Anti-Malaria medication puzzle

rajpop

i got my tablets this week
i paid £19 for 9 weeks worth...
i have two take two of one pill a day
and with the 2nd batch of pills its once a week.

Nick-H

Pretty sure Odomos is DEET, which I think there are two chemical names for? it is 12%.

Yes, it is Indian and easily available here. There are other local makes too.

There's a new reppelent, developed by Indian government labs and released to Industry not so long ago Called something like DEPA or DEAP, it comes in an aerosol and can be sprayed on clothes, bedding and skin. Said to keep all bloodsucking insects at bay.

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wonderwomanusa

Check REI and if they don't have it, try a fishing store/bait shop. I got Cutters in stick form (easy to carry and you're not spraying half the world to use it) from an online fishing supply site... it arrived in about a week after my order.

Amazon may also have this.

derek cox

we are traveling to kovalam /Trivandrum and then up to Goa by train in January a total of 8 weeks away, and we do not want to take anti malarial tablets for this ammount of time, anyway its only low risk areas we will visit, is there a good mossi repelant that can be purchased in India at a resonable price that anyone can recomend? we do not want to pack any unessary weight.

Nick-H

Odomos --- see above.

But it is only 12%; fine for repeated application during the day, but, at least in theory (google about this...) not enough to get you through the hours of the night.

York Stiller

Only for your attention, there´s a current article on the german fit-for-travel website accounting that in Goa are over 2.800 malaria diseases registered to term 2007 (2006: around 1.500). Most of the malaria tropica infections are reported from ther northern regions of Goa in Bardez and the adjoining region Tiswadi. In both regions almost 800 cases of malaria were noticed, from which quite a few affected European travellers. Some of them visited the favoured costal regions of Goa amongst others - Calangute Beach and Candolim Beach..... .

I surely don´t want to cause dismay here but surely want to recommend anybody out there who is toying with the idea to travel to Goa, please don´t underestimate the risk of malaria. In the past there may wasn´t such a fuss to make about in Goa, but now it is for sure.

See ya in Feb.

NeeliAankhen

Please when sharing stories about side effects of anti-malarials, include the name of the medication you're talking about, that would be really helpful!

Nick-H

...That's putting it very politely

Countless posts here over the years tell that someone is unwilling to take anti-malarials because of the side effects.

Without telling which side effects of which drug, that is a pretty pointless statement. In fact it is just scare-mongering.

NeeliAankhen

Yes -- maybe not all posters have been aware that there was more than one commonly presecribed med. I never thought abut it myself until I was discussing my upcoming trip with my friend who's travelled in India several times with her husband, who's a medical doctor.

--from them I got a strong warning against something called Lalium, which the doctor has observed to have very bad mental side effects on some people (psychosis). They -- friend and doctor husband -- said Malarone was fine.

I regard this as good advice as the doctor has been in practice at least 30 years in NY and travels a lot himself -- these are old Peace Corps people -- so pays attention to things like this.

machadinha

Lariam, actually Also known as mefloquine (the active ingredient, Lariam is a brand name.) Others report to do OK by it. I wouldn't touch it with a ten-foot pole, but that's just me. (It's also said to have a possibly negative effect on your eyesight.) I think it's the only antimalarial available for some countries though (due to resistent strains), so I guess that's the choice to make.

http://en.wikipedia.org/wiki/Lariam
http://en.wikipedia.org/wiki/Malaria

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NeeliAankhen

Thanks for the correction re: Larium!! I got the name off of a phone message when I called to ask for the name of the "disrecommended" one to pass along to someone else. I'll go correct my email to her.

Just to state a very obvious thing - nothing on the market in the US probably has very bad side effects on everyone. I think the variability in response to just about anything is fairly wide.

machadinha

Yes, absolutely. If there were any hard and fast answers to it, it'd be a big fat sticky thread here. Again: Just as many people report no problems whatsoever with Lariam. My understanding is that a psychiatric history is a contraindication in any case, but better speak to your medics about it.

Nick-H

Yep... Larium is the one whose side effects would put me right off too. Works out for some.

