A MALARONE CONFESSION
A MALARONE CONFESSION
We recently returned from a trip to Namibia, Botswana and Zimbabwe- Victoria Falls area. We must have been on at least a dozen tours where there was a Malaria risk and have always taken medicine, usually Malarone or whichever Malaria medication is recommended for the region of the world we are visiting.
Namibia has virtually eradicated Malaria, so we decided to start the medication once we were in Namibia. The general rule is to start taking it two days before you go to the Malaria area. We decided that the Malarone would be working well in our systems before we got to Botswana and Zimbabwe where Malaria remains endemic. Our tour company recommended that we take Malaria preventing medication, a difference to when we travel with Tauck, they gloss over that, pushing the responsibility over to us and the CDC website or our doctor to decide for us.
We took the medication with our evening meal which we have always done as it is easier to remember then for us and we eat more food than at breakfast and at a more consistent time. .The notes for Malarone stress taking it at least with milk, the idea being that the fattier the food, the less chance of digestive problems.
Within the first couple of days, I experienced nausea,.Then my husband started with some diarrhea, then hours later, so did I. At first we thought it might have been oysters we had eaten, but they were so fresh and bad oysters usually cause vomiting and within a short time. My hubby was not too bad and his resolved somewhat in a couple of days. I got worse, much worse, and our TD was convinced it was the Malaria meds.
There were six of us on the tour, two were nurses like me, they wanted me to start my emergency Cipro, I was a bit reluctant but stopped the Malerone and began the recommended three days course for traveler’s diarrhea. Within twenty four hours it had improved. I spent a day in our hotel room and missed two safari drives including the only cheetah sitings of our tour.☹️
My husband stopped his Malaria meds but did not take the Cipro. He has to be very careful taking antibiotics as in the past, he took them and they wiped out his gut biome and he became seriously ill. After about four days, my husband recommenced his Malarone ready for our Botswana part of the trip. I did not. Within a short time, his diarrhea kicked in again. Darn, it was the Malarone, he stopped it again.
We always wear long pants and long sleeved T shirts in Malaria areas and use Deet. Spray on our ankles and cream near our faces. I was still scared of being bitten. Last time, we were on the Zimbabwe side of Victoria Falls, there were lots of mosquitoes, even in our room. Mosquitoes carry other diseases, like yellow fever, dengue fever and the one I can never remember how to spell……. So it really is a good idea to keep yourself covered up.
Everyone els on the tour was taking Malaria meds and had no issues.
If we develop a fever within the next year, we will have to keep the possibility of Malaria at the back of our minds.
We already have two more tours booked to areas where Malaria is endemic. Will we take Malaria meds? I don’t know!
Comments
Yikes, I am glad you recovered and sorry you missed some safari days. My second thought is do you think it could have been the milk? That happens to me when I don’t know whether or not the milk is pasteurized. I stay away from dairy products in third world countries.
Wow, British! Sorry to hear of your Malarone issues. We are heading to two tiger zones in India in March that are malaria areas and have the scripts for Malarone. Unhappy about what happened to you and your husband, but now forewarned should those side effects kick in. I remember years ago taking Larium, but suppose that is not the preferred prophylaxis now?
Our travels, I didn’t drink milk on the trip, I have black tea and didn’t eat cereal. but took the Malarone with the evening meal as we have always done.
Marla, as I said, this is the first time, in many trips we have had an issue with Malarone. The way it all happened, from our own sort of detective work, it had to be the Malerone. Others here in the past have mentioned they had issues, but not delved into exactly what they were, nausea, or diarrhea like us. I don’t think Larium is used anymore, didn’t it cause erotic dreams 😀🤪
When my husband and I took the Zambia, Botswana, S. Africa tour in 2017, our doctor recommended Doxycycline instead of Malerone because of the side effects. We had no issues with it. Our friend, who took Malarone, had diarrhea and had to stop taking it. The fortunate part about taking the Doxycycline is I got a tick in my scalp in the Kalahari and when I got to S. Africa, the doctor removed it and was going to prescribe Doxycycline but since I was already taking it, he said I had no chance of infection.
British, sorry for your illness on your trip. We took Malarone while in Kenya and Tanzania and had no reaction at all. We would take it with our morning meal and ate a larger breakfast than usual, which always included a cup of yogurt. Although I did have a bout of diarrhea mid-trip (a full 10 days after beginning the Malarone), Imodium and a 3-day course of Azithromycin did the trick; we continued uninterrupted with our Malarone prophylaxis without incident. We will likely use that treatment again when we head to South Africa and Zimbabwe in September pending discussions with our International Travel Clinic.
AZCreeker, thank you for your reply. Doxycycline would have not been an option since we both take cholesterol drugs. Also from the notes, it is not apparently very effective against Malaria. See below
‘You should know that when you are receiving doxycycline for prevention of malaria, you should also use protective measures such as effective insect repellent, mosquito nets, clothing covering the whole body, and staying in well-screened areas, especially from early nighttime until dawn. Taking doxycycline does not give you full protection against malaria.’
We Will certainly be discussing with our doctor.
