.. Posted May 16, 2005 Report Share Posted May 16, 2005 Re: Lariam and Malaria. Methinks that this is a case where the "cure" is worse than the disease. Avoid it IMHO. And as someone else mentioned, I know no one who has contracted malaria, but a lot who have had dengue (including me). Cheers, SD Link to comment Share on other sites More sharing options...
Encore Posted August 28, 2005 Report Share Posted August 28, 2005 Lariam, NO. Took it three years ago, while living in BKK, and travelling in Malaria risk areas. ended up with a terrible nightmare, woke up, nightmare continued while awake, similar to bad paranoic speed trip. Never again for me! Link to comment Share on other sites More sharing options...
vox1 Posted August 31, 2005 Report Share Posted August 31, 2005 my ex-wife and I had nasty side effects from this stuff about 12 years ago: nightmares, general unsettled feeling, paranoia, disorientation...and it lasted for a good three months. never again. vox Link to comment Share on other sites More sharing options...
trooper Posted August 31, 2005 Report Share Posted August 31, 2005 Friend from work also had to stop taking that drung after she got hallucinations and paranoia. Avoid it. Link to comment Share on other sites More sharing options...
chilli13 Posted September 13, 2005 Report Share Posted September 13, 2005 "And as someone else mentioned, I know no one who has contracted malaria, but a lot who have had dengue (including me)." as mentioned I got malaria while not on any med (in india) & know of a few friends who got malaria and/or dengue. pretty chocking how powerful these diseases are when they got a good surprise stanglehold. but even with those experinces I still recommend not to take any precautionary malaria med. unless e.g. going trekking forever in some remote pristine jungle near burma! best thing is to wear as much clothes as possible when outside at exposure & ensure a mosqioto free bedroom Link to comment Share on other sites More sharing options...
Boring_Man Posted September 13, 2005 Report Share Posted September 13, 2005 ib13 said: but even with those experinces I still recommend not to take any precautionary malaria med. unless e.g. going trekking forever in some remote pristine jungle near burma! No offense, ib, but this is extraordinarily bad advice. One should always check about the prevalence of malaria in the tropics, and there are many places where you have to be plain crazy not to take the prophylaxis. Regarding Lariam, the counterindications are pretty clear, and you certainly shouldn't take it if you have any problems with depression, any tendency toward epilepsy, or various neurological issues. As always, ask your doctor for Christ's sake, not a bunch of guys on the internet. But since you brought this up... A pal took Lariam in the bush in Africa and described the experience as not pleasant, constantly feeling as if he were just coming down off an acid trip. The best prophylaxis, IMO, is doxycycline. Very few side effects apart from a greater tendency toward sunburn. The only downside is that you need to remember to take it every day, including for 4 weeks (if I recall correctly) after leaving malarial areas. A doctor specializing in this sort of thing told me at one point that there's no current strain of malaria (in Asia, at least) which is doxycycline-resistant. Bug repellent, proper clothing, and mosquito netting are all very fine, but there's no substitute for the right meds. Link to comment Share on other sites More sharing options...
chilli13 Posted September 19, 2005 Report Share Posted September 19, 2005 Excuse me but everytime I ask a doctor these kinds of advice he pulls up a colored worldmap & asks me where I go? LOS! Ok I write note to pharmacy you go pick up & pay with him. Oh pay me too! Very good advice indeed!!! This thread is already more scientific IMO. So I still maintain for the typical 1-3 week tourists don't take any pills, but yeah bring a few just in case... Of course any doctor would readily sign you up for 1 or more expensive drugs & tell you start take them upto 4 weeks prior & after the trip!!! Take care Link to comment Share on other sites More sharing options...
elef Posted September 19, 2005 Report Share Posted September 19, 2005 Hi, I posted this already in an old thread. This is the recommendation for Thailand by the Swedish Institute for Infectious Disease Control (my translation) On round trips in rural areas (especially border districts near Myanmar and Cambodia, including Koh Chang island) more than one week under more primitive conditions prophylaxis with Malarone, mefloquine or doxycycline is recommended. Prophylaxis is not needed for a few days excursions and accommodations for instance near river Kwai. For longer staying near the border to Myanmar and southeast part of Cambodia doxycycline should be considered (due to spread resistance against mefloquine) for a limited number of travellers. PS This recommendation is made for doctors, " limited number of travellers" is probably interpreted as for "people belonging to a risk category". Link to comment Share on other sites More sharing options...
