Proguanil with atovaquone for malaria prevention (Malarone)

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These tablets will help protect against malaria when travelling to a country where malaria occurs.

They are one of a number of measures that you need to take to reduce your risk of malaria. Others include wearing suitable clothing, using insect repellents and sleeping in screened rooms or beds.

It is important that you take these tablets for one or two days before you travel, during the whole of your stay, and for seven days after you return.

Type of medicineAnti-malarial
Used forTo prevent malaria (it may also be used to treat malaria)
Also calledMalarone®; Malarone® Paediatric; Mafamoz®; Reprapog®
Available asTablets

Proguanil with atovaquone tablets are used to prevent malaria. Malaria is a serious infection. It is common in tropical countries such as parts of Africa, Asia and South America. Malaria is a disease which is passed on to humans by infected mosquitoes. A parasite called plasmodium lives inside the stomachs of infected female mosquitoes and is passed on to humans by a bite.

Because the pattern of malaria varies with the part of the world you are travelling to, as well as the season and the type of activity you have planned, you should always obtain the latest advice about malaria prevention from your doctor, pharmacist or travel organiser. A backpacking trip may well require different preventative measures against malaria to those needed for a business trip to a city.

Proguanil with atovaquone is usually obtained on a prescription from a doctor; however, it is not prescribable on the NHS. This means that you will be given a private (non-NHS) prescription and you will be asked to pay for the tablets. Some pharmacies and travel clinics can sell proguanil with atovaquone without the need for a doctor's prescription. You will still be asked for details of your health and travel plans to ensure the medicines are suitable.

Proguanil with atovaquone can also be used to treat some forms of malaria if you become infected. This leaflet does not contain information about this, but your doctor can give you more information if you have been prescribed it for this reason.

Some medicines are not suitable for people with certain conditions, and sometimes a medicine may only be used if extra care is taken. For these reasons, before you start taking the tablets it is important that your doctor or pharmacist knows:

  • If you are pregnant, trying for a baby or breast-feeding.
  • If you have kidney problems.
  • If you are taking any other medicines. This includes any medicines you are taking which are available to buy without a prescription, as well as herbal and complementary medicines.
  • If you have ever had an allergic reaction to a medicine.
  • Before you take proguanil with atovaquone, read the manufacturer's printed information leaflet from inside the pack. The leaflet will give you more information about the tablets and a full list of side-effects which you may experience from taking them.
  • You should start taking the tablets 1 or 2 days before you enter the area which has malaria. This is to ensure there is sufficient medicine in your bloodstream to give you the required protection. Take one dose each day throughout your stay, and then continue to take one dose a day for a further seven days after you leave the area. There are two strengths of tablets: 250 mg/100 mg tablets which are suitable for adults and children weighing more than 40 kg, and 62.5 mg /25 mg tablets which are suitable for children weighing between 11 kg and 40 kg:
    • The dose for an adult or a child weighing over 40 kg is one 250 mg/100 mg tablet daily.
    • The dose for a child weighing 31-40 kg is three 62.5 mg/25 mg tablets daily.
    • The dose for a child weighing 21-31 kg is two 62.5 mg/25 mg tablets daily.
    • The dose for a child weighing 11-21 kg is one 62.5 mg/25 mg tablet daily.
  • Where possible, take the tablets with a snack or a milky drink and try to take your doses at about the same time of day, each day. The tablets are best swallowed whole, but for children who have problems swallowing tablets, they can be crushed and mixed into soft food or a milky drink if needed. You should ensure the child consumes the entire mixture to get the full dose.
  • If you are sick (vomit) less than one hour after taking the tablet(s) you should take another dose. If it happens more than one hour afterwards, the medicines will have already entered your bloodstream so another dose is not needed.
  • If you forget to take a dose, take it as soon as you remember. If you do not remember until the following day, skip the missed dose. Do not take two doses together to make up for a forgotten dose. You should complete the course of tablets unless you are told otherwise by a doctor. Make sure you continue to take the tablets for seven days after your visit has finished.
  • These tablets will help prevent you from getting malaria, but it is also important that you take the following precautions against being bitten by mosquitoes:
    • Cover up bare areas of your arms and legs with long-sleeved, loose-fitting clothing, long trousers and socks. This is especially important if you are outside after sunset, as this is when mosquitoes feed.
    • Use an effective insect repellent spray on your clothing and any area of your skin which is bare.
    • Spray the room with an insecticide each evening a couple of hours before you go to bed. Check your sleeping areas for mosquitoes - pay particular attention to furniture and areas under your bed where insects can hide.
    • If you are sleeping in an unscreened room, use a mosquito net impregnated with an insecticide.
  • If you need to take a medicine for indigestion (such as an antacid), do not take it during the two hours before you take proguanil with atovaquone, or during the two hours after you take it. This is because some magnesium-containing antacids interfere with the way one of the medicines (proguanil) is absorbed by your body, making it less effective.
  • If you take a medicine called warfarin to prevent blood clots you may need to have your warfarin dose adjusted. You should ask for an INR appointment to be arranged prior to travel and start taking proguanil with atovaquone at least two days before the appointment.
  • If you feel ill or develop a fever or flu-like symptoms while you are travelling or within one year of returning home, you should see your doctor straightaway. This is important, even if you have taken your anti-malarial tablets correctly.

Along with their useful effects, most medicines can cause unwanted side-effects although not everyone experiences them. These usually improve as your body adjusts to the new medicine, but speak with your doctor or pharmacist if any of the following side-effects continue or become troublesome.

Most common side-effects - these affect more than 1 in 10 people who take this medicineWhat can I do if I experience this?
Feeling or being sick, tummy (abdominal) painStick to simple foods - avoid spicy or rich foods. If you are sick within one hour of taking a dose then take a second dose
Loose, watery stools (diarrhoea)Drink plenty of water to replace any lost fluids
HeadacheAsk a pharmacist to recommend a suitable painkiller
Common side-effects - these affect less than 1 in 10 people who take this medicineWhat can I do if I experience this?
Cough, feeling dizzy, high temperature (fever), itchy rash, sleeping problems, unusual dreams, feeling low, lack of appetiteThese will pass when your course is finished. If they become troublesome in the meantime, speak with a doctor

If you experience any other symptoms which you think may be due to this medicine, speak with a doctor or pharmacist.

  • Keep all medicines out of the reach and sight of children.
  • Store in a cool, dry place, away from direct heat and light.

Never take more than the prescribed dose. If you suspect that you or someone else might have taken an overdose of this medicine, go to the accident and emergency department of your local hospital. Take the container with you, even if it is empty.

If you are having an operation or any dental treatment, tell the person carrying out the treatment which medicines you are taking.

This medicine is for you. Never give it to other people even if their condition appears to be the same as yours.

Do not keep out-of-date or unwanted medicines. Take them to your local pharmacy which will dispose of them for you.

If you have any questions about this medicine ask your pharmacist.

Further reading & references

Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. EMIS has used all reasonable care in compiling the information but make no warranty as to its accuracy. Consult a doctor or other health care professional for diagnosis and treatment of medical conditions. For details see our conditions.

Original Author:
Mr Michael Stewart
Current Version:
Peer Reviewer:
Prof Cathy Jackson
Document ID:
3714 (v24)
Last Checked:
Next Review:
The Information Standard - certified member

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