70s-80s overlander

I'll give you a clue: malarial encephalitis [brain inflammation] is no "picnic". Given a choice between starting Lariam then stopping it if side effects develop -- versus coming down with malarial encephalitis, where "stopping" the consequences of a mosquito bite is not an option -- I'd choose taking Lariam, IF that is indeed the medication of choice for where I'd be traveling.

Side effects with Lariam are somewhat related to how long you take it; ie, taking Lariam for 6 weeks carries less risk than taking for 6 months.

The onset of Lariam psychiatric side effects are described as "abrupt" -- ie, NOT gradual -- but subtle changes -- toward dizziness, insomnia, and anxiety. There are plenty of folks who don't "read the directions" on anything -- but this would seem to be a case where one should pay attention to the sudden onset of dizziness, insomnia, and anxiety -- even if these don't seem to be very dramatic symptoms. A 2005 article using data from the Netherlands puts the unisex risk at 3.8% for those without any past psychiatric history and at 8.0% for those with a past psychiatric history -- with the risk considered much higher in women than in men-- ie, these unisex risk numbers include the higher incidence of problems in women. [J Clin Psychiatry. 2005 Feb;66(2):199-204.] A 2004 article using data from Britain found lower risk percentages than these. [Drug Saf. 2004;27(3):203-13]

Almost every medication has side effects; the question is the cost/benefit ratio on comparing the side effects to the illness effects.

I do suppose I would feel best about taking Lariam if I were traveling with someone -- or made it my business to keep finding travel partners along the way -- but, then, that is probably the approach I would take anyway if I were entering a high-risk malaria zone.

As I tell medical students constantly, the worst problem is "the fatal combination of a stupid patient and a stupid doctor". For good medical care, Step One is making sure that the patient is smart enough to report any symptom to a physician, and Step Two is making sure that the physician is smart enough to grasp what the patient is describing. If I were taking Lariam, I would make sure to report any symptom -- and to report it to a physician who actually has experience using Lariam. There are specialized malaria units throughout India.

As several articles have concluded: keep your focus: avoiding malaria is the issue. Start with the most effective regimen for that part of the world, and switch to the next most effective regimen if necessary.

70s-80s overlander

[/b]It dawned on me that IF a patient came down with any of the most common symptoms related to Lariam -- eg, dizziness, insomnia, anxiety -- one of the first things I would check would be the serum magnesium level -- and I would want it at the high end of the "normal" range. Then I remembered that Israeli troops are said to take a magnesium tablet daily. So -- it seemed reasonable to check for Israeli articles on Lariam side-effects.

Interestingly enough, a 2000 Israeli article -- on travelers with a mean length of stay in a malarial area of 5.3 months, 11.3% had some kind of neuropsychiatric issue; the most common of these symptoms AMONG THOSE REPORTING SYMPTOMS were insomnia (52.1%), fatigue (48.7%) and dizziness (39.3%); (2.5%) of these had severe symptoms, and (1.2%) had symptoms lasting more than 2 months.[J Travel Med. 2000 Jan;7(1):5-9]

That is, of the total pool of 2,500 travelers taking Lariam, the incidence of severe neuropsychiatric side effects was slightly less than 3 per 1,000

This research, too, found that women were much more likely to have neuropsychiatric symptoms on Lariam than were men.

This study wisely asked about use of "recreational drugs" -- and obtained a reported incidence of 22% -- noting that this was a complicating factor in trying to assess neuropsychiatric symptoms that might relate to Lariam.

So, I was not able to find any decent research on Lariam side-effects and magnesium use. I found a fair of bit of research on the paucity of magnesium in the Indian diet -- but none of the studies seemed that great. Overall, though, I think I would err toward taking a magnesium tablet daily -- especially if I had any possibly Lariam-related side-effects -- on any day that I did not have loose bowels [which could be made worse by magnesium].

At a serious neuropsychiatric risk rate of 3 per 1,000, I think I would take the Lariam if I really thought that having to put up with the long-term consequences of malaria was a reasonable likelihood. Choose your own multiplier, but even if a woman were at greater risk taking Lariam might be the better bet.