Malaria Tablets

Malaria tablets are antiparasitic medications which prevent you from becoming infected with malaria. However they do not provide complete protection, and you will need another treatment if you catch malaria.

Malaria is an infection caused by a parasite that is transmitted by the bite of a female Anopheles mosquito. If left untreated, malaria can be life-threatening.

Malaria tablets work by:

• stopping the parasite from multiplying in red blood cells enabling your immune system to fight the infection before you develop symptoms
• preventing the parasite from developing in the liver and infecting red blood cells

You usually start taking anti-malaria tablets a few days before you enter an area where malaria is present and continue taking them for the duration of your trip, and then for a short time when you have returned to a malaria-free zone.

Malaria can be hard to spot and the signs are often similar to flu. Some of the symptoms to be aware of are:

• a high temperature, sweats, and chills
• headaches
• confusion
• feeling tired, sleepy or generally unwell
• feeling and being sick
• stomach pain
• diarrhoea
• muscle aches and pains
• loss of appetite
• a sore throat, cough, and difficulty breathing
• yellowing of the skin or the whites of the eyes (jaundice)

In more severe or complicated cases of malaria, additional symptoms may develop, including:

• cerebral malaria – impaired consciousness (with symptoms similar to a traumatic brain injury) or seizures
• renal (kidney) impairment – may cause reduced urine output (oliguria)
• acidosis – may cause laboured, deep breathing (acidotic breathing) due to a build-up of carbon dioxide
• hypoglycaemia – low blood sugar, common in pregnant women
• respiratory distress (difficulty breathing, laboured breathing) – could result from fluid in the lungs (pulmonary oedema) or acute respiratory distress syndrome (ARDS), especially in pregnant women
• severe anaemia – may present as paler than usual skin (pallor)
• spontaneous bleeding or abnormal blood clotting (disseminated intravascular coagulation)
• shock – may cause low blood pressure
• sepsis – a life-threatening condition that can cause symptoms like fever, confusion, rapid breathing and is more common in pregnant women
• haemoglobinuria (an abnormally high level of haemoglobin in the urine) – severe cases can cause dark red urine (‘blackwater fever’)
• parasitaemia – high levels of malaria parasites in your blood

If you think you may have been bitten by a mosquito or are experiencing flu-like symptoms, get urgent medical attention.

How long after being bitten will symptoms appear?

Symptoms of malaria will normally appear 7 to 18 days after you have been bitten by an infected mosquito. In some cases, malaria symptoms may even occur 2 to 3 months after travel.

Almost all cases of malaria caused by plasmodium falciparum (the most predominant type of malaria) present themselves within 6 months.

There are several different malaria tablets available. Which one you’ll need to take may depend on:

• where you are travelling to
• how your body responds to the medication
• your current health status

At Superdrug Online Doctor, we offer the following anti-malaria tablets:

Doxycycline

The active ingredient, doxycycline, is an antibiotic that can be taken to prevent malaria. The treatment course is usually started 1 to 2 days before entering an at-risk area and continued until 4 weeks after you leave. Doxycycline is a generic, prescription-only medication, so you will need a doctor’s approval to get it.

Malarone

Malarone is a branded anti-malarial medication that contains the active ingredients atovaquone and proguanil. Malarone tablets should be started 1 to 2 days before travelling to an area which has malaria and continued throughout your stay, until 7 days after you have returned to a malaria-free zone. It is a prescription-only medication but we also offer generic Malarone: atovaquone and proguanil. It works in exactly the same way but is available at a lower cost.

There are also several other anti-malaria tablets available which we no longer offer, including:

• Maloff Protect – a branded form of atovaquone and proguanil, similar to Malarone
• Lariam – Lariam tablets contain the active ingredient mefloquine

How to take doxycycline to prevent malaria

The usual dose of doxycycline for malaria is one 100mg tablet daily from 1 to 2 days before travelling to an area where you may contract malaria, until 4 weeks after you return.

When taking doxycycline tablets, you should:

• swallow them whole with plenty of water
• take them around the same time each day, in an upright position (such as sitting or standing, not lying down) to prevent the medication from irritating your stomach
• avoid lying down for at least 30 minutes after taking doxycycline to allow the tablet to swiftly move through your digestive system and avoid irritation
• take them with food or milk if they upset your stomach

Doxycycline tablets increase your risk of photosensitivity, making your skin more sensitive to sunlight. You should reduce sun exposure and use high-SPF sun cream.

