In a couple of weeks I will be traveling to Northern India and Nepal which will require me to take malaria pills a week before I go and during. Now, half my friends, none of which are part of the medical community, instantly advised me not to take the malaria pills. Reasons varied from bad dreams, various mood swings, terrible body pain and possible contraction of malaria itself. Is there any validity to any of this or are my friends possibly suffering from malaria?
I’d don’t know about getting malaria, but the nightmare and joint pain stuff are relatively common side effects of some anti-malarials.
I was given a choice between the drug with that side-effect and a slightly less effective one without when I went to Vietnam. I chose the latter.
This may be available for your visit, although differing drug immunities have arisen in some areas. You may even have to take a cocktail of anti-malarials, for which the side-effects can be really bad, although very rare (I’ve heard of complete exfoliation, but that may be an UL).
Lots of people don’t take anti-malarials on this basis, but remember that malaria is a shocking, life long disease.
Not only go and see a doctor, but go to one specialising in travel.
picmr
And ignore your friends. Also ignore the side effects. Bad dreams and joint pains are much better than the alternative.
Based on what I’ve read, Picmr is right, you will most likely get a cocktail because of parasite immunity to most Quinine-based drugs.
Your only other alternative, on a wing and a prayer, is to do like the British soldiers did–Drink mass quantities of gin & tonics! 
Not a half-bad alternative, eh?
I almost hate to spoil the fun with facts but:
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Malaria is not a lifelong disease and hasn’t been for decades. The business of Uncle Jethro getting recurrent attacks of malaria ever since serving in the South Pacific in WWII is a myth. (Either that or Uncle Jethro never had the sense to go to a doctor to get cured.)
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“Exfoliation” is not a myth. One antimalarial preparation that goes under the trade name Fansidar does, rarely, cause severe reactions that can be fatal. Your skin peels off. This is not so terrible if you took the Fansidar to avoid dying of malaria (which can definitely kill you) but in at least one published case the unfortunate individual took Fansidar for antimlarial prophylaxis when he could have taken a much safer and just as effective drug. (I hope it wasn’t a “travel medicine” specialist who prescribed it.)
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Most of what you will read in the popular press about side effects of antimlarials is nonsense.
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If you want to know about the side effects of antimlarials it helps to consult the people with the most experience. Auntie Em’s nephew who went to Mexico for two weeks, took antimalarials, and got the runs is not likely to be one of the people with the most experience. Neither is Antie Em. The people with the most experience are the the Unites States Peace Corps (I think they have around 3000 Volunteers taking antimalarials and any given time), the U.S. Military, and Dr. Robert Steffen of Zurich who has been interviewing Swiss travelers returning from the tropics for years. Basically, mefloquine is pretty well tolerated although some people do say they get vivid dreams. Doxycycline is also pretty well tolerated. If I were going to be exposed to life threatening malaria I would not hesitate to take either. Malaria can definitely kill you.
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Do you really need to take antimalarials prophylactically? Just because you are going somewhere where there is malaria, you don’t necessarily need to take prophylaxis. Prophylaxis is wise for prolonged (weeks, months or longer) exposure (spending time out of doors at night without a net and insect repellant) in a malarious area. It is especially important if you expect to be somewhere where good medical care will not be available at the time you might come down with malaria.
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I think you would be well advised to seek advice from someone familiar with the risk of malaria to travellers visiting the particular parts of Northern India and Nepal (the Terai, I assume) you will be visiting. You might, at a minimum, try to find someone who has been certified in Tropical Medicine and Travelers’ Health by the American Society of Tropical Medicine and Hygiene (this means the person at least passed a test) and I think it is also a good sign if they are member of the ACCTMTH.
Good luck.
From personal experience, Larium is the bad-boy of the antimalarial world. I’m not sure if they’re still giving this out, but on taking it myself (whilst, incidentally, travelling in India) I found them to cause pretty bad paranoia, along with the physical symptoms mentioned.
If it’s any help to you, I worked for 2 years in a highly malarial province of Cambodia, and during this time the advice of the WHO was to “do everything you can not to get bitten”. They simply acknowledged that the antimalarials available at the time were so ineffective and caused such extreme side-effects (esp. when taken over a long period of time)that they weren’t worth taking. My advice to you is to be far more wary of how you can avoid being bitten by mozzies in the first place, rather than getting your drug cocktail right.
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Lariam is the trade name for mefloquine. It remains one of the best antimalarials available.
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I think you would be doing yourself a disservice to assume that if you took mefloquine you would experience the symptoms that GabbaGabbaHey attributed to malaria. (If it helps any, I can tell you that I have never experienced any side effects I was aware of from taking mefloquine.) (Although I was once tempted to attribute a “C” I got on a statistics final to “mental confusion caused by taking mefloquine.”)
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The situation on the Thai-Cambodian border is unique. The malaria there is highly resistant to nearly everything. Advice for malaria prophylaxis on the Thai-Cambodian border is not relevant for other areas.
Umm, I’m not a doctor but your pals are telling you not to take an antidote to something that could very well kill you? Take them off your will.
And here’s what I’ve learned.
Doctors in the west are huge on giving people prophalactic malarial medicines.
These change almost yearly and it is not uncommon for them to tell you that the stuff they gave you only 12 short months ago isn’t safe or doesn’t work
The fact is that the mosquitoes that carry malaria only bite after sundown. When you think about it, it’s not a lot of the day to take precautions. Get some bug spray. Use it. Do not be swayed by the actions of the other people you will meet on the road. Many a traveler has contracted this disease because they were away for over a month and nothing happened so they thought what the heck.
