Last week, I returned to France after a hectic month or so of work travel that brought me to Haiti, Rwanda, and Nigeria. I truly had a blast with my team and our projects in each of the countries, but what I’d like to talk about here is my experience taking the antimalarial drug Malarone. Because these countries are prone to malaria and mosquitoes love me, I was advised by my doctor to take malaria tablets, so I did. But I didn’t have the best time with the drug and experienced several side effects of Malarone.
Note: I am not a medical professional and am sharing my personal experience. Nothing written her should be substituted for medical advice.
I’m guessing the majority of you reading this are new to my blog and are finding this post via Google (hey you!!!) because you’re considering taking Malarone or another malaria pill for an upcoming trip. I’ll try to be as detailed as possible in case reading about my experience helps prepare you for yours. My regular readers may not be so interested in this post, but I think it’s important for me to share specifics of what I experienced because I would have appreciated this sort of info before my trips.
I didn’t find a ton of first-hand information when I googled whether or not malaria pills were safe and people’s side effects. That’s probably because most people tolerate the drugs just fine and I’m in the minority. So let’s get into it.
What’s malaria and what antimalarial drugs help prevent it?
Malaria is a serious disease transmitted by mosquitoes carrying a certain parasite that’s common in tropical climates and certain parts of Africa. More specifically, the WHO explains that “malaria is caused by Plasmodium parasites that are spread to people through the bites of infected Anopheles mosquito vectors. Of the 5 parasite species that cause malaria in humans, P. falciparum is the most deadly. The first symptoms of malaria – fever, headache, and chills – usually appear 10–15 days after the infective mosquito bite. Left untreated, P. falciparum malaria can progress to severe illness and death.”
It’s no joke. If promptly treated, malaria can be cleared up in a couple of weeks but the disease is not always so simple. In my case, I had upcoming work travel so being down and out with malaria was something I couldn’t risk. Yes, I was in cities and staying at hotels, so the risk of contracting malaria was lower than if I had been camping in a rural area, but still, the risk is there.
The antimalarial medicines have a reputation for being pretty hardcore in terms of side effects and overall impact on the body, especially for long-term use. Not all of the antimalarial medications work on every strain of malaria so the drug you take depends on what area of the world you’re visiting.
Since it was my first time taking this sort of medication, I wanted to do my research and make sure I was doing everything possible to make sure I’d have an uneventful experience. There were a couple of options that would suit my upcoming travel and the least aggressive with the shortest duration was Malarone. The generic for Malarone is atovaquone/proguanil and that’s what I took.
To recap, here are the countries I traveled to:
- Haiti: 1 week, in and around Port-au-Prince
- Home for 2 weeks in France when I took a break from Malarone
- Rwanda: 12 days, Kigali
- Nigeria: Flew there for a week directly from Rwanda, Lagos and Ibadan
So let me give you some quick background on me, as it relates to medicine and medical topics. I’m in my 30s, healthy and active, and don’t generally have issues when traveling. I’m not fragile. My stomach isn’t sensitive and I don’t think I’ve ever had an upset stomach or many side effects at all from any medicine. I can take anti-inflammatories no problem, antibiotics don’t bother me (unlike my husband who is the opposite), and my body is pretty tolerant.
Regardless though, I’d read stories online about side effects of antimalarial pills, so I set out to do my own research since these drugs have a bit of a reputation (mainly Larium, for hallucinations, which I didn’t take). Out of all the options, Malarone seemed to be the least evil of them all — short duration and mild side effects.
Both my doctor and pharmacist reassured me that I’d most likely be fine. Even some of my readers who had taken Malarone let me know that they hadn’t experienced any side effects.
Here’s the list of side effects on the drug’s info packet that came in the box (in French):
They organize it by the frequency people experience each side effect. One in 10 people experiences headache, diarrhea, vomiting, and stomach discomfort and the list continues on with less frequently experienced side effects.
Anyway, I felt reassured by the medical professionals I talked to along with people I knew as well as the fact that my body has been very tolerant in the past, that I didn’t worry too much and started taking the medicine as described. You take one pill a day — at the same time and with food — starting one day before you enter a malaria-prone area and continue for 7 days after you return. My first pill was the day before I left for Haiti and everything was great… until Day 4.
I found myself on the toilet in my hotel room. I wondered if my body wasn’t agreeing with something I ate or if it was a side effect of Malarone. It was too soon to tell.
While I sat there on the john, I wondered how long my gastrointestinal distress would last and if it would compromise my ability to do my job. Luckily, in 10 minutes or so, I was able to finish up and I left my hotel room. I’d hoped it was a one-time experience.
