Offshore Medicals Direct
Malarone (licensed for malaria prevention in the UK)
Preparations available: Malarone (GSK), Reprapog (Sandoz)
Adult dose is one tablet daily - each tablet contains 250mg of atovaquone plus 100mg of proguanil.
It should be taken for 1 or 2 days before entering the malarious area, thoughout exposure, and for 7 days after leaving the infected area. It is licensed for trips of upto 28 days but there is no evidence of increased side-effects if used for longer.
Atovaquone/proguanil need only be commenced one or two days before exposure.
Abdominal pain, headache, anorexia (reduced appetite), nausea, diarrhoea, coughing and aphthous (simple) mouth ulcers can occur.
Absorption may be reduced in diarrhoea and vomiting. Blood levels of the drug are significantly reduced if taken at the same time as tetracyclines, metoclopromide and especially rifampicin or rifabutin
The proguanil component can delay the metabolism of the anticoagulant warfarin, and result in bleeding. Those individuals taking wafarin should discuss this with their GP before starting any treatment.
It should be used with caution in individuals with reduced kidney function.
Lack of experience in pregnancy and during breast feeding means that this antimalarial drug should be avoided in these circumstances unless there is no suitable alternative.