we visited the travel clinic in boston today in preparation for our upcoming trip....there are some changes to the areas which are considered malaria risk areas....

phuket is still considered safe, but krabi and khao lak have been added to the risk areas....

lombok in indonesia is also a risk area...but bali is not

consequently we each will have 28 malerone pills to take on this trip...

we suggest that you check the latest advisories for changes....

You can take malarone, with its panoply of side effects, which also includes not being able to drink alcohol while taking them, or, do as I did for 6 weeks, take a milder, but just as effective alternative Doxycycline-an antibiotic, which costs around 6.00, compared to around 90.00 for malarone. Not only that, but doxycyline, as an antibiotic, works to provide protection for infections and chest colds-which in my case it very much did. I'm so glad that I asked my Dr. for alteratives.

"You can take malarone, with its panoply of side effects, which also includes not being able to drink alcohol while taking them" - are you sure we're talking about the same Malarone? I've taken a lot of it, with no side effects, and while drinking plenty of alcohol at the same time!

Yes, I absolutely am. The pharmacist ran off two sheets of side effects to the drug, and when I first discussed my options, the alcohol prohibition was one of them. I wouldn't take it, my Dutch friends weren't taking it, because it does cause psychogenic reactions in some people, but doxycycline? Anyone can take it, there are no restrictions with alcohol, and like I said, it helps to keep you healthy in other ways. Not to mention the dramatic cost difference!

Malarone has the fewest side effects of the 3 choices for SEA. Alcohol is totally fine with it, as well. Doxycycline is a reasonable and cheaper alternative, but with more side effects. Lariam, the other choice, has the most side effects that people find troublesome and also the most contraindications, but still, alcohol is OK.

The psychological side effects are with Lariam, not Malarone.

No, KimJapan, they are with BOTH drugs.

KimJapan-alcohol is NOT totally fine with malarone, otherwise, the Travel Medical Clinic would have stated that, and they did not. In fact, they said if I drank one glass of wine that SHOULD be okay, but it was not recommended, as this drug can have adverse liver effects, among many side effects. Do a little reading. It's there on the internet.

Would you mind providing some link to evidence of psychiatric side effects with Malarone? In my extensive research about malaria medications, neither the alcohol issue nor the psychiatric issue came up...in online research, talking with a malaria and lyme disease specialist friend who is a professor at UMASS, and in in depth online discussion with the head of the tropical disease section at Nagasaki University.

I really think you might have been given the wrong information.

And KimJapan, as someone who has suffered side effects to nearly every single drug I've ever been prescribed, I can tell you unequivocally that doxycyline BY FAR is the drug amongst the 3 prescribed for malaria with the least side effects, which is precisely why I took it in lieu of Malarone. But, if you don't care about the side effects and want to spend US90.00 as opposed, to US6.00 for an antibiotic with virtually no side effects, (any side effects to doxycycline are mild, quite mild, compared to those other two drugs.) why, go right ahead. Doxycycline was brilliant-it cut my chest cold sickness in half, and I wasn't left with a hacking cough like the rest of my fellow travelers who had the same chest cold. I was SO pleased with doxycycline, I wouldn't even consider the other two.

Prescribing info for Malarone says that alcohol may increase the incidence of dizziness if that is a side effect you will have...it does not say that you can't drink alcohol.

"Malarone may cause dizziness. These effects may be worse if you take it with alcohol or certain medicines. Use Malarone with caution. Do not drive or perform other possibly unsafe tasks until you know how you react to it." from drugs.com

Believe me, I've done a lot of research, and I'm thorough. If I've missed the alcohol and psychiatric bits, it's not for my lack of research. That's why it would be good to have a scientific source...to add the base of knowledge.

Here you go:

Table 4. Adverse Experiences in Active-Controlled Clinical Trials of Malarone for Prophylaxis of Malaria Percent of Subjects With Adverse Experiences*

(Percent of Subjects With Adverse Experiences Attributable to Therapy)

Study 1
Study 2

Adverse Experience
Malarone

n = 493
Mefloquine

n = 483
Malarone

n = 511
Chloroquine plus Proguanil

n = 511

Diarrhea
38
(8)
36
(7)
34
(5)
39
(7)

Nausea
14
(3)
20
(8)
11
(2)
18
(7)

Abdominal pain
17
(5)
16
(5)
14
(3)
22
(6)

Headache
12
(4)
17
(7)
12
(4)
14
(4)

Dreams
7
(7)
16
(14)
6
(4)
7
(3)

Insomnia
5
(3)
16
(13)
4
(2)
5
(2)

Fever
9
(<1)
11
(1)
8
(<1)
8
(<1)

Dizziness
5
(2)
14
(9)
7
(3)
8
(4)

Vomiting
8
(1)
10
(2)
8
(0)
14
(2)

Oral ulcers
9
(6)
6
(4)
5
(4)
7
(5)

Pruritus
4
(2)
5
(2)
3
(1)
2
(<1)

Visual difficulties
2
(2)
5
(3)
3
(2)
3
(2)

Depression
<1
(<1)
5
(4)
<1
(<1)
1
(<1)

Anxiety
1
(<1)
5
(4)
<1
(<1)
1
(<1)

Any adverse experience
64
(30)
69
(42)
58
(22)
66
(28)

Any neuropsychiatric event
20
(14)
37
(29)
16
(10)
20
(10)

Any GI event
49
(16)
50
(19)
43
(12)
54
(20)

* Adverse experiences that started while receiving active study drug.

Is there something we can take to avoid Spylaria? I feel it coming on as I am feeling weak in the knees.

Thank you. Would you post the source of that so I can see it in its original form...it's hard to read here, and I'd like to see the source of data as well.

The CDC website says the most common side effects for Malarone are abdominal pain, nausea, vomiting, and headache, and says nothing about alcohol.

The CDC says doxycycline may cause you to sunburn faster than usual, that you should take it on a full stomach to minimize stomach upset; not to lie down for an hour after taking it to prevent reflux and that women may develop a vaginal yeast infection.

If doxycycline works for you, that's fine, but I'll stick to Malarone, which works for me.

Yes, Thursday, and those are utterly minor compared to Malarone's effects. You just wear sunscreen, which you would anyway!

KimJ, if you do an internet search, you'll find all the FDA drug information on Malarone that you want. Even my Dr. did not recommend it for me, and my friends told me that one of their friends had to quit taking it because it made him feel "messed up in the head." The pharmacist said "do you REALLY want to read all the side effects to this drug? Because there are a lot." Enough said.

P.S. Thursday, the CDC is not going to list all the side effects. You have to read the FDA reports on Malarone, or have a Dr. or pharmacist who will print them out for you.

I have done extensive research, and not found what you found. Would you please list the source of your data?

The two Malarone groups in the studies have different enough results for the validity of the studies to be questionable.

Actually, I don't usually wear sunscreen. I cover my shoulders and use an umbrella as a sunshade... And if I worried about all the possible side effects I'd never take any drugs. I had psychological side effects from Lariam (just one pill), but never from Malarone. But like I had said, take what works for you.

Never mind, I found the data here. http://www.rxlist.com/cgi/generic/malarone_ad.htm

It is poorly presented in the pasted format here, and is easy to read on the linked chart, which clearly shows that Malarone has fewer side effect than Lariam, and is in fact consistent across both groups. In fact, the chart above shows Malarone side effects as being similar or fewer than placebo group.