When we did K&T in 2013 I was prescribed Malone- I stopped after bad side effects mid-tour when we reached Amboseli (thank goodness for the newly opened, modern restroom on Observation Hill.
My wife was prescribed doxycycline by the same Navy doctor I saw at the local Marine base. She had no problems. One of the doc's jobs is to supply meds to Marines deploying to all areas of the world. So???
Oh, British, what a sad thing to happen on what looked like a great trip. Missing the cheetah would almost have made me feel as bad as taking the Malarone. Glad you soldiered through.
I have taken Malarone 4 times- never any issue.
I normally take it at breakfast time and always drink milk with it and ate yogurt... never a problem.
I once heard that some people were having nightmares and could not sleep, reason why I decided morning time it's best.
British I'm glad you're back and feeling better.
It's interesting that you both developed a sensitivity to Malarone at the same time. You might consider whether that specific production batch of the drug might have had a contaminate that caused the problem. If I was in your situation, I’d be willing to try one or two pills from a known safe manufacturer (US, Canada, or European) just to test that possibility.
Mike, as far as I know, you have to accept what your pharmacist has. It just might be that we are older and our bodies got sensitive after all the past times. We last needed to take Malerone in 2019. I’d have to check the bottles to see where they were made. Probably India where most generics are made.
I agree with Mike Henderson. The composition of the medicine can be and is questionable when manufactured in other countries. There was an episode quite a while ago on 60 minutes about this same topic and it was downright concerning. When I had breast cancer, I insisted the medication I had to take for years came from the U.S. Canada, or Europe. You have a right to ask where the meds were manufactured and opt to get generic or not.
On our last Africa trip many were taking malaria drugs at the beginning. By the end only one young girl was still taking them. Almost everyone taking the drugs had some sort of problem with them. I’ve taken them in the past with no problems, but not this time.
I just checked. Our Malarone was made in a US facility, an American company. My husband spent his entire working life in the Pharmaceutical industry so we know all about generics and how their formulas are allowed to vary by certain percentages from the original drug. It’s allowed by the FDA.
Of the medications I take, the only original one is Synthroid because that medication is critical for constantly being the same dose and not vary from manufacturer to manufacturer. All my other meds are generic. Our insurance wont pay for the original medications in almost every case. One of my BP medications frequently comes from different manufactures, completely different colors and shapes. If I want the original, it’s hundreds of dollars out of pocket. It’s the changing from one brand to another that is the problem, as some will be more or less effective.
It’s as common in the US for factories to be shut down when standards fail as it is in other countries until they fix the production problems.
We have done mefloquine instead of malarone, with good success. It is taken once a week, starting a week before and for 4 weeks after travel. Taking it well in advance of travel gave an opportunity to see its effects prior to traveling.
Mefloquine is the same as Larium and is rarely used because of the following. It has a black box warning. You also can’t take Cipro while taking it. Discuss with your doctor
IMPORTANT WARNING:
Mefloquine may cause serious side effects that include nervous system changes. Tell your doctor if you have or have ever had seizures. Your doctor may tell you not to take mefloquine. If you notice any of the following symptoms while taking this medication, call your doctor immediately: dizziness, a feeling that you or things around you are moving or spinning, ringing in the ears, and loss of balance. These symptoms may occur at any time while you are taking mefloquine and can last for months to years after the medication is stopped or can be permanent.
Mefloquine may cause serious mental health problems. Tell your doctor if you have or have ever had depression, anxiety, psychosis (difficulty thinking clearly, understanding reality, and communicating and behaving appropriately), schizophrenia (an illness that causes disturbed or unusual thinking, loss of interest in life, and strong or inappropriate emotions) or other mental health disorders. Also tell your doctor immediately if you develop the following symptoms while taking this medication: anxiety, feelings of mistrust towards others, hallucinations (seeing things or hearing voices that do not exist), depression, thoughts of suicide or harming yourself, restlessness, confusion, difficulty falling asleep or staying asleep, or unusual behavior. These symptoms may occur at any time while you are taking mefloquine and can last for months to years after the medication is stopped.
These symptoms of nervous system changes or mental health problems may be more difficult to note in young children. Watch your child carefully and contact their doctor right away if you find any changes in behavior or health.
Keep all appointments with your doctor, eye doctor, and the laboratory. Your doctor may order certain lab tests and periodic eye examinations to check your body's response to mefloquine.
Your doctor or pharmacist will give you the manufacturer's patient information sheet (Medication Guide) when you begin treatment with mefloquine and each time you refill your prescription. Read the information carefully and ask your doctor or pharmacist if you have any questions. You can also visit the Food and Drug Administration (FDA) website (http://www.fda.gov/Drugs/DrugSafety/ucm085729.htm) or the manufacturer's website to obtain the Medication Guide.
Talk to your doctor about the risks of taking mefloquine.
Now all of this discussion makes me wonder if we should take some doses of Malarone WAY in advance of our tiger safari! I certainly don’t want to miss a day due to yucky side effects. Bleh……going to my doctor on Monday. Definitely discussing this!