Stay safe and order malaria tablets before you travel

Malaria is a dangerous disease common to tropical countries. Once you have it, it’s difficult to cure. So, you better avoid it in the first place. Our doctors can provide you with effective malaria prevention drugs.


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What is malaria?

Malaria is a mosquito-borne disease caused by parasites of the plasmodium family. When travelling abroad to a region where malaria is known to be prevalent, you will need to take antimalarial medication and try to avoid being bitten by mosquitos. There are 5 different types of malaria, and the type of antimalarial you take will depend on the area you are travelling to and the type of malaria that is known to be there.

What causes malaria?

Malaria is caused by plasmodium parasites which are passed between people and transferred into the bloodstream via the saliva of female mosquitos. Once in the bloodstream, the parasites move towards the liver where they grow and multiply in the liver cells. The parasites are then released in significantly higher numbers back into the bloodstream, where they continue to multiply in the red blood cells until the cells explode. It is the multiplication of parasites in the blood cells which causes symptoms, with the process continuing and parasites rapidly increasing in numbers. The disease is not immediately obvious, as it takes around 7 days after being bitten by a malaria-carrying mosquito for parasites to begin multiplying in the blood.

Which countries have malaria?

More than 100 countries are known to be malaria hotspots. The disease is particularly prevalent in Africa, South Asia, Southeast Asia, Oceana, the Middle East, the Caribbean, and much of Central and South America.

Is malaria seasonal?

In many countries, malaria reaches its peak-transmission during and just after the rainy season, because mosquitos breed in hot and humid climates.

How dangerous is malaria?

Malaria can be very dangerous and, in some cases, fatal. Plasmodium Falciparum, which is prevalent in sub-Saharan Africa is the most dangerous malaria-causing parasite and is responsible for the most malaria deaths globally. It is possible to treat and cure malaria if it is caught early, so it is important to recognise the early symptoms. However, some types of malaria act very quickly and lead to complications including swelling of the brain, anaemia, kidney failure, liver failure, a ruptured spleen, low blood sugar, pulmonary oedema, acute respiratory distress syndrome (ARDS), or a sudden drop in blood pressure leading to shock.


What are the symptoms of malaria?

Malaria symptoms tend not to develop until 7 days after the initial mosquito bite. Some malaria parasites remain dormant in the liver, with symptoms taking up to a year to develop. If you have recently travelled to a malaria zone, you should seek immediate medical help if you develop and of the following symptoms:

  • A high body temperature of 38C or above
  • Feeling hot and shivery
  • Headaches and muscle pain
  • Vomiting and/or diarrhoea
  • Feeling generally unwell

More severe symptoms of malaria can indicate serious health complications and require urgent medical attention. These include:

  • Severe exhaustion
  • Difficulty breathing
  • Severe dehydration
  • Convulsions
  • Confusion
  • Jaundice (yellowing of the skin and the whites of your eyes)
  • Blood in the urine

What is malaria like?

Early symptoms of malaria can feel like having a bad bout of flu, with full body aches and pains, a high temperature, a feeling of being generally unwell, vomiting and/or diarrhoea, and often a bad headache from dehydration. It is important to seek medical help if you experience any of these symptoms and have recently travelled to a malaria zone.


How to avoid malaria

It is vital to be aware of the risk before travelling to a region where malaria is known to be prevalent. You should take all measures possible to avoid being bitten by mosquitos. This includes choosing appropriate accommodation, well ventilated and away from damp, dark places or stagnant water sources. Equip your accommodation with mosquito nets, which can be bought impregnated with mosquito repellent, and repellents in the form of air sprays, coils to be burned and electric humidifiers which can be plugged into the wall. While it is tempting to choose shorts and sleeveless tops when visiting a hot, humid climate, try to keep your skin covered with loose, long clothing. In addition, apply a mosquito repellent to your skin, preferably one containing 50% DEET. This is particularly important at dusk and night, as mosquitos love to feed at these times, and it may be worth staying indoors in the evenings.

In addition, you will need to take antimalarial medication with you when travelling to a mosquito zone. Speak to your doctor to find out which type is suitable for your trip and to make sure you take it correctly, as some will need to be started before you leave for your trip.

How is malaria treated?

If you notice symptoms of malaria you will need to go to hospital for a blood test to confirm the disease. Non-severe cases can generally be treated at home with prescription-only antimalarials, which will be dependent on the type of malaria, the severity of symptoms, and which antimalarials have already been taken. More severe cases will need to be treated in a hospital, where the patient will have their lungs, kidneys and blood sugar levels monitored. In the UK, the standard treatment for severe malaria is a quinine injection into the bloodstream followed by treatment with an antimalarial. 

Antimalarial medication

The type of antimalarial medication you take will depend on where you are travelling to, the length of your trip, and the cost, so it is important to speak to a doctor about which one is appropriate for you. The three main types of antimalarial are Chloroquine (Lariam), Malarone (atovaquone-proguanil) and Doxycycline

Chloroquine needs to be started 1 - 2 weeks before your arrival in a malaria zone, and for 4 weeks following your departure. It is best suited to long trips, as it only needs to be taken once a week, and is suitable for use in all pregnancy trimesters.

Malarone is a more expensive option that is better suited to short trips or last minute travel. You should start taking it 1 or 2 days before travel, and for 7 days following your return. Malarone has few side effects and is also available in a form suitable for children, but should not be taken during pregnancy.

Doxycycline is much cheaper than other antimalarials. It is an antibiotic that should be started a day or two before travel and taken once daily throughout your trip. It may cause side effects in some people, and should not be used by children under the age of 8 or by women who are pregnant or breastfeeding.

