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Malaria Medication - Doxycyline or Malarone?

Travel Forums Central/South America & The Caribbean Malaria Medication - Doxycyline or Malarone?

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1. Posted by uladh sa turas (Budding Member, 3 posts) 16 Jan '13 15:31

Hi folks,

We have just joined the forum ahead of our travels to Central & South America starting in March. We have already read loads of interesting forum posts and will definately be using the forum as a help to us as we travel (and hopefully we will, in time, be able to advise others).

We are just in the process of getting vaccinations and have had some conflicting advice about the medication we should be taking for malaria - could any of you help clarify?

In areas where the mozzies are resistant to chlorquine we understand that there are really only two viable options - Malarone and Doxycycline. One of our GP's told us that Doxycycline was fine, although there were side-effects mainly associated with photo-sensitivity but that it was cheaper and could be taken for a longer period of time and since we are travlling indefinately, this sounded like the pill for us! Today one of us was visiting a nurse in another practice who really went on a rant about how Malarone was the only drug we could possibly consider. She stated that Doxycycline, as an antibiotic, could mask real illness and that I would have to 'wear a burka' if I went outside. She intimated that Malarone was far more effective than Doxycycline and that we were practically dicing with death thinking of not taking Malarone.

So we're a wee bit confused about what to take - but definately feel we should be taking something. We would be so grateful to get some input from travellers in the areas and what advices you have received or side effects experienced/not experienced. Also, although there are many areas where mozzies aren't chloroquine resistant - can it be taken for extended lengths of time and are there any significant side effects with it that forum users know of- would it be better to just take doxycycline in these areas? It's just that we seem to be being advised to take chloroquine in all the other areas...

Our plans are very loose as we are hoping to do some voluntary work as we go along - but coutries and likely order are as follows and estimating a year from start to finish:
Mexico (Yucutan), Belize, Guatemala, El Salvador, Honduras, Nicaragua, Costa Rica, Panama, Columbia, Equador, Peru, Chile, Bolivia, Argentina, Paraguay, Brazil.

We are now considering staying west of the Andes down the west coast of SA for as long as possible (without venturing inland) due to cost implications of Malarone. We had been hoping not to have the restriction on us.

Any advices / experiences are greatly appreciated.

2. Posted by jamierbw (Budding Member, 2 posts) 16 Jan '13 15:47

I can't help with your specific areas, but I can advise about the side affects of Doxycyline. Myself and a 40 strong volunteer group all took this for a month in Uganda. We had a few strange dreams, but the increased sensitivity was hard to notice because we were in a sunnier place than we were used to. 40 Brits living under the equator for a month, imagine that! Anyway, what was ultimately important was that none of us got malaria during the period we were taking the medication.

3. Posted by frandavi99 (Budding Member, 3 posts) 16 Jan '13 22:48

Photosensitivity like any side effect isn't a given and can vary in severity. As for effectiveness there are clear guidelines on what options are best and your GP wouldn't be advising using an ineffective medicine. Personally I would go for doxycycline solely because of the reduced cost. For indefinite travelling malarone could bankrupt you! Side effects are a potential with either and you won't know unil you try, but I know plenty who have used both without issue.

Go chat to a pharmacist if you need more info.

4. Posted by Isadora (Moderator, 13924 posts) 17 Jan '13 07:24

Well, I don't need to tell you to discuss this with you physician as it's obvious that you have.

Trust your GP's advice about doxycycline. The dosage of the antibiotic is the same as they prescribe for the treatment of acne. Just take it with food early in the day as it can cause acid reflux (heartburn) if taken before bed. It's worst side effect is an increased sensitivity to the sun. Basically, use your suntan lotion and a recommended SPF15 or greater. Doxy can be taken for at least 2 years of continuous use. Malarone can not.

Malarone is expensive and has greater side effects. Some do experience hallucinations while others have no effects at all. But, it is not meant for long-term travel. It was designed for the military and it does not have a lot of long-term effects information available to the public. Doxy has a long-term history. You will have to continue the drug for ~3 weeks after your travels but... I'd rather do that than take my chances with Malarone.

As for Doxy masking other medical problems - unlikely at the dosage taken. If you do need medical attention for anything, tell the medical personnel what medications either of you are taking at that time. If you need an antibiotic, there is a plethora other medications available. Doxy (at the anti-malarial dosage) does not interfere with other antibiotics.

Malaria

5. Posted by bex76 (Moderator, 3595 posts) 17 Jan '13 07:50

I took doxycyline for a couple of months in Asia and had no noticeable side effects. I'd happily take it again if necessary.

I was advised malarone has fewer side effects but as already mentioned, it's expensive.

The only malaria drug I've heard of having horrible side effects is Mefloquine (larium) which can cause hallucinations and other psychological effects.

6. Posted by Isadora (Moderator, 13924 posts) 17 Jan '13 11:00

Bex is correct - mefloquine (Larium) should be at the bottom of anyone's anti-malarial list, especially for women. Women experience the more severe side effects than men.

Things I forgot to mention...

1) Doxy is available as an OTC in most CA/SA countries. Just be sure to purchase it (if necessary) from a reliable pharmacy.

2) Alternative contraceptive methods should be used during the first three weeks of doxy use if a woman is taking birth control pills. Doxy does decrease their effectiveness short term. Basically, stay on the OCs but also use additional protection, such as condoms or a diaphragm for the three weeks.

7. Posted by talesbackpack (Full Member, 117 posts) 17 Jan '13 12:16

I can vouch for the Lariam/Mefloquine side effects. I had some seriously trippy hallucinations on that stuff

After month or two on it, I started to experience nightly hallucinations, fevers, chills and nausea. It was the strangest thing - I would be sick as a dog every night just before I went to bed, shaking, burning up, seeing all manner of things, then by morning I would be perfectly fine again. Physically at least.

Once the hallucinations started I just felt mentally off until I stopped taking it. Those last few months were defiinitely interesting!

Jen

[ Edit: Edited on 17-Jan-2013, at 12:17 by talesbackpack ]

8. Posted by uladh sa turas (Budding Member, 3 posts) 17 Jan '13 12:26

Thank you all so much for taking the time to respond to my post.

I do trust my GP so was quite surprised by the other healthcare professional's very strong opinion against doxycycline. I thought I had totally missed something in what I had read to date

Thank you all, you have put my mind at ease. Isadora, thank you for your detailed advice and the malaria link.

9. Posted by MattyRex (Full Member, 117 posts) 17 Jan '13 13:16

This thread came at just the right time. Just bought my Doxycycline pills and had heard about the side effects of all the different types of pills that there is. Sounds like I made the right choice after the info on here!

10. Posted by Isadora (Moderator, 13924 posts) 18 Jan '13 11:50

uladh sa turas and MattyRex - glad to be of help. And thanks to talesbackpack for giving a personal experience with mefloquine (Larium). These types of threads show up regularly but most of the replies about Larium and no side effects have been written by men. (Sorry guys, but true.) There have been minimal replies from women at all.

I chose chloroquine for our trip to Panama because it's one of the only CA/SA countries where malaria is present but is not chloroquine-resistant. Had we included other countries, I would have chosen Doxy.

Not to put too fine a point on it (but being a woman) doxy can increase the chances of a vaginal yeast infection, though rarely. I'd rather treat that than a case of malaria. When women decide to take Doxy, I always recommend taking along one package of OTC treatment with them. They are not always readily available in more rural areas. Call it precautionary measures and do not take up space in your backpack or luggage. (Just a recommendation...) ;)