Boring_Man Posted September 19, 2005 Report Share Posted September 19, 2005 ib13 said:Excuse me but everytime I ask a doctor these kinds of advice he pulls up a colored worldmap & asks me where I go? LOS! Ok I write note to pharmacy you go pick up & pay with him. Oh pay me too! Very good advice indeed!!! This thread is already more scientific IMO. So I still maintain for the typical 1-3 week tourists don't take any pills, but yeah bring a few just in case... Of course any doctor would readily sign you up for 1 or more expensive drugs & tell you start take them upto 4 weeks prior & after the trip!!! Take care Ib, I've been living in the tropics for some time now, and my sources are doctors based here, including people who are researchers in the field of infectious tropical diseases. If you want to compare them to some GP in Europe, go ahead, after all didn't you get malaria already following your own advice? The average monger going to Bangkok, Pattaya, Jakarta, Manila, AC, or various parts of Cambodia doesn't need prophylaxis. I never said they did, and a responsible doctor who knows what he's talking about wouldn't say so either. There are a variety of well-touristed places where prophylaxis is a good idea, Manado, for instance. As always, check with a doctor, not a bunch of guys on the internet, although elef's post is absolutely correct and had good info. Link to comment Share on other sites More sharing options...
Boring_Man Posted September 19, 2005 Report Share Posted September 19, 2005 Here's some basic information from the CDC in the U.S. Check their website if you need more specifics. --------------------------------------- Malaria Risk by Country Brunei Darussalam: No risk. Burma (Myanmar): Rural only. No risk in cities of Rangoon (Yangon) and Mandalay. Special note: Travelers to the eastern states of Burma (Shan, Kayah, Kayin) should see the special Burma box below for additional information. Cambodia: All, except no risk in Phnom Penh and around Lake Tonle Sap. Risk exists at the temple complex at Angkor Wat (Siem Reap). Special note: Travelers to the western provinces bordering Thailand should see the special Cambodia box below for additional information. East Timor: All areas. Indonesia: Risk in all areas of Irian Jaya (western half of island of New Guinea) and at the temple complex of Borobudur on Java. Risk in rural areas only in remainder of islands and in the province Aceh. No risk in cities on Java and Sumatra and no risk in the main resort areas of Java and Bali. Lao People's Democratic Republic (Laos): All, except no risk in city of Vientiane. Malaysia: Risk limited to rural areas. No risk in urban and coastal areas. Note: No risk in Republic of Singapore. Philippines: Risk exists in areas below 600 meters (1,969 feet), except no risk in the provinces of Aklan, Bilaran, Bohol, Camiguin, Capiz, Catanduanes, Cebu, Guimaras, Iloilo, Leyte, Masbate, northern Samar, Sequijor, and metropolitan Manila. No risk in urban areas. Note: See the special Philippines box below for changes in the recommended antimalarial drugs for the Philippines. Singapore: No risk. Thailand: Limited risk in the areas that border Cambodia, Laos, and Burma. No risk in cities and major tourist resorts (Bangkok, Chiang Mai, Chiang Rai, Pattaya, Phuket Island, and Ko Samui.) Note: Travelers to the border areas of Thailand/Burma and Thailand/Cambodia should see the special Thailand box below for additional information. Vietnam: Rural areas, except no risk in the Red River Delta and the coastal plains north of Nha Trang. No risk in Hanoi, Ho Chi Minh City (Saigon), Da Nang, Nha Trang, Qui Nhon, and Haiphong. Prevention Please read the malaria-risk and prevention information carefully. Please read the malaria-risk and prevention information carefully. Some countries in Southeast Asia have malaria that is resistant to one or more of the usual antimalarial drugs (so the drug may not prevent malaria, even if taken correctly). All travelers to a malaria-risk area, including infants, children, and former residents of Southeast Asia, should take an antimalarial drug. Travelers to malaria-risk areas in Burma should take atovaquone/proguanil, doxycycline, mefloquine, (or primaquine in special circumstances) unless travel includes the eastern states of Shan, Kayah, and