Unfortunately, it was soon confirmed that I was experiencing Malarone side effects. The same thing happened that evening, and then like clockwork, the diarrhea hit at about the same time each day until about 7 days after I stopped taking the drug. It was a pain — literally. That annoying side effect was accompanied by a couple of others.
Flash forward to Day 4 of my Rwanda trip, and the same gastrointestinal side effects started again just like they had in Haiti. I can say with 100% certainty that the diarrhea, cramping, and stomach distress were from the Malarone. It’s highly likely some of the other symptoms I experienced were also from Malarone and not just the result of being in a new environment with different food and a new routine.
Here are the side effects I experienced that I feel are 100% from Malarone:
- Diarrhea: Not horrible but more trips to the bathroom than usual and often on short notice
- Less of an appetite
- Intestinal gurgling/bubbling and unsettled stomach
- Stomach cramping and pain
- Mild nausea and overall blah feeling
These physical symptoms may or may not have been from Malarone and could be chalked up to travel, heat, and a new environment:
- Easily got lightheaded and off-balance
- Fluttery heart, aware of my heart beat a couple times per day
- Got a weird hollow sensation/hearing issue in my right ear on Day 10 of the medicine, almost like if someone screams in your ear, the weird sensation you have after like you can’t hear properly. Hard to explain the sensation and freaked me out.
I will say that the gastrointestinal side effects did not interfere with my work to the point of sidelining me, but they did make me nervous and I was pretty much always aware of them to some degree. It’s hard to ignore stomach discomfort. If I was out in a rural area the whole time, which I was not, without access to a toilet, it would have been bad. Or embarrassing. Or embarrassingly bad.
I found myself worrying about whether or not the side effects would become more severe as time went on and affect my ability to work. I was scared the diarrhea would become more frequent and leave me holed up in my hotel room the entire trip. The physical side effects started becoming mental because I was stressed about the “what-ifs.”
The worst part of that first course of Malarone was when I considered stopping the drug cold turkey after my last couple of hours in Haiti when the diarrhea became the most severe. That was Day 8. I had to make several unpleasant trips to the bathroom as my flight home was boarding. For about a 30-minute period, I was unsure if I’d be able to fly and even let the flight attendants know I wasn’t feeling well once I boarded. Luckily, all the bathroom nonsense stopped but I panicked. The mental stress surrounding the side effects made me question if the medicine was even worth it. I continued for 7 days after I returned home, as prescribed, since I had a bunch of mosquito bites but I was fighting it.
So how bad were the side effects of Malarone?
The on and off cramping wasn’t ideal but I could play normal just fine most of the time. It made me slightly nauseous with less of an appetite than usual, so I felt kind of blah most of the time as far as my stomach went, but it didn’t interfere with my ability to be active and “on” for work. At times, I was uncomfortable but it was something I could push through aside for the more urgent bathroom trips that came a couple of times per day.
The one gastrointestinal side effect that made me the most nervous was my need to use the toilet. From Day 4 on, this was my reality for both courses of Malarone. As I mentioned, diarrhea was one of the most common Malarone side effects listed on the leaflet that came with the medicine. I had a daily excursion or two to the toilet that lasted a good 10 minutes, complete with some stomach pain.
I was always afraid to get in the car for a multi-hour drive knowing I wouldn’t be able to easily access a toilet. I had a bit of warning in the form of gurgling and cramping but it was somewhat urgent. I’m happy to report that my stomach cooperated and always got bad when I was within safe distance of a bathroom. But yeah, not ideal.
TMI warning: The diarrhea wasn’t explosive, complete liquid or anything that would dehydrate you or make you sweat, but it was somewhat urgent and was accompanied by cramping. Each time, I was delayed for a good 10-15 minutes before I felt comfortable enough to leave the bathroom. Not to be gross, but it didn’t really smell normal for me either.
How long do malarone side effects last?
In my case, the gastrointestinal side effects lasted about one week after stopping my last pill. It seems like the medicine stays in your system for a little bit or at least affects you enough for side effects to continue for about a week after completing treatment. It pretty much wrecked my gastrointestinal tract for the time I was on it and a week or so after.
Information I got from my doctor said that if you do have side effects, they lessen as time goes on as your body gets used to the medicine. That was not the case for me. My first foray with Malarone was my 1-week trip to Haiti (plus 7 days after returning home) and the side effects from Day 4 onward were consistent. The good part is they didn’t really get worse and stayed at a medium level of annoyance and discomfort.
Ways to minimize Malarone side effects
Midway through my trip, I was looking for a magical cure… that never came. But the advice I’m sharing with you below helped me to some extent.
To help lessen the side effects of Malarone:
- Take the medication at the same time each day. That way, the level in your system is consistent.
- Take it with food, preferably some sort of dairy product like yogurt or milk to ease stomach discomfort. The medicine is better absorbed when taken with fatty foods or dairy. If I had taken the pills at different times each day or without food, I’m scared to think how bad my side effects might have been.