How to take branded or generic Malarone to prevent malaria

The usual dose for Malarone, both generic and branded, for adults preventing malaria is 1 tablet once per day, taken with food or a milky drink where possible. Each tablet contains 250mg of atovaquone and 100mg of proguanil hydrochloride.

To prevent malaria, you should:

• start taking Malarone/atovaquone and proguanil, 1 to 2 days before travelling to an at-risk area
• take the medication as instructed every day during your trip
• continue taking it for 7 days after you have returned to a no-to-low-risk area

What happens if I miss a dose?

If you forget a dose of malaria tablets, take it as soon as you remember. Then take your next tablet at the correct time.

Do not take a double dose to make up for a forgotten dose, take your next dose at the usual time.

As with all medications, there is the risk of experiencing side effects when taking malaria tablets. However, not everyone will experience them.

Common doxycycline side effects (may affect up to 1 in 10 people) include:

• feeling sick (nausea)
• being sick (vomiting)
• worsening of a disease called lupus
• pericarditis (inflammation of the heart)
• rashes (especially after sun exposure)
• headache
• allergic reaction

Uncommon doxycycline side effects (may affect 1 in 100 people) include:

• vaginal infection
• heartburn

Very common Malarone side effects (affecting more than 1 in 10 people) include:

• headache
• feeling sick (nausea)
• being sick (vomiting)
• stomach pain
• diarrhoea

Common Malarone side effects (may affect up to 1 in 10 people) include:

• sleeping problems (insomnia)
• dizziness
• strange dreams
• loss of appetite
• depression
• fever
• rash, this may be itchy
• cough

Uncommon Malarone side effects (may affect 1 in 100 people) include:

• an unusual feeling that your heart is beating faster (palpitations)
• anxiety
• hair loss
• itchy, bumpy rash known as hives
• redness and swelling of the mouth
• low sodium levels in the blood

How long do side effects last?

Doxycycline side effects are usually mild and temporary, going away on their own within a few days to weeks. If you are concerned about side effects or are finding them difficult to manage, you should contact your doctor for advice.

Malarone side effects usually go away once your body has got used to the medication, or 12 to 48 hours after stopping treatment.

What to do if you get side effects

If you experience any of the following serious malaria tablet side effects, you should call 999 or get someone to take you to A&E straight away:

• sudden wheezing, chest or throat tightness, difficulty breathing
• rash and itching
• swollen eyelids, face, lips, tongue, or other body parts
• bloody diarrhoea
• fever, swollen lymph nodes or skin rash
• severe headache with visual disturbances, double vision or vision loss
• serious illness with widespread severe skin blistering

If you experience any other side effects that you are concerned about or find difficult to manage on your own, speak to your doctor. If you experience symptoms of malaria such as fever, chills, headache or fatigue, speak to a doctor straight away as they could indicate that the treatment isn’t fully working.

You can also report any medication side effects to the Yellow Card Scheme.

Malaria tablets may not be suitable for everyone.

Doxycycline warnings

Do not take doxycycline if you are:

• allergic to any of its ingredients
• pregnant or trying to become pregnant
• breastfeeding

You should tell your doctor before taking doxycycline if you:

• are going to be exposed to strong light including sunbeds
• have liver or kidney problems
• have myasthenia gravis, a disease that affects certain muscles
• have porphyria (a rare blood pigment disease)
• systemic lupus erythematosus, an allergic condition that causes joint pain, skin rashes and fever
• think you may have syphilis
• have or get diarrhoea with antibiotics
• are taking oral retinoids

Doxycycline and other medications

Before taking doxycycline, you must tell your doctor about any other medications you are taking, including those that are prescription-only, over-the-counter, or herbal.

The following medications can lower the effectiveness of doxycycline:

• antacids used to treat indigestion
• epilepsy medications including carbamazepine, phenytoin and barbiturates

Doxycycline can affect how the following medications work:

• warfarin or coumarins for preventing blood clots
• oral contraceptive pill
• penicillin antibiotics
• ciclosporin, used to affect how the immune system works

Doxycycline and the contraceptive pill

Doxycycline doesn’t stop the oral contraceptive pill from working but it can make it less effective if you experience sickness or diarrhoea for more than 24 hours.

