.

Kathie, I agree with you. But given the areas the OP is traveling to, and the time of the year, the risks of malaria are negligible. It is best to check websites like the CDC and then make an informed decision.

Also, as far as I know, you can build up some level of resistance only if you have been infected by malaria and survived it and not just by living in a malaria risk area.

Sharon, you are correct about how resistance is built. I just wanted to be clear that the issues for people who live in an malarial risk area and for someone who lives there are different.

Speaking from personal experience, I would be very, very careful with any anti-malarial medication. I took malarone and suffered considerable damage to my liver function, according to my U.S. doctor upon our return. It was about two years before that function returned to normal.

USNR, all anti-malarials are prescription medicines that should be taken only under a doctor's direction. Since virtually all medications are metabolized in the liver, any medication can add to the buden of the liver metabolizing any other medications or alcohol. That said, your reaction to malarone is quite rare. Larium (melfloquine) is more likely to cause liver problems.

But your reminder is quite right, no medication should be taken lightly, just as malaria should not be taken lightly.

Kathie: you are correct and my memory is at fault. It was Larium that caused my liver numbers to go haywire. Thanks for the correction.

I am going to India on Friday and have just begun my Larium pills. I have underlying medical conditions that warrant my taking the medication. I saw my MD yesterday and while I was in the room with her she checked the CDC website for the appropriate medication for me. Her choice was based upon the places I would visit (Mumbai and Kerala) and the the fact that there are now drug resistant malaria strains that are in the areas we are visiting.

I find the medication to be a bit rough on the stomach. But, my contracting Malaria would be a lot worse overall.

When your doctor mentions drug-resistant strains of malaria in India, she is referring to chlorquinine resistance. Malaria in much of India and all of SE Asia has been resistant to chlorquinine for years (decades in many areas).

Thanks, I just wanted to know that I was being as covered as possible. But my stomach is a bit off from the medication.

Are you taking the larium with food? Taking it with food can decrease stomach problems.

If you are really uncomfortable with the medicine, another option for you would be malarone. Malarone has fewer side effects overall, but it must be taken daily. Also, you only have to take it for a week after leaving the malarial risk area (while you must continue with the Larium for a month). If you are continuing to have problems with the Larium, talk with your doctor about switchig to malarone.

Kathie-it only lasted a day, otherwise I wouldn't take it. For me the need to take the drug out weighs some of the side effects.

Thanks for your input.

Goodness Larium? I would not take it but my friend does. Too many sode effects I hear. I have been to India 3 times on Business and going back a lot more soon. I take Malarone for the Better safe than sorry. Take it with food and you should be fine. I have been eaten alive by mosquitos in Hyderabad and even delhi at an outdoor party but thats the risks. I take my clothes beofre I put them pn and give a light spray. Also I spray my legs and arms before putting on. It works for me. Use a stong repellent. I get mine at Boots.

Some people just seem to be tasteir to the mosquitos! My frinds angle got swollen from so many bites. Personally I would take Malarone over Larium any day!

SiobhanP, everyone is different. While Larium does have the most (and the most widely publicised) side effects, many people take it with absolutely no problem. It also has the advantage of being taken weekly rather than daily. There is no one best antimalarial... which one to take depends on exactly where one is going and all of one's individual medical variables.

I am very interested in this post as we are going to be in Delhi, Agra, Ranthambhore, and Alwar in March.

Looking at both malaria maps and recommendations (CDC & UK), I'm confused why the CDC still recommends malaria meds ALL OVER India rather than breaking it down into sections like the UK. I have a feeling our US-based travel doctor is going to recommend the meds even though a UK-doctor would likely not.

So confusing. Why the difference in opinion?

Since we're leaving on Saturday I've been researching the question as well. I believe the CDC recommends antimalarials whenever there is a risk, regardless of how small it is. The NHS does not recommend antimalarials if the risk is small enough. Is there malaria in Rajasthan? Sure. See for example:

http://www.medindia.net/news/view_news_main.asp?x=14588

Our chance of contracting it is very small but not 0. Since malarone carries very little known risk it's not a big deal to take it, so we'll be taking our malaria pills.

The NHS has just recently made this change in their recommendations.

The cdc does NOT recommend anti-malarials no matter how small the risk. (Indeed, if they did, they'd recommend anti-malarials in all of Thailand - but they use a threshold, so only a small part of Thailand is considered to have enough risk for someone to take antimalrials.) It also depends on which types of malaria are present in a region. Each of the various agencies making recommendations has a different take on the data, and a different level of willingness to take risk.

Note that the NHS and the cdc have had long-standing difference in anti-malarial recommendations. In the past, the NHS recommended the over-the counter combination sold in the UK, chloroquine and proguanil (Paludrine) fofr India but the cdc felt it was inappropriate as there has been long-standing chlorquinine resistance in India. Indeed, there have been a number of deaths from malaria of persons taking the combination drug. So some people view the NHS recommendations as perhaps a bit negligent, while others see the cdc as overly cautious.

I recommend you do your research ahead of time, even take the printouts from the website with you, and ask the travel med doc to talk with you about his/her recommendations and the reasons for their recommendation. Individual differences in risks of getting malarial (exactly where you are staying, activities, availablity of good medical care, etc) as well as individual health difference should go into making this decision.

