Chemoprophylaxis for malaria
| Drug | Adult dosage | Adverse effects and cautions | Pricea |
|---|---|---|---|
| Chloroquine phosphateb | 500 mg (300 mg base) once every week Start 1–2 weeks before travel; stop 4 weeks after leaving malaria-endemic area | Hypoglycemia, potential retinopathy from prolonged use Only in chloroquine-sensitive areas (Central America and Caribbean) | $23.11–$55.60 (7 tablets) |
| Atovaquone-proguanil | 250 mg/100 mg daily Start 1–2 days before travel; stop 1 week after leaving malaria- endemic area | Diarrhea, dreams, oral ulcers, headache Take with food or whole milk Contraindicated in severe renal impairment (creatinine clearance < 30 mL/min) | $64.10–$86.02 (30 tablets) |
| Doxycycline | 100 mg daily Start 1–2 days before travel; stop 4 weeks after leaving malaria-endemic area | Drug-induced esophagitis, photosensitivity Do not use in children < 8 years old or in pregnant women | $13.65–$52.23 (30 tablets)b,c |
| Mefloquineb,d | 250 mg once every week Start 2 or more weeks before travel; stop 4 weeks after leaving malaria-endemic area | Do not use in individuals with cardiac conduction abnormalities, history of seizures, or serious psychiatric illnesses Do not use in first trimester of pregnancy | $30–$46.97 (8 tablets) |
| Primaquine phosphate | 30 mg daily Start 1–2 days before travel; stop 1 week after leaving malaria-endemic area | Contraindicated in glucose-6 phosphate dehydrogenase (G6PD) deficiency and women who breastfeed G6PD-deficient infants | $37.68–$47.73 (28 tablets) |
| Tafenoquine | Loading: 200 mg daily starting 3 days before travel Maintenance: 200 mg/week while in malaria-endemic area, starting 7 days after the last loading dose Terminal prophylaxis: 200 mg once, 7 days after the last maintenance dose | Contraindicated in G6PD deficiency and women who breastfeed G6PD-deficient infants Contraindicated in patients with history of psychotic disorders or current psychotic symptoms | $37.52–$42.41 (2 Krintafel 150-mg tablets) |
↵a Drug price obtained from www.goodrx.com on 10/25/19 at 11:33 AM.
↵b Can be used in pregnancy.
↵c Doxycyline monohydrate.
↵d Do not use if traveling to mefloquine-resistant areas (eg, Thailand, Myanmar, Cambodia, Vietnam).