Malarone: New Malaria Medication With Fewer Side-effects

Malarone is a newly released medication for prevention and treatment of chloroquine-resistant forms of malaria, including cerebral malaria caused by Plasmodium falciparum. Studies have shown Malarone to be 98% effective in prevention of malaria which is as effective as mefloquine or doxycycline.

Malarone is a fixed-dose combination of two antimalarial agents, atovaquone and proguanil hydrochloride. These interfere with different pathways in the biosynthesis of pyrimidines that are the building blocks of nucleic acids involved in DNA structure. Thus, the agents block malaria replication both inside and outside the red blood cell.

Malarone is taken once daily with food or milk, starting two days before entering a malaria risk area and continuing daily until seven days after leaving the area of malaria risk. A pediatric dose is available for children weighing less than 88 pounds. Dosage in children is calculated based upon body weight.

Malarone appears to be extremely well tolerated with fewer side effects than other available medications. Side effects may include GI upset or headache. This contrasts with neuro-psychiatic side-effects of mefloquine and GI upset and sun sensitivity with doxycycline. Malarone has been available in Denmark since 1998 and was approved for use in the United States in August, 2000. The drug combination has been used in Denmark for the past year with an excellent safety record. Malarone is not licensed for pregnant women or nursing mothers.

The cost of Malarone is more expensive than other commonly used medications for malaria prophylaxis. Doxycycline costs pennies per day. Lariam (mefloquine) and Malarone are considerably more expensive; coverage for a two week trip using Malarone daily or Larium weekly may cost between $75 and $100. Malarone becomes more expensive than Larium after two weeks because it requires a daily pill whereas Larium is taken weekly. The price per pill decreases as more pills are purchased and pharmacies have considerable variance in pricing.

I currently recommend this medication as the drug of choice for travelers entering areas with chloraquine-resistant malaria. Travelers should also use personal protective measures such as clothing with long pants and sleeves, insect repellants with 35% DEET for exposed skin, permethrin spray for their clothing and mosquito netting to prevent infection.

Each year, Medical College of Wisconsin physicians care for more than 180,000 patients, representing nearly 500,000 patient visits. Medical College physicians practice at Children's Hospital of Wisconsin, Froedtert Memorial Lutheran Hospital, the Milwaukee VA Medical Center, and many other hospitals and clinics in Milwaukee and southeastern Wisconsin.