Can I still get malaria if I take antimalarials?

When taken correctly, antimalarials provide good protection against malaria. However, no antimalarial is 100% effective, and it is still possible to contract malaria while taking them. Therefore, it is a good idea to take extra precautions such as using mosquito nets and repellent and avoiding being outside at night.

Which type of antimalarial do I need to take?

The type of antimalarial you will need to take depends on the area you are travelling to, as different types of malaria are prevalent in different areas of the world. It is recommended that you consult a doctor to make sure you take the right antimalarials with you. For a rough guide, this map will give you an idea of which antimalarials are suitable for which country.

Are malaria tablets a prevention or a cure?

Malaria tablets are used for prevention and as a cure for malaria. The are available for purchase on prescription from Dr Felix as a preventative measure for travellers.

How long do I need to take antimalarials for before and after my trip?

The length of your course will depend on the type of antimalarial you are taking. Chloroquine needs to be taken 1 to 2 weeks before your trip and for 4 weeks after your return. Malarone will need to be started 1 or 2 days before your arrival in a malaria zone and for 7 days following your departure. Doxycycline should be started 1 or 2 days before travel and continued for 4 weeks following your return.

Side Effects

What are the complications of antimalarials?

Like all medicines, antimalarials can cause side effects in some people. These side effects are usually mild and easy to manage. Doxycycline tends to cause more side effects, including yeast infections and an increased sensitivity to sunlight. The most common side effects of antimalarials are gastrointestinal. If you experience any nausea or sickness when you take your daily dose, try taking it with or just after a meal. Staying hydrated and taking Paracetamol or Ibuprofen where necessary can help to deal with headaches. Chloroquine can cause around 1 in 10 people to experience sleeping problems. If this symptom persists, speak to your doctor for advice, as a different antimalarial might be better suited to you.

If you experience any symptoms of an allergic reaction to your antimalarial, stop taking it and seek medical help immediately. Symptoms include difficulty breathing, wheezing, chest pain, swelling of the face, lips, tongue, throat, hands or feet, fever, or rash. 

Will my other medications interfere with my antimalarials?

Before taking antimalarials, you should tell your doctor if you are taking any other medications. Some medications may interact with antimalarials, including:

  • Halofantrine
  • Quinine or quinidine
  • Quinapril
  • Beta-blockers and calcium-channel blockers
  • Antihistamines
  • Antidepressants, selective serotonin reuptake inhibitors, bupropion and antipsychotics
  • Epilepsy medications including sodium valproate, carbamazepine, phenobarbital, and phenytoin
  • Ketoconazole
  • Rifampicin, penicillin, tetracycline and cephalosporins
  • Efavirenz
  • Tramadol
  • Medicines for diabetes or blood-clotting disorders, such as anticoagulants
  • Kaolin
  • Sucralfate
  • Oral contraceptives
  • Barbiturates
  • Ergotamine or methysergide
  • Typhoid vaccine
  • Ciclosporin
  • Methoxyflurane
  • Antacids and other medicines containing aluminium, calcium, iron, bismuth or zinc salts
  • Retinoids
  • Metoclopramide
  • Warfarin
  • Etoposide

To be safe, let your your doctor know if you are taking any of the above medications.

Is it okay to drink alcohol when taking antimalarial medication?

While taking Malarone or Chloroquine, you are advised to drink alcohol with caution, as it can make you feel drowsy or dizzy. You should avoid drinking alcohol while taking Doxycycline, as alcohol can reduce its effectiveness.

Are malaria tablets safe to use during pregnancy?

Chloroquine is the only antimalarial that can be taken during pregnancy. The WHO recommends that pregnant women avoid travelling to areas with a high risk of contracting malaria, as it can be dangerous to both mother and baby. Malaria can increase the risk of miscarriage, premature birth, restricted growth or stillbirth.

Will antimalarials make me drowsy?

Antimalarials can cause you to feel drowsy, particularly if you drink alcohol with them. You should limit your alcohol intake when taking antimalarials and make sure to stay well hydrated at all times.


Do commercial pilots need to take antimalarials all the time?

Advice about malaria prevention for pilots and aircrew depend on their travel routes and length of stay. Crew are cautioned to take precautions against mosquitos bites, but do not have to take antimalarials all the time if they do not wish to do so.

What are the risks of long term use of antimalarials?

Antimalarials are generally used for a short time period, to protect against malaria while travelling. The risks of long-term use are relatively unknown, but research suggests that long-term use of Chloroquine can cause gastrointestinal distress which may have serious health complications.

How long can I safely take antimalarials for?

Doxycycline is thought to be safe to use for at least 6 months. Some countries limit use of Malarone to 28 days, although clinical research has indicated that it safe to use for up to 20 weeks. Chloroquine should be limited to short-term use only, as its use in the long term carries a potential risks of health complications. If you are planning on taking an extended trip to a malaria zone, speak to your doctor for advice on which malarials to take.

Can I get antimalarials on the NHS?

Antimalarials are not available on the NHS for preventative purposes. They can be accessed on the NHS for treating malaria, and in very rare cases where the patient has specific medical needs.

Can you catch malaria in the city?

Malaria is prevalent in many cities across the world and spreads quickly in areas of dense population. Depending on the country, transmission may vary between urban and rural areas, but it is best to be safe and take antimalarials regardless.

Can children take malaria tablets?

Chloroquine is suitable for use in children, and Doxycycline can be taken by children over the age of 8. Malarone is available in a paediatric form which is suitable for use in children.

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