It’s one of the most commonly prescribed antimalarials, but have you got questions & concerns about Malarone or Atovaquone & Proguanil? I’m one of Nomads expert Travel Nurses and recommend malaria medications every day. Read on to find out everything you need to know about his widely used malaria tablet.

What is Malarone/Atovaquone & Proguanil? 

Malarone belongs to a group of medication called antimalarials. One of the most commonly recommended malaria tablets, Malarone, contains two active ingredients, Atovaquone & Proguanil Hydrochloride. You will often see this medication referred to as Malarone. This is the branded medication but there is no difference between this and unbranded/generic Atovaquone & Proguanil. This malaria tablet is the one we most commonly recommend to clients in our travel health clinic consultations.

What is Malarone/Atovaquone & Proguanil used for? 

Malarone has two uses: 

To prevent and to treat malaria.

What is Malaria? 

Malaria is a common, life threatening disease found in the tropics. It is a serious febrile illness due to infection of red blood cells with a parasite called Plasmodium (P). 

Malaria is spread by female anopheles moquitoes, which mainly bite from dusk until dawn. When an infected mosquito bites a person, it passes the parasites into the blood stream. These parasites quickly travel down to the liver where they can stay usually for up to 7 days before being released back into the blood stream. It is at this stage that the parasites start to infect and invade the red blood cells, multiplying and reproducing, causing damage to these cells which in turn reduces oxygen to the major organs of the body. 

There are 5 different species of Plasmodium (P) that can cause Malaria in humans, the most serious of them being P. Falciparum Malaria is widespread around the tropics and is responsible for the deaths of up to a million people per year.  

Symptoms of Malaria 

Due to the life cycle of the malaria parasite it takes at least a week to develop initial symptoms. Malaria almost always starts with a fever, sweats, chills and/or shivering. Other symptoms can include headache, feeling nauseas, vomiting, diarrhea and aching muscles. These symptoms are also common to other diseases and quite non specific making it difficult to tell whether they are caused by malaria or some other infection/virus. 

Anyone can catch malaria, but it can be prevented

Without taking a malaria tablet you are leaving yourself at serious risk of developing malaria. Malaria is a disease that, once infected, can be fatal within 24 hours of the onset of symptoms. 

Malarone prevents malaria by killing the parasites in the causal phase (liver stage)Successful treatment at this stage, kills the parasites and prevents them from being released into the blood stream and from multiplying and infecting the red blood cells in the first placeAtovaquone & Proguanil works at an earlier stage than other antimalarials which target the parasites when they are released back into the blood stream. 

How do I take Malarone/Atovaquone & Proguanil? 

Out of all the antimalarials, Atovquone & Proguanil has the advantage of being the shortest course. The adult dose is 1 tablet per day, which you must commence 1-2 days before travel to a malaria zone, every day whilst in the risk area and then continuing for 7 days upon leaving. 

It is important to complete the whole course of your malaria prevention. As the medication works at this early stage of infection, stopping before the 7 days can leave you at risk of malaria.

Always take your medication with or after food or a milky drink, this helps you to absorb the medication better, meaning it is more effective, and also helps to minimise the chance of these unpleasant side effects such as an upset stomach. We recommend to take your tablet at the same time each day, usually morning time with breakfast is a good time to take it. You could always set an alarm on your phone as a reminder. 

Side effects of Malarone/Atovaquone & Proguanil

Some travelers worry about the side effects of the malaria tablets and allow this to impact their trip. The good news is that Malarone/Atovquone & Proguanil are malaria tablet options that are tolerated well by most and are associated with a lesser chance of side effects. 

Some possible side effects can include nausea, vomiting, diarrhea, abdominal pain/loss of appetite. In some travelers it can also cause a cough, headache, insomnia/dizziness and abnormal dreams. 

Taking your antimalarials in the morning rather than before bed could help to minimise the possible abnormal dreams, which are sometimes (although not commonly) a reported side effect. 

Travelers sometimes say to us, I don’t want to take malaria tablets, surely the medication side effects are worse than malaria? Talk to anyone who has had malaria and they will tell you that this is simply not true. In comparison to malariawhich can be fatal, it is a no brainer to take malaria tablets! 

How effective is Malarone/Atovaquone & Proguanil? 

Malarone tablets offer up to 98% protection against the more serious strains of malaria parasites. Unfortunately no antimalarial is 100% effective. We always recommend for you to take additional steps to prevent being bitten alongside taking your malaria tablets. These include: 

  • Using a DEET insect repellent, ideally at concentrations of 50%
  • If DEET is not tolerated, an alternative DEET free repellant such as Icaridin Saltadin can be used
  • Sleeping under a permethrin (insecticide) treated mosquito net
  • Closing windows/doors at before dusk & while you sleep
  • Use of insecticide plug-in an enclosed room to ‘knock down’ biters
  • Wearing long, light, loose clothing, particularly when out and about, particuarly dusk until dawn

Malarone offers excellent protection if used correctly and in conjunction with bite prevention measures. In cases where antimalarials are not effective, it is usually due to an individual not taking the medication correctly or finishing the course too early. 

If despite taking all the above precautions you develop malaria symptoms, at any point during or after travel, it is important to seek advice from a medical professionalThe incubation period of some strains of malaria parasites can be long (potentially up to a year), therefore always bear this mind if you have travelled to a malaria risk area in the past year.

How long can I take Malarone for? 

Long term trips increase the risk of developing malaria. It is more important then ever to ensure you are adequately protected on extended trips. There is no evidence of harm in long-term use and in the absence of significant side effects, Malarone can be used confidently for travel up to one year.

How do I know if I need to take Malarone? 

Malaria is wide spread around the world. Malarone/Atovaquone & Proguanil is usually the advised medication for travel to high risk areas. Sometimes it is also recommended to travellers to lower risk areas if you fall into certain higher risk categories; extensive travel into rural/remote areas, certain medical conditions, the elderly or the very young. To see if the country you are travelling has a malaria risk, search for your destinations in our health guides or book a consultation with our Nomad Nurse to discuss your options. 

Can I buy Malarone/Atovaquone & Proguanil whilst away? 

We would always recommend you purchase your complete supply of antimalarial tablets prior to travel from a reputable source in the UK. There is a risk that medications brought abroad are fake or counterfeit and dangerous to take. Sometimes, pharmacies in other countries may recommend alternative medications that may not be a suitable & effective choice for you. If you are travelling and require malaria tablets, perhaps due to extending your trip, we recommend you check the ISTM global travel clinic directory for a reputable clinic close to your destination.

Is Malarone/Atovaquone & Proguanil a suitable antimalarial for me? 

The recommended antimalarial for you will depend on your destination, your medical history and sometimes your travel budget. 

There are some reasons why Malarone/Atovquone & Proguanil is not suitable for certain individuals. It is important to seek advice from a medical professional, either a Nomad Nurse, Pharmacist or your GP before your trip to work out whether Malarone is suitable for you to take. Some factors such as known medical conditions, taking certain medications, if you are pregnant or breastfeeding, may mean this medication is not a suitable choice. Before you travel, book a consultation for expert advice on malaria & other health risks at your destination. Our Nurses can dispense the right malaria tablets for you & your family, alongwith making sure you know about the other risks & recommended vaccinations.


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