If you are concerned, speak to your doctor before taking doxycycline or follow the instructions about what to do in the patient information leaflet provided with your contraceptive pill.

Malarone warnings

Do not take Malarone if you are allergic to any of its ingredients.

Before taking Malarone, tell your doctor if you have a severe kidney disease.

Other medications and Malarone

Some medications can affect how Malarone works or Malarone may affect the effectiveness of other medications. It is important to tell your doctor if you are taking any prescription, over the counter or herbal medications before taking Malarone, particularly:

• metoclopramide
• tetracycline, rifampicin or rifabutin
• efavirenz
• warfarin
• etoposide

Malarone in pregnancy and breastfeeding

You must not take Malarone if you are or suspect you may be pregnant unless your doctor recommends it. Malarone must not be taken if you are breastfeeding, unless no other alternative is available, because the active ingredients may pass into your milk and harm your baby.

If you are travelling to any of the following areas there is a risk of malaria.

Africa, including but not limited to:

• Angola
• Benin
• Botswana
• Burkina Faso
• Burundi
• Cameroon
• Central African Republic
• Chad
• Comoros
• Congo
• Democratic Republic of Congo
• Djibouti
• Eritrea
• Equatorial Guinea
• Eswatini
• Ethiopia
• Ivory Coast
• Mozambique
• Nigeria
• Uganda
• Zimbabwe

Central Asia, particularly:

• Afghanistan
• Pakistan

Eastern Asia, including but not limited to:

• Bangladesh
• Bhutan
• Cambodia
• Democratic People’s Republic of Korea
• India
• Indonesia
• Laos
• Malaysia
• Nepal
• Philippines
• Republic of Korea
• Thailand
• Vietnam

Central and South America, such as:

• Costa Rica
• Guatemala
• Honduras
• Nicaragua
• Panama
• Bolivia
• Brazil
• Colombia
• Ecuador
• French Guiana
• Guyana
• Peru
• Suriname
• Venezuela

Some of the Pacific islands, including:

• Papua New Guinea
• The Solomon Islands

Caribbean, including:

• Dominican Republic
• Haiti

Before you travel, you should search for the country or countries you are travelling to, to find out if you will be at risk of malaria and any other diseases on the NHS Fit For Travel website. Here you’ll find out more about any preventative medication, like malaria tablets and vaccinations, you may need before you travel.

Are malaria tablets available on the NHS?

No, malaria tablets are not available on the NHS. Instead, you need a private prescription from a GP or from a reputable online service like Superdrug Online Doctor. The cost of a private prescription can vary for malaria tablets.

Can you get malaria tablets over the counter?

Yes, a type of malaria tablet called chloroquine is available over the counter without a prescription from most pharmacies.

Is doxycycline or Malarone better for malaria?

Doxycycline and Malarone are both effective at preventing malaria but doxycycline is available at a cheaper cost.

Malarone may be more effective in areas where the malaria parasite is resistant to doxycycline. Tell your doctor where you will be travelling to and they can provide guidance on the best malaria tablet to take. When you order through Superdrug Online Doctor, our doctors will make sure you’re taking the most effective malaria tablet for the country or countries you’re visiting.

Can I drink alcohol while taking malaria tablets?

Whether you can drink alcohol while taking malaria tablets will depend on which type of medication you are taking. You should read the patient information leaflet before starting your medication. If you’re taking:

• doxycycline – alcohol should be avoided while taking doxycycline as it can stop the tablet from working as it should
• atovaquone and proguanil – alcohol in moderation should be fine with this medication but it is important to avoid large amounts, especially if you experience side effects

If I get malaria, will I have it for the rest of my life?

No, malaria is not a lifelong condition, and if it is diagnosed and treated promptly the infection will go away. Sometimes malaria can come back, if it does, you will need to be treated again.

Do all mosquitoes transmit malaria?

No, only female Anopheles mosquitoes can transmit malaria from one person to another.

Is malaria contagious?

No, malaria is not contagious and cannot be spread from person to person through casual, close, or sexual contact. You must be bitten by an infected mosquito to catch malaria.