Kayin. Travelers to these states should use atovaquone/proguanil or doxycycline as their antimalarial drug. Mefloquine would not be recommended in these states. Travelers to malaria-risk areas in Cambodia should take atovaquone/proguanil, doxycycline, mefloquine, (or primaquine in special circumstances) unless travel includes the western provinces that border Thailand. Travelers to these provinces should use atovaquone/proguanil or doxycycline as their antimalarial drug. Mefloquine would not be recommended in these provinces. In the Philippines, travelers to malaria-risk areas should take atovaquone/proguanil, doxycycline, mefloquine, (or primaquine in special circumstances). Note: Chloroquine is no longer recommended for any areas in the Philippines. Most travelers to Thailand are not at risk for malaria and do not need to take an antimalarial drug. Travelers to the border areas of Cambodia, Laos, and Burma should take an antimalarial drug. Travelers to malaria-risk areas in Thailand should take either atovaquone/proguanil or doxycycline as their antimalarial drug. Mefloquine is no longer recommended for Thailand. Travelers to malaria-risk areas in Indonesia, East Timor, Laos, Malaysia, and Vietnam should take atovaquone/proguanil, doxycycline, mefloquine, (or primaquine in special circumstances). Most antimalarial drugs are well-tolerated; most travelers do not need to stop taking their drug because of side effects. However, if you are particularly concerned about side effects, discuss the possibility of starting your drug early (3-4 weeks in advance of your trip) with your health care provider. If you cannot tolerate the drug, ask your doctor to change your medication. Atovaquone/proguanil (brand name: Malarone? ) Atovaquone/proguanil is a fixed combination of two drugs, atovaquone and proguanil. In the United States, it is available as the brand name, Malarone Directions for Use The adult dosage is 1 adult tablet (250mg atovaquone/100mg proguanil) once a day. Take the first dose of atovaquone/proguanil 1 to 2 days before travel to the malaria-risk area. Take atovaquone/proguanil once a day during travel in the malaria-risk area. Take atovaquone/proguanil once a day for 7 days after leaving the malaria-risk area. Take the dose at the same time each day with food or milk. Atovaquone/proguanil Side Effects and Warnings The most common side effects reported by travelers taking atovaquone/proguanil are abdominal pain, nausea, vomiting, and headache. Most travelers taking atovaquone/proguanil do not have side effects serious enough to stop taking the drug. Other antimalarial drugs are available if you cannot tolerate atovaquone/proguanil; see your health care provider. Contraindications The following travelers should NOT take atovaquone/proguanil for prophylaxis (other antimalarial drugs are available; see your health care provider): children weighing less than 11 kilograms (25 pounds); pregnant women; women breast-feeding infants weighing less than 11 kilograms (25 pounds); patients with severe renal impairment. patients allergic to atovaquone or proguanil Doxycycline (many brand names and generics are available) Doxycycline is related to the antibiotic tetracycline. Directions for Use The adult dosage is 100 mg once a day. Take the first dose of doxycycline 1 or 2 days before arrival in the malaria-risk area. Take doxycycline once a day, at the same time each day, while in the malaria-risk area. Take doxycycline once a day for 4 weeks after leaving the malaria-risk area. Doxycycline Side Effects and Warnings The most common side effects reported by travelers taking doxycycline include sun sensitivity (sunburning faster than normal). To prevent sunburn, avoid midday sun, wear a high SPF sunblock, wear long-sleeved shirts, long pants, and a hat. Doxycycline may cause nausea and stomach pain. Always take the drug on a full stomach with a full glass of liquid. Do not lie down for 1 hour after taking the drug to prevent reflux of the drug (backing up into the esophagus). Women who use doxycycline may develop a vaginal yeast infection. You may either take an over-the-counter yeast medication or have a prescription pill from your health care provider for use if vaginal itching or discharge develops. Most travelers taking doxycycline