Malaria

Octathorpe

I was able to purchase Paludrine from a chemist in the Paharganj main bazaar in Delhi. It has been pointed out on this site that Paludrine is difficult to find in India, and I found this to be true to an extent. However, I was able to find it and a 4 week supply was only around three dollars US.

The active ingredient in Paludrine is proguanil hydrochloride (or just proguanil for short). This is also the main active ingredient in the US branded drug called Malarone. (Malarone also contains a secondary ingredient called atovaquone) It costs US$5 per day to buy Malarone in the states (it's still under patent and there is no generic equivalent inthe states). I decided that the proguanil/chloroquine combination was what I wanted to do and I decided to take a risk and try to buy the proguanil in India instead of forking over the cash for Malarone at home.

In general one should be careful when buying pharmaceuticals in India because they are not necessarily equivalent to the drugs one buys in Europe or the US. For what it's worth I'm a R&D chemist at a US pharmaceutical company (although one who isn't willing to pay for an overpriced pill when an effective substitute is available). So I'm pretty careful about checking out the pills I buy over there. India has no oversight body like the FDA to make sure that the pill actually contains what it's supposed to contain. Lucky for me, it turns out that the Paludrine I found in Delhi is the actual branded substance manufactured by AstraZeneca - it was NOT a copy/generic/knockoff. I believe that it's manufactured in India and shipped to the UK and the stuff I got is basically just black-market material. It is not a normal stocked item and this is why it's hard to find. However since India is India, the walla will supply what the market wants. I had to ask several chemists if they had any - nobody at the first six shops had it. I found nothing in the chemists that were off the tourist trail, but in the middle of the bazaar in Pahargang (near the Star Palace) I found several shops that either had it or could "get it by tomorrow". I also bought chloroquine tablets (available anywhere).

I'm writing all of this because this is the kind of information I was looking for before I left. My advice for the backpacker going to India who wants to save a few bucks on malaria medicine but still feel confident that they are getting good medicine: buy it in Delhi. BUT you have to be willing to work for it. Now you know that it IS available, but it's a 'black-market' item. That means not everyone will have it - just keep asking. Go to the most touristy areas - ask if they can get it by tomorrow. When you do get it, it will not be in a box, but it will clearly say "Pauludrine tablets" and contain the words 'AstraZeneca' and 'proguanil hydrochloride B.P. 100mg' on the foil.

By the way, both myself and my wife did not experience any side effects that we can associate with the malaria medicine (the Delhi belly is a different story). No bad dreams or any of that stuff. And I didn't catch malaria either.

caro

1`m off to India in 3 days and still not clear about antimalerials. Best of both worlds I am taking homeopathic pills with me and the scarry coventional medecine ones.

Peyompian

Best of both worlds if they have any effect

J&M

So much more confused, especially seeing as the mossy's bl**dy love me and my juicy body. I swear they eat me alive, one small bite has a 12inch diameter! They ate me alive in Majorca, Turkey, everywhere - let alone India!

Went to an adventure exhibition in London today and spoke to a travel doctor who suggested Doxycycline over the my NHS nurse's suggested Chloroquine and Paludrine so that's nearly me decidied on that one.

Better safe than sorry, especially considering all the other rubbish we pump into us on a reular basis, can it really be that bad?

!!

I'm willing to risk it. Saying that we also stocked up on 50% deet spray.

reddragon

I highly recommend everyone taking anti malarials. Either Larium or doxy works well in India and surrounding areas. The side effects are minimum (for 90% of people) and it sure as hell beats getting malaria.
For people who are wary about taking larium I suggest that before you leave home get 4 weeks supply of the stuff and trial it. I was suggested this by a GP friend of mine who is working in the Tropical health unit. I did the trail and found I had a few nightmares in the first 2/3 weeks but after that I was ok. I decided to take doxy in the end as it was a daily pill and being a forgetful sort decided that a daily pill was much easier for me as I could take it along with my contraceptive pill ( by the way doxy is a antibiotic so it will take away the contraceptive effect of you contraceptive pills – just a note for all the girls out there). Most people will not experience side effects from larium. But just try it before you leave home if you have problems with antibiotics. Also I have been told that it is easier to get doxy over there than larium. Not sure how true that is in India as that came up in a conversation about Bangladesh. But I’m sure someone here will be able to set that one straight.

wonderwomanusa

>>Also I have been told that it is easier to get doxy over there than larium. Not sure how true that is in India as that came up in a conversation about Bangladesh. But I’m sure someone <<

Doxy is really easy to get in India; I just walked into the pharmacy in Delhi (Connaught Place) and in 5 minutes had a 100-day supply for about US$20.

