Atovaquone proguanil

Proguanil (Paludrine) is sometimes taken on its own for malaria prophylaxis. More often proguanil is taken in combination with atovaquone (Malarone) or in combination with chloroquine (paludrine/avloclor).

In practice proguanil on its own is recommended only rarely.

Details of which malaria tablets are recommended for which countries are provided on the NHS travel website links to which can be found on the Dr Fox malaria web page.
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Combination treatments containing proguanil

The combination of proguanil with atovaquone is called malarone. Malarone is a single combined tablet of atovaquone and proguanil and is taken daily.

A combination of proguanil (paludrine) with chloroquine (avloclor) is usually supplied as separated tablets in packs containing 14 proguanil tablets to each 2 chloroquine tablets. The combination is taken as two proguanil tablets daily and two chloroquine tablets weekly started one week before and continued for 4 weeks after exposure. Details on the combination of proguanil and chloroquine can be found in the patient information leaflet.

Buy proguanil online: proguanil combined with atovaqone (Malarone tablets) are started 2-3 days before entering malaria are and continued for one week after exposure. Malarone is a daily tablet.

Taking Malarone (atovaquone/proguanil)

Malarone is one of the few drugs best taken with food or a milky drink. This increases absorption. If a person vomits within 1 hour of taking malarone the dose should be repeated. Diarrhoea reduces absorption however proguanil/atovaquone (malarone) or proguanil of its own should not be stopped during diarrhoea.

Side effects

The most frequent side effects of malarone are abdominal pain, headache, anorexia, nausea, vomiting, diarrhoea and coughing. These side effects are seen in similar proportion with other anti malaria tablets.

The dosage of proguanil and proguanil atovaqone tablets (malarone) does not need to be reduced in liver disease. Where there is severely reduced kidney function dosage reductions are required.

There are only a few significant interactions of malarone with other prescription medicines. Metoclopramide, tetracycline, indinavir, rifampicin and rifambutin all decrease circulating malarone levels.

Pregnacy and breast feeding

Malarone has not be shown to have adverse effects on pregnancy in humans, however it should not be taken by pregnant and breast feeding women without specialist advice and where the dangers of malaria outweighs the risks. Malaria is usually more serious in pregnancy.

The manufacturers do not recommend continuous use of malarone for more than 28 days. However malarone is prescribed routinely for periods of 12 weeks at a time. The Health Protection Agency in the UK advises malarone can be used for 12 weeks where benefits are likely to outweigh the risks.

Cheap proguanil

Malarone is expensive. There is only one licensed manufacturer of genuine malarone. A prescription is required. Dr Fox supplies malarone on prescription from aregistered pharmacy. [UPDATE: generic Malarone is now available at lower cost].

Doxycycline, melfoquine (Lariam), proguanil (paludrine), chloroquine, chloroquine/proguanil and atovaquone/proguanil (malarone) online on prescription also at reasonable prices.

We would recommend against buying atovaquone/proguanil abroad as there is a possibility the tablets bought could be fake.