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Antimalarial

Drug Class: Commonly Known As: Category:
Antimalarial Adult, Children

Antimalarial - What is it for

Malaria is a mosquito-borne disease caused by a parasite (Plasmodium species). It is transmitted through the bite of an Anopheles mosquito. In the human body, the parasites multiply in the liver, and then infect red blood cells.

Mefloquine, Doxycycline, Atovaquone with Proguanil (Malarone ® ) and Chloroquine are available for treatment and prevention of malaria. You only need to take one of these. Discuss with your pharmacist or doctor which is the most suitable for you and according to the country you will be visiting.

Antimalarial - Side Effects, Precautions, and Contraindications

What side effects can Antimalarial cause?

Mefloquine (can be purchased at retail pharmacies)

  • Nausea, vomiting, abdominal pain, headache, insomnia, vivid dreams. Continue the course unless these side effects become unbearable.
  • Dizziness, loss of balance, and ringing in the ear. Discuss with you pharmacist or doctor if you are involved in activities that require a high degree of alertness, sense of balance or performance of skilled tasks. These side effects can occur at any time during drug use, and can last for months to years after the drug is stopped or can be permanent. If you experience these symptoms stop taking Mefloquine immediately and see your doctor for an alternative anti-malaria medication.
  • Rare side effects: acute anxiety, depression, restlessness, confusion, severe dizziness, hallucinations. If you experience these symptoms stop taking Mefloquine immediately and see your doctor for an alternative anti-malaria medication.
  • Most side effects from this medication usually occur before the second dose.

​Atovaquone with Proguanil (Malarone®) (requires a doctor's prescription)

  • Nausea, vomiting, abdominal pain, headache, diarrhoea. If you experience such symptoms, please continue unless side effects become intolerable.

Doxycycline (requires a doctor's prescription)

  • Sunburn due to sunlight sensitivity, therefore try to avoid prolonged exposure to sunlight and use sunscreen.
  • Nausea or diarrhoea. This is minimised by taking the medication with a meal.
  • Inflammation of the oesophagus. Avoid lying down for half an hour after taking medication.
  • Space the medication apart from iron supplements and antacids as it impairs the absorption of medication.

Chloroquine (available at pharmacies)

  • ​Nausea, vomiting, abdominal pain, headache, insomnia, dizziness, visual disturbances, itchy skin. Continue the course unless these side effects become unbearable.
  • Although uncommon, chloroquine may lower your blood glucose level; seek medical attention immediately if you experience symptoms such as dizziness, confusion, feeling hungry, nervous or anxious.​

Before taking Antimalarial, what precautions must I follow?

Mefloquine (can be purchased at retail pharmacies)

  • For women of childbearing age, take measures to avoid pregnancy while on this medication and for three months after the last dose.
  • Should not be taken by travelers with a history of epilepsy or psychiatric disorders (including depression, generalized anxiety disorders, psychosis and schizophrenia) and heart conduction abnormalities.

Atovaquone with Proguanil (Malarone®)(requires a doctor's prescription)

  • ​​Avoid pregnancy while taking this medicine and for 2 weeks after the last dose.
  • Should not be taken by pregnant or breastfeeding women.

Doxycycline (requires a doctor's prescription)

  • ​Should not be taken by pregnant or breast-feeding women and children aged 8 years and below.
  • For women of childbearing age, take measures to avoid pregnancy while on this medication and for one week after the last dose.

Chloroquine (available at pharmacies)

  • Should not be taken by travellers with a history of epilepsy and patients with known G6PD deficiency. May exacerbate psoriasis.

What food or medicine must I avoid when I take Antimalarial?

Antimalarial - Dosage and How to Use

How should Antimalarial be used?

Mefloquine (available at retail pharmacies)

Start two to three weeks before departure, continue to take the medication once a week during travel and continue once a week for 4 weeks after leaving endemic area.

Adult dose ( Weight >45kg )
  • One 250mg tablet once a week, on the same day of the week.
  • Check with your pharmacist or doctor for the correct dose if your weight is 45 kg or lower.

Paediatric dose (Applies to children age ≥6 months and weight >5 kg)

​Body Weight Dose​
​20-30kg​125mg (1/2 of 250mg tablet) once weekly
​30-45kg​187.5mg (3/4 of 250mg tablet) once weekly
​>45kg​250mg once weekly

 

Administration

  • Take with or after food and with at least one full glass of water.
  • The tablets may be crushed and suspended in a small amount of water, milk or other beverage for administration to people unable to swallow them whole.
  • If you vomit within 30 minutes of administration, repeat the dose.​

Atovaquone with Proguanil (Malarone®)(requires a doctor's prescription)

  • Start one to two days before departure; continue to take the medication every day during the trip and for one week upon your return from endemic area.