Dav

I am heading to India for three months and have chosen not to take any anti-malaria tablets with me. I have tried them before and they made me feel sick. Last trip I actually threw out five months worth for this reason.

I visited a doctor last week and advised him that I wasn't going to take any anti-malaria medication with me. He did strongly urge me to take an impregnated mosquito net. He said they don't cost much $20 AUD?? and are a worthwhile investment. Other precautions will include: covering as much skin as possible at night with light weight clothing and using heaps of roll on mosquito repellent. A Deet?? (illegal in some countries) based repellent worked well last time. I know you can impregnate your clothes with repellent as well but I won't be going to that extreme.

How bad can Malaria be anyway? (joke)

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Davinski

goangoangone

US prefer Doxy and don't recommend chloroquine and proganuil now.

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GoanGoan......here

Peyompian

Doxycycline... man, if I took an antibiotic everyday for months, god only knows what would happen to my digestive tract. Everytime I take them, I end up eating gallons of yogurt over the course of a month trying to get things regular again.

Ikuru

Malaria seams to be the most popular topic on IM.
Allways on the fronpage...
Strange huh?

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http://www.ikuru.se My art.

goangoangone

Antibiotics will be fighting the yog as well!

amogasiddhi

The whole point of buying 'anti-malarials' in your home country is that the supply is limited to people who need it, to what they need and is controlled by licensing laws, advisory organisations, medical organisations, research organisations, pharmaceutical organisations etc etc etc.
If people in one malarial region of India used the 'anti-malarial' (eg: Proguanil/Chloroquine)which was designed to counteract the effects of contracting Malaria from another species of Mosquito which existed in another region, it would not work. There is no point taking Malarone where it doesn't work and the only way you could know that is to have a medical opinion on the subject. So you get that before you go to India.
When Mosquitos generate a resistance to an 'anti-malarial' it is because they themselves have evolved through re-generation only this time with a resistance to the chemical which previously had a negative effect on them. Over use of the chemical prophylaxis produces a greater resistance to it, thereby eventually negating the efficacy of that prophylaxis as the mosquito's in that region will eventually breed a resistance to it. It's a horrible situation to think of but if everyone took the currently accepted anti-malarials, they eventually would cause the species in their region to breed a resistance to it.
Aside from that, you cannot guarantee the quality, authenticity, if it has been stored correctly, if it is what you are being told it is and so on. I could get a passport, driving license, student card, birth certificate, ID whatever from a little man in Bankok so how hard do you think it is to package little white pills?
I agree that 'anti-malarials' cost too much but what if you're not being sold an anti-malarial?!
This is, of course, a sweeping generalisation. you may be able to buy the real thing from a man in Delhi but how do you know the difference and unless the person is a registered chemist, from where did they get it?
I have been quoted £45 for 18 week's supply of (proguanil/ chloroquine). That's less than half of what I have been quoted for insurance which I probably will never need. You work it out.
Of course, you could always check out Homeopathy.

reddragon

I Know what you're on about so I take a product called Forbiotic its a probiotic - Lactobacillus reuteri - to be exact - its like the acidophilus in yoghurt but much stronger and it will replace all the good bacteria in your digestive tract killed by the antibiotic - its not too expensive either about $12 Australian from health food stores. Also I have taken acidophilus tablets (one tablet has as much acidophilus as 15-20 tubs of yoghurt depending on the strength of the tablet) so you'll find that you wont get upset by the antibiotic. The only reason I take forbiotic over the acidophilus tablets is that forbiotic doesn't need refrigeration to it is much handier whilst travelling.

tukat

I leave for Mumbai in 2 days, my MD declined to re-prescribe Malerone because I would not come in for a $200 travel visit ($200 to hand me a script!)
So, is Paludrine or malerone (proguanil hydrochloride & atovaquone)
easily available in Mumbai? Any specific suggestions for medical shops carrying it appreciated. I will be staying in Vashi outside Mumbai, on a "lake". Is it always mosquito season around Mumbai? Are those treated nets easy to find?

Has anyone else noticed that it seems no one has any screening/netting across windows in their houses in India, even the rich people? All those flys & mosquitos
allowed to come right in. Why?

edwardseco

Great post