Posted by: passedportsnyc | July 8, 2009

The Great Malaria Debate

Would you rather: have psychotic episodes; get yeast infections; or shell out $8,000?

Or just get malaria?

We will spend much of the coming year in malaria zones.  Unfortunately, there is no malaria vaccine.  As much as I hated all those pricks, they are looking pretty good right now, in comparison our antimalarial pill options.  There are four main antimalarials to choose from:

Chloroquine is a weekly pill with standard side effects – nausea, headache, vomiting.  Side effects do not seem too severe or pervasive and the pill is relatively affordable.  But it is mainly recommended for use in Central America and the Caribbean, as most African and Asian strains of malaria are resistant to chloroquine, so it is not an option for us.

Doxycycline is an affordable daily antimalarial pill.  At $0.75 (USD) per pill (and even cheaper from Canadian suppliers) it is by far the most affordable option. Side effects include the basic nausea, vomiting, and heartburn; additionally it often increases photosensitivity.  This is mildly inconvenient given that most malaria zones are disproportionately hot and sunny, but it’s nothing that a decent dose of SPF can’t handle.  Though carrying a year-long supply of a daily pill could be burdensome, this could be a great option for Max.

However, Doxycycline is a decidedly sexist drug.  Women, in addition to the side effects listed above, are warned that the drug “may” make oral contraceptives “less effective.”  So, what, you find out whether it does “in fact” make contraception less effective when you find yourself knocked up in the middle of Africa?  Great.  And even if contraception/conception is not a concern, Doxy is associated with the increased frequency of yeast infections.  This is common enough that the doctor recommends traveling with several doses of self treatment.  Imagine: week after week being searched at airports for violating the liquid and gel ban, only to have airport security discover the culprit: a year-long supply of Monistat.  Not to mention the fact that we may frequently find ourselves in places where bathroom facilities leave something to be desired. So I’ll go with No, thanks.

Malarone is another daily antimalarial, but with far fewer and less severe side effects.  The Doxycycline/Malarone comparison is a classic example of you-get-what-you-pay-for.  At $12 (USD) a pop Malarone is far from affordable for anyone traveling for more than a couple of weeks.  One pill costs more than we will spend on lodging in many places.  It would run us about $4,000 for the year.  Each.

Mefloquine (Lariam) is the current frontrunner.  It is a relatively affordable weekly pill whose common side effects include insomnia, vivid dreams, nausea, and dizziness.  The primary concern here is that Lariam has been banned in Europe because of the risk of more dangerous side effects: paranoia, panic attacks, depression, hallucinations, convulsions, and psychotic episodes. (The drug was originally developed by and for the US Army, so the politics of the military-industrial complex make it unlikely that it will be banned in the US.  In my opinion anyway.)

We are currently experimenting with a trial dose of Lariam, to see how our bodies and minds react.  As promised, the dreams are frequent and vivid.  Which is kinda fun.  Last night after dinner I popped my second dose of Lariam and prepared for a wild night.  After two hours of tossing and turning I finally drifted into dreamland.

Last night’s episode involved some people I went to elementary school with, some former students, a bi-level treehouse cabin in the woods, mud and rain, lots of drugs, and a huge forest fire.  I woke up in the middle of it and remembered the whole thing so clearly that felt like I had been watching TV, except that I was in it.  But the craziest part was that when I fell back asleep my dream picked up exactly where it had left off.  Suddenly going to sleep at night is like watching a full-length feature film in which I am the star.  Which is pretty awesome, provided that I remain free of psychotic episodes.  Who knows, it might even provide fodder for a weekly drug-induced-dream column on the blog.



  1. […] a trial dose of the weekly antimalarial drug Lariam for that past couple of weeks.  As previously noted, the possible side effects of Lariam include insomnia, vivid dreams dreams, feeling disoriented, […]

  2. I have a feeling that you’ll never know if you made the right decesion. I took Malarone in Vietnam last year and it was great, no side effects what-so-ever. THis year however when i took it in India it made me really sick…long story short i ended up throwing up over quite a few temples and monasteries in the middle of pilgram season… but it was okay in the end 🙂
    May the malaria pills be the hardest decision you have to make! 🙂

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