Topping off this thread.
We will be visiting India for a longer period and I am not sure I want to take Malarone for that long. We'll be in Madras, Cochin, Goa, Mumbai in Feb/March on a cruise and then 2 weeks later in Delhi, Rajastan, Agra & Varanasi in March. That covers a period of over 1 1/2 months - I am not sure what to do.
Any advice?

We were due to be in Sierra Leone for 1 year in 2007 (we left after 2 months) we had comprehensive medicals and vacination programs before we left on our assignment with VSO. We were given a years supply of Larium and did not hesitate to take it. Why? Because I had contracted Malaria twenty years previously whilst in Vietnam and belive me the two weeks I spent in hospital was not a pleasant experience. A few side unpleasant side effects (and yes, I do appreciate that in rare cases some of those side effects can be serious)is nothing compared with this disease, which is still the one of, if not, the biggest killer in the world.

I do not pretend to know all of the answers and with the greatest respect to those on this board, few non-doctors do. Even amongst the medical profession the knowledge is often limited and usually out of date. The only place you can can get realiable up to date advice is from a specialist travel doctor /clinic.
The only way to be perfectly safe, is to spray and cover up completely. I always use 50% deet but even that is not 100% effective (mozzies seem to find me particualry tasty!).

The other thing that I do is to take a "treatment course" of meds (i.e. different to the ones I am taking regularly) so I can start a course of treatment asap if I am far from medical facilities.

Whatever you decide cover up and spray and above all, enjoy your self - the risks are minimal

Preventing mosquito bites is the best first defense.

Personally, I do not take anti-malarials when in India (I live in the US).

There are several mosquito borne illnesses with Malaria being just one.

Again, protect yourself against their bite in the first place - clothing (loose rather than tight to the skin), repellents, mosquito netting on your bed if needed.

It's pretty cool in N. India right now so the mosquitoes will be much less.

Paul, do read the cdc and nhs recommendations regarding malaria in India. Note that the cdc has a new address: wwwn.cdc.gov/travel

Also, consult with a travel med professional.

You mention that you will be in Indai 6 weeks and don't want to take malarone that long. You might also consider another effective anti-malarial, doxycycline. Doxy has been taken for years by adolescents with serious acne, and is considered quite safe. (Of course all medicines have possible side effects). You do have to continue doxy for one month after leaving the malarial risk area.

While I regularly recommend that people consult with a travel med doc, a well-informed travel med specialist can talk with you about the lower and high risk areas you are visiting and can help you make an informed choice about malaria prevention.

As Jaya says, make sure you use an effective mosquito repellant.

crellston, Jaya & Kathie - thank you all for your advice. I do have a call out to the travel MD I had used in the past. The CDC web site is not that informative - it doesn't break down India in diffferent levels of risk and also they do not make any recommendation per se (liability issues?). Of the top of my head I am thinking Doxycycline...

When I go to India, I'm more worried about eating or drinking something that will land me in the bathroom for 3 days (or longer) than getting malaria!

Paul, the cdc does tell you which anti-malarials are and are not effective (chlorquinine and chlorquinine combinations are not effective; larium, malarone and doxcycline are effective). Beyond that, it does not make recommendations for a specific anti-malarial as it is really dependent on the particular traveler. That's where your consultation with your doctor comes in.

I spent three weeks in India --New Delhi/Bangalore regions-- and just came back. I definitely got bit by mosquitos (not too many but couple bites a day). I have no idea whether or not they carried malaria because they didn't tell me :), but as I was on malarone I didn't particularly worry. So sometimes it is the peace of mind issue. Jaya, I had zero stomach complications but it may be because I exclusively used mineral water during the entire stay and never ate anything uncooked (and boy, was I tempted everywhere I went!!).

Take all the anti-malarials you want - but please, just for me, do a search about negative side effects of Larium. I won't upset myself by lurid descriptions of the nightmares I endured. I still remember then. Just for Dog, eh? I'm serious.

Dogster is correct. My PCP gave me options of potentially feeling dizzy or having nightmares!! I took the feeling dizzy one :) I should add that I didn't experience ANY side effects.

I meant to say 'negative psychological side effects' of Larium.

Larium is the anti-malarial with the most side effects, the most severe side effects, and the best-publicized side effects. Approximately 30% of people taking larium have some psychological side effects from taking larium. For most people, these side effects are nightmares or depressed mood or some anxiety or irritability. For a few, however, they may experience severe psychological side effects such as acute anxiety, paranoia, or even frank psychosis or severe depression with suicidality. That said, about 60% of people taking larium do so without major side effects.

Doxycyline and malarone have fewer side effects and less severe side effects. Fear of side effects is not a good reason to avoid anti-malarials.

For any medication you take, you should carefully research side effects and know what to do if you develop side effects.

Unfortunately, because of the side effects of larium that people hear about, some people are of the belief that all anti-malarials have severe side effects which must be worse than malaria. This is not true. Of course, the worst possible side effect of malaria is death.

My Larium episode was one of the scariest experiences I've ever had. I guess I'm one of the 40%. Never, never, never again.

As Kathie knows, I don't go for this relentless over-prescription of travel meds - but that's MY thing. There are cultural considerations here, lol. Do what you feel comfortable with. Just be happy, be safe and please don't take Larium. I worry.

Thanks everyone.
One thing is settled - I will take meds. What is not settled whether it will be Doxy or Malarone (definitely no Larium).