For what it is worth I visited my doctor (who has hunted Africa three times himself) today and he prescribed Malarone for my wife and me.

Drug-drug interactions are tedious for us MD's.
I resort to Epocrates on a Palm Pilot to check for these.

Epocrates says: No significant interactions between warfarin and Malarone.

It should not affect PT(INR) if you are on the rat poison.

Malarone has very few interactions, two listed are rifampin and metoclopramide. Tetracyclines such as doxycycline may counteract the Malarone (affects the Atovaquone component of Malarone), but then the doxy would still be providing some protection from Malaria, and doing a world of good for tick borne disease.
Doxy is not a good prophylaxis for traveler's diarrhea.

If you have renal insufficiency with creatinine clearance less than 30 ml/min, you should not take Malarone.

If you have mild to moderate cirrhosis from all the sundowners, Malarone will probably be O.K., but they don't know for sure about severe cirrhotics, Ruark never took it. Yes, it has only been around for about 10 years.

Malarone has easy dosing for kiddies, with pediatric tablets available, and established dosing for those who weigh 11 Kg (22 lbs) or more.

Malarone has the least side-effects of all the malaria phrophylactics, greatest safety, and efficacy as good as it gets.

I took it in 2001. Best choice for Malaria prophylaxis.

Thanks RIP. I will go with Malarone again.

quote:

Originally posted by 500grains:

quote:

Originally posted by Atkinson:
I have seen only a couple of reactions with Malerone and Lariam over the last 40 plus years.

I don't mean to niggle, but hasn't Malarone only been available for 8 or 10 yrs and Larium for 20?



History of Lariam (Mefloquine)
history of Lariam

History of Malarone and other antimalaric drugs
history of antimalaric drugs and Malarone

Dan, You're spot on.
In 1985 I became a chemist but haven't heard of Malarone or Lariam at the faculty of pharmacy.

I took my first Lariam in 1987. I still remember one dream in particular. Scary stuff.
The drug of choice prior to that was Chlorquine Phosphate.
Rich Elliott

I hate Larium. I had the same symptoms that Wendell had while on a lioness/bull elephant hunt in the Matetsi in 1994. I wouldn't tell my enemies to use the damn stuff. It just wouldn't be right.

quote:

Originally posted by 500grains:

quote:

Originally posted by Atkinson:
I have seen only a couple of reactions with Malerone and Lariam over the last 40 plus years.

I don't mean to niggle, but hasn't Malarone only been available for 8 or 10 yrs and Larium for 20?



History of Lariam (Mefloquine)
history of Lariam

History of Malarone and other antimalaric drugs
history of antimalaric drugs and Malarone

quote:

Malarone

In 1998 a new drug combination was released in Australia called Malarone. This is a combination of proguanil and atovaquone. Atovaquone became available 1992 and was used with success for the treatment of Pneumocystis carrinii. When combined with proguanil there is a synergistic effect and the combination is at the present time a very effective antimalarial treatment. The drug combination has undergone several large clinical trials and has been found to be 95% effective in otherwise drug resistant falciparum malaria. How long it will be before resistant strains of malaria appear remains to be seen. It has been claimed to be largely free from undesirable side effects but it should be noted that proguanil is an antifolate. This is not likely to be a problem with a single treatment course of the drug but some caution should be exercised when using it for prophylaxis. At present it is a very expensive drug.

quote:

The History of Lariam (Mefloquine)

Partially in response to the danger of American soldiers contracting malaria during their service in the Vietnam War, the Walter Reed Army Institute of Research, in 1963, began a search for new anti-malarial drugs. During their research the institute found mefloquine to be one of the more successful potential drugs. Further development of mefloquine for the mass-market was given over to Swiss company Hoffman LaRoche, who eventually released mefloquine to the public during the mid-1980s. The Food and Drug Administration approved mefloquine for use in the United States in May of 1989. Currently, the Roche Laboratories markets the drug under the name Lariam, Mepha markets under the name Mephaquine, and Cipla-Medpro markets under the name Melfiam.

When I travelled first in Africa in 1988 neither Larium nor Malarone were available. I used the Tropical Diseases Hospital in London. That is only 20 years ago. I travelled again in 1994, 2002 and 2006. And also in several parts of South East Asia. Over a twenty year period it is quite noticeable how medical treatments change for travellors and also what the advice is. ANYONE travelling over an extended period would know this.

Of course if malarial preventative medicines might not have changed much since 1999 ...... so some might think it has always been like that.



PS I don't take Larium as it does have affects for me.

I've used Doxycycline the last few times and the sun sensitivity doesn't bother me.

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