- Avoid alcohol. It can intensify dizziness and feeling off-balance.
- Get some stomach medication from your doctor before you leave in case of gastrointestinal side effects. I ended up at the hospital in Rwanda on two separate occasions (more on this below) but not because of Malarone. While there, I mentioned the side effects from Malarone and the doctor gave me Nexium and Buscopan to help ease my discomfort. Did it help? Maybe a little, but I felt better knowing I had some help. It would have been good if I had had these remedies ahead of time. Finding a pharmacy and/or doctor locally isn’t always a simple process.
- Along with the above point, discuss a backup plan with your doctor at home in case you’re having trouble tolerating the medication. That way, you know what to do if the side effects get to be too much. This might include switching medications, taking something to ease the side effects, taking other preventive measures, etc. Trying to get ahold of your doctor at home across time zones or on the weekend isn’t always easy, so be prepared for the worst.
So were mosquitoes even a problem?
In Haiti during the month of July, there were mosquitoes and I got a couple of bites each day. So yes, mosquitoes were quite present in and around Port-au-Prince. But in Rwanda in August, I maybe got 2 bites the entire trip. And in Nigeria? Zero. Yes, really, and we were out at night! I didn’t see any bugs at all.
We were in cities and stayed at hotels, so our risk was low, but better safe than sorry. In addition to the antimalarial medication, I took all of the other preventive measures my doctor told me about. These included sleeping in a screened-in enclosure, liberally applying a mosquito repellent if outside between dusk and dawn, treating my clothes with a permethrin liquid in advance, and wearing light clothing that covered my body.
2 Trips to the hospital in Rwanda
While in Rwanda, I unfortunately had to go to the hospital twice. One might have been Malarone related now that I think about it in retrospect and the other time was for food poisoning (even though I was so careful). I really know how to put the finishing touch on a trip. 😉
Hospital visit 1: Allergic reaction
I woke up and noticed a bad allergic reaction on my skin that was progressing before my eyes. I’d never experienced anything even remotely similar. It covered most of my body including my legs, back, hips and glutes, and arms, and my throat was starting to itch. I’m allergic to citrus but it doesn’t present like that at all, so I knew something wasn’t right and I needed help.
Now this is the curious part. I ate a tamarind sauce the day before, which is something I’d never eaten in my life. Although it’s not citrus, it is a fruit and could be the cause (though I’m not eating any anytime soon to test my theory!). It’s highly likely the tamarind caused my allergic reaction.
But my mind also went back to that list of Malarone side effects. Two of them raised an eyebrow: skin rash and allergic reaction. While it only happened once and didn’t return, I’m still suspicious of the reaction. The doctor couldn’t pinpoint the cause of my reaction but gave me prednisone and within 2 hours, my skin was 90% back to normal and 100% healed by the next morning. Was it a reaction to tamarind, something else, or a side effect of Malarone ? No way to know but it happened while on Malarone so I’ll always wonder about that.
Anyway, while there, the doctor examined my stomach after I complained of the Malarone side effects. He is not a fan of the drugs at all, gave me Nexium and Buscopan, and I was on my way.
Hospital visit 2: Food poisoning
Even now, I can’t tell you with certainty what made me sick, but the official diagnosis was food poisoning. I suspect it was either a meal from my hotel or meatballs from the day prior that only I ate. Regardless, I had a fever, was vomiting, and had BAD diarrhea, so to get me well enough to fly, they hooked up to two IVs and I ended up missing my flight to Nigeria the next morning. I’m totally fine, but that was not fun at all. That had nothing to do with Malarone, but because of the fever, they did a malaria test to see if I’d picked up malaria in Haiti. Thankfully, it was negative. At least the Malarone worked and kept me malaria free, so there’s that.
Final thoughts on taking Malarone
Most people I’ve talked to didn’t experience any of the side effects of Malarone that I did, so please take what I’m writing about into consideration but remember it’s just one person’s experience. In all likelihood, you’ll make out like one of my colleagues and have zero side effects from Malarone.
What I’ve written here isn’t to scare anyone or make you second-guess your decision to protect yourself against malaria. It is a serious condition and isn’t quick and easy to treat. It’s not better to take your chances and treat malaria after the fact. I do think prevention is necessary and despite everything I’ve written here, I would take Malarone again the next time I travel to a malaria-prone area. I’d dread it. I’d be anxious about it. But even with the side effects, it’s the lesser of two evils, by far. Getting malaria is not the easier option. Always consult with your doctor to make the best decision for your personal circumstances.
Also, feel free to email me if you want to chat about this further. 😉
Have you taken antimalarial pills before? How did you fare?