After taking anti malarials during many visits I stopped when they reached an actual antibiotic that made you very sensitive to the sun.You also need to continue taking these babies after your return, you should know. And for a full year after you consume your last pill no blood bank will take your blood!
The only authority you should be consulting on this in a microbiologist, find a university campus.
Family doctors don’t cut it, some are still giving shots for Cholera, long since determined to be contra indicated by the World Health Organization.
I have visited both northern India and Nepal and am not aware of any risk from malaria in either of those areas. Are you going into the wilds for an extended visit?
My advice, use bug spray when the sun goes down. Every evening. If you’re really worried.
I found a site that reccomends prophylactic treatments for malaria
http://health.iafrica.com/doconline/qa/pharmacology/current_malaria_prophylaxis.htm
I hope that helped.
I agree with much of what elbows3 writes but some explanation/clarification/correction is needed:
“These [prophylactic malaria medicines]change almost yearly and it is not uncommon for them to tell you that the stuff they gave you only 12 short months ago isn’t safe or doesn’t work.” This is because Plasmodium falciparum resistant to chemoprophylaxis agents continues to spread (meaning that the drug that was effective in 1998 might not be effective in 1999) and because new chemoprophylactic and chemotherapeutic agents are constantly being developed and tested (meaning that better drugs displace worse drugs and new drugs are sometimes found, after widespread use, to have rare but unacceptable side effects).
“The only authority you should be consulting on this in a microbiologist, find a university campus.” Microbiologists are not generally the best people to consult. Their main interest and experience is with the parasite itself. They don’t generally give advice to travellers and they don’t generally treat patients. The only cases they get invovled with tend to be serious cases. They do not normally have any experience with side effects of antimalarials. I would only consult a microbiologist if she were also a clinician or if she had a special interest in the prevention and management of malaria.
I have filled two International Certificates of Vacinations booklets, that’s how many shots I’ve had and I hate them all!
But I got almost all of them at my local university, Department of Tropical Medicine, staffed entirely by microbiologists.
My pet peeve:
I weigh 98lbs soaking wet and am getting the same dose of nastiness that the 350lb man in the waiting room is getting! Does that seems fair? Is it any wonder it knocks me over? The bastards! And you know they find it humerous. Oh, they always got a joke when they see you got two books stapled back to back. Ha, Ha, Ha.
I love to travel, I hate to get jabs, grrrrr.
Oh, and D Ream Whirled and the Anti-Malarials would make a good band name.
picmr
In response to elbows:
“I have filled two International Certificates of Vacinations booklets, that’s how many shots I’ve had and I hate them all!” What in the world are you getting all those shots for? Or are people recording things like immune globlulin injections on your WHO card?
“But I got almost all of them at my local university, Department of Tropical Medicine, staffed entirely by microbiologists.” Isn’t at least one of the “microbiologists” licensed as a nurse, physicians assistant, or medical doctor? In the U.S., you can’t give shots if your training is limited to microbiology.
“My pet peeve: I weigh 98lbs soaking wet and am getting the same dose of nastiness that the 350lb man in the waiting room is getting!” You have a genuine problem. I remember a patient about your size who treated herself for malaria with the standard dose of chloroquine. She got almost every side effect of acute chloroquine toxicity in the book.
“Does that seems fair? Is it any wonder it knocks me over? The bastards! And you know they find it humerous. Oh, they always got a joke when they see you got two books stapled back to back. Ha, Ha, Ha.” You think that is funny, I saw a bantamweight army recruit who got turned around in a vaccination line and received two injections of typhoid vaccine, one in each arm. Injectable typhoid vaccine makes everyone sick. This poor guy really suffered.
My jabs date back to 83, when they still took up a whole page with a contraindication stamp for smallpox, another for cholera, several rounds of japanese encephalitis, typhoid by the half dozen, yellow fever, polio/tet, meningococcus and, actually your gamma shots are listed in your yellow book. (Half a dozen extended trips to SE Asia, India & Nepal, and South American parts too!)
I am in Canada, and these are MD’s with Phd’s in Microbiology and I give them credit as the most informed people on this topic. It may be different where you are. They are always up on the latest changes when I’m there.
Yeah, I did suffer with antimalarials, but I switched to bug spray, was vigilant and never had a problem. Personally, I’d be much more worried about contracting Dengue Fever (aka Bonecrusher), I’ve seen it and it aint pretty.
My first series of typhoid shots were the worst, I was sweating bullets and shivering like I was at the north pole. I had to go home in a cab, though it was only a short 3 blocks. When I got home, I didn’t even turn on the lights, or take off my coat, went straight to my couch and pulled down a big pile of blankets on top of me. And there I stayed for I don’t know how long, when my SO came home there I was still shivering !
Also, I had deluded myself into believing when I’d filled the first book, I’d be, like, full up with vacines! No, sir, when they filled all the spaces they filled the covers, when those were full they just stapled another one on. Bastards.
And they always say the same thing, as you are recovering from your swoon, “Don’t worry it won’t last long.” Bite me.
I asked them once if they were giving me the same dose as my SO, who has 50+ lbs on me, they said, “it’s a minimum dose.”
For 150+ lb man or a 98lb woman? And what about that one they jab into the muscle in your ass that hurts for a week! Bastards.
Don’t get me wrong, it’s not that I don’t like a needles per se. I goo to the dentist no worries. And do you know why? Because it’s not poison. Ick