do not have side effects serious enough to stop taking the drug. (Other antimalarial drugs are available if you cannot tolerate doxycycline; see your health care provider.) Contraindications The following travelers should NOT take doxycycline (other antimalarial drugs are available; see your health care provider): pregnant women; children under the age of 8 years; persons allergic to doxycycline or other tetracyclines. Mefloquine (brand name: Lariam? and generic) Directions for Use The adult dosage is 250 mg salt (one tablet) once a week. Take the first dose of mefloquine 1 week before arrival in the malaria-risk area. Take mefloquine once a week, on the same day each week, while in the malaria-risk area. Take mefloquine once a week for 4 weeks after leaving the malaria-risk area. Mefloquine should be taken on a full stomach, for example, after a meal. Mefloquine Side Effects and Warnings The most common side effects reported by travelers taking mefloquine include headache, nausea, dizziness, difficulty sleeping, anxiety, vivid dreams, and visual disturbances. Mefloquine has rarely been reported to cause serious side effects, such as seizures, depression, and psychosis. These serious side effects are more frequent with the higher doses used to treat malaria; fewer occurred at the weekly doses used to prevent malaria. Most travelers taking mefloquine do not have side effects serious enough to stop taking the drug. (Other antimalarial drugs are available if you cannot tolerate mefloquine; see your health care provider.) Contraindications Some travelers should NOT take mefloquine (other antimalarial drugs are available; see your health care provider): persons with active depression or a recent history of depression, persons with a history of psychosis, generalized anxiety disorder, schizophrenia, or other major psychiatric disorder; persons with a history of seizures (does not include the typical seizure caused by high fever in childhood); persons allergic to mefloquine. Mefloquine is not recommended for persons with cardiac conduction abnormalities (for example, irregular heartbeat). Primaquine (primary prophylaxis) In certain circumstances, when other antimalarial drugs cannot be used and in consultation with malaria experts, primaquine may be used to prevent malaria while the traveler is in the malaria-risk area (primary prophylaxis). Directions for Use Note: Travelers must be tested for G6PD deficiency (glucose-6-phosphate dehydrogenase) and have a documented G6PD level in the normal range before primaquine use. Primaquine can cause a hemolysis (bursting of the red blood cells) in G6PD deficient persons, which can be fatal. The adult dosage is 52.6mg salt (30mg base primaquine)/once a day. Take the first dose of primaquine 1-2 days before travel to the malaria-risk area. Take primaquine once a day, at the same time each day, while in the malaria-risk area. Take primaquine once a day for 7 days after leaving the malaria-risk area. Primaquine Side Effects The most common side effects reported by travelers taking primaquine include abdominal cramps, nausea, and vomiting. Contraindications Some travelers should NOT take primaquine (other antimalarial drugs are available; see your health care provider): persons with G6PD deficiency; pregnant women (the fetus may be G6PD deficient, even if the mother is in the normal range); women breast-feeding infants unless the infant has a documented normal G6PD level; persons allergic to primaquine Antimalarial Drugs Purchased Overseas You should purchase your antimalarial drugs before travel. Drugs purchased overseas may not be manufactured according to United States standards and may not be effective. They also may be dangerous, contain counterfeit medications or contaminants, or be combinations of drugs that are not safe to use. Halofantrine (marketed as Halfan) is widely used overseas to treat malaria. CDC recommends that you do NOT use halofantrine because of serious heart-related side effects, including deaths. You should avoid using antimalarial drugs that are not recommended unless you have been diagnosed with life-threatening malaria and no other options are immediately available. Link to comment Share on other sites More sharing options...
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