Adult dose

  • One tablet once a day
​Body weight  ​Dose
​11-20kg ​1 tablet (62.5 mg/25 mg) once a day  
​21-30kg​2 tablets (125 mg/50 mg) once a day  
​31-40kg​3 tablets (187.5 mg/75 mg) once a day  
​>40kg​4 tablets (250 mg/100 mg) once a day  ​

        

Administration

  • ​Take the daily dose with or after food or a milky drink at the same time each day.
  • Tablets may be crushed and suspended in a small amount of water, milk, or another beverage for persons unable to swallow tablets.
  • If you vomit within 1 hour of administration, repeat the dose.

Doxycycline (requires a doctor's prescription)

  • ​Start one to two days before departure; continue to take every day during the trip and for four weeks upon your return from endemic area.

Adult dose

  • 100mg once a day

Paediatric dose (Applies to children age> 8 years)

  • 2.2mg/kg dose once a day, up to a maximum of 100mg per dose

​Administration

  • ​Take with a full glass of water and avoid lying down for about 30 minutes after taking this medication.
  • Space doxycycline capsules one hour before or 2 hours after taking antacids and preparations containing calcium, iron and zinc.
  • If gastric irritation occurs, take this medication with food or milk.

Chloroquine (available at pharmacies)

  • Start one week before departure and continue to take every week during the trip and for four weeks upon your return.

Adult dose

  • Two 250mg tablets once a week (Total 300mg base), on the same day of the week.

Pediatric dose (according to weight)

  • 5 mg base/kg (8.3mg/kg salt), once a week on the same day each week. (Do not to exceed 300mg base/dose)

Administration

  • Take with or after food to decrease gastric side effects and bitter aftertaste.

What should I do if I miss a dose?

What should I do if I overdose?

Antimalarial - Handling

How should I handle Antimalarial safely?

Antimalarial - Storage

How should I store Antimalarial?

Keep away from children;#Keep in a cool, dry place, away from direct sunlight;#Store at room temperature;#Store at room temperature.

How should I dispose of Antimalarial safely?

Antimalarial - Additional Information

What is Malaria?

Malaria is a mosquito-borne disease caused by a parasite (Plasmodium species). It is transmitted through the bite of an Anopheles mosquito. In the human body, the parasites multiply in the liver, and then infect red blood cells.

What are the symptoms?

People with malaria often experience fever, chills, and flu- like illness. Symptoms usually appear between 10-15 days after the mosquito bite; it may also be presented as late as several months after departure from an endemic area and after anti-malaria medications have been stopped.

Left untreated, it may develop severe complications and even cause death.

Who is at risk?

Risk varies from place to place and also within a country. For example, there may be no or lower risk in the cities but substantial risks are present in the countryside. Travelers staying in airconditioned hotels may be at lower risk than backpackers or adventure travelers.

Malaria commonly occurs in places like Sub- Saharan Africa, Southeast Asia, India, Haiti, Papua New Guinea, Central and South America and the Dominican Republic.

Inform your pharmacist or doctor of every city/ state/region that you are visiting so that the risk can be accurately assessed.

What can I do to prevent malaria?

  • Protection from mosquito bites is the first line of defence against malaria since it is transmitted by the bite of infected mosquitoes

  • Wear long-sleeved clothing and long trousers between dusk and dawn as the mosquitoes are more active during these times.

  • Apply insect repellent containing DEET more than 20% to exposed skin. For children not more than 10% DEET. Alternatively, insect repellent patches can also be used.

  • Use mosquito coils or electric inserts impregnated with synthetic pyrethroids in the room at night.

  • Sleep with netting around beds, with the edges tucked or in a screened room.

Are there any medications that I can take to prevent malaria?

Yes. Mefloquine, Doxycycline, Atovaquone with Proguanil (Malarone®) and Chloroquine are available.

You only need to take one of these. Discuss with your pharmacist ​or doctor which is the most suitable

for you and according to the country you will be visiting.​

After the trip:

Following these guidelines and medication might not guarantee complete protection. If you have a fever and/or experience chills between one week and up to 1 year after your return, you should seek medical attention. Inform the doctor that you have been to a malarious area. Malaria can be effectively treated if detected early. A delay in treatment may result in serious consequences.

    The information provided is not intended as medical advice. Terms of use. Information provided by SingHealth

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