Malaria is a potentially serious infection spread by the bites of infected mosquitoes. It occurs in many tropical and subtropical parts of the world, including areas of Africa, Asia, Central and South America, the Caribbean and the Pacific. The level of risk can vary considerably between countries and even between different regions of the same country.
Malaria tablets, also called antimalarial medicines, can reduce the risk of developing malaria during and after travel. They are not suitable or necessary for every traveller, however. The right advice depends on your destination, travel plans, health, medicines, age and personal circumstances.
At Murrayfield Pharmacy in Edinburgh, our travel health consultations provide an individual assessment before prescribing malaria tablets where appropriate. We can also advise on mosquito-bite prevention and other measures to help you travel safely.
When might malaria tablets be needed?
Whether you need antimalarial medicine depends primarily on where you are going and what you will be doing there. A clinician will consider the current malaria risk for each part of your itinerary, rather than assessing the country as a whole.
- Some destinations have a high or continuous risk of malaria.
- Other areas have a seasonal risk, which may be higher during or after the rainy season.
- Some cities, resorts or high-altitude areas may have little or no malaria risk, while nearby rural areas may carry a greater risk.
- Travelling at night, staying in basic accommodation or spending time outdoors can increase exposure to mosquitoes.
- A short visit does not necessarily mean that malaria tablets are unnecessary.
For certain lower-risk itineraries, avoiding mosquito bites may be the main recommendation. In other circumstances, a clinician may discuss a standby emergency treatment approach. This is not suitable for everyone and should only be used following clear, destination-specific instructions.
Why a travel health assessment is important
There is no single malaria tablet that is best for every traveller or every destination. Different medicines are recommended in different parts of the world because malaria parasites can vary in their response to treatment. A consultation also helps identify whether a particular medicine is appropriate and safe for you.
During an assessment, you may be asked about:
- Your full itinerary, including stopovers, excursions and areas outside the main resort or city.
- Your dates of travel and length of stay.
- Accommodation and planned activities.
- Previous travel to malaria-risk areas and any past problems with antimalarial medicines.
- Pregnancy, plans to become pregnant or breastfeeding.
- Medical conditions, allergies and current prescription or non-prescription medicines.
- Your age and, where relevant, your child’s weight.
This information helps the clinician balance malaria risk against possible side effects, interactions and practical considerations. It is important not to use leftover tablets from a previous trip, share medicines with another traveller or buy treatment without checking that it is suitable for your current destination.
Common malaria tablet options
Depending on your itinerary and medical history, a clinician may consider medicines such as atovaquone/proguanil, doxycycline or mefloquine. Chloroquine with proguanil may be considered for some destinations, although resistance means it is not appropriate in many malaria-risk areas.
Atovaquone/proguanil
Atovaquone/proguanil is taken once daily. It is usually started shortly before entering the malaria-risk area, continued daily during the stay and continued for a short period after leaving. It is often convenient for shorter trips, but may not be suitable for everyone, including some people with significant kidney problems.
Doxycycline
Doxycycline is also taken daily and is continued for several weeks after leaving the risk area. It can make the skin more sensitive to sunlight and may cause indigestion or heartburn. It is not suitable for everyone, including pregnant women and some children, and it must be taken with care according to the prescribing instructions.
Mefloquine
Mefloquine is generally taken weekly and is continued for a period after travel. Because it can cause neuropsychiatric side effects in some people, the clinician will carefully review your medical history. It may not be suitable for people with certain mental health, neurological or heart conditions. When appropriate, starting it in advance can allow time to identify problems before departure.
The choice of medicine, dose and timing must be individualised. Always follow the instructions supplied with your prescription, including advice about what to do if you vomit or miss a dose.
When should you arrange malaria tablets?
Ideally, book a travel health consultation as soon as you know your plans. Four to eight weeks before departure allows time to review your itinerary, arrange any recommended vaccinations, start medicines that need to be taken before travel and discuss side effects or alternatives.
Do not assume that it is too late if your departure is soon. A consultation can still be useful at short notice. Depending on the medicine and destination, some antimalarial regimens can be started shortly before travel. However, last-minute planning may limit your options, particularly if a medicine needs to be started earlier or if you require additional travel health measures.
Bring your planned itinerary, travel dates, details of your regular medicines and information about relevant medical conditions to your appointment. If you are travelling with children, their ages and current weights are also important.
Preventing mosquito bites remains essential
Malaria tablets reduce risk but do not provide complete protection. Malaria mosquitoes can bite from dusk until dawn, so bite avoidance is important even when you are taking your prescribed medicine.
- Use an effective insect repellent on exposed skin, following the product instructions.
- Wear loose-fitting clothing that covers your arms and legs, particularly after sunset.
- Sleep in an air-conditioned or screened room where possible.
- Use an insecticide-treated bed net if suitable accommodation is not available.
- Consider treating clothing and equipment with an appropriate insecticide where advised.
Seek medical advice urgently if you develop a fever, flu-like symptoms, headache, chills, sweating, vomiting or unusual tiredness during travel or after returning home. Tell the healthcare professional that you have visited a malaria-risk area, even if you took your tablets correctly. Malaria symptoms can occur after you return and should never be ignored.
Book a malaria tablets consultation in Edinburgh
Murrayfield Pharmacy offers convenient private travel health consultations at 115 Corstorphine Road, Edinburgh, with no waiting lists. Our clinician can assess your itinerary, prescribe suitable malaria tablets where appropriate and provide practical advice for your trip.
Book your malaria tablets consultation before you travel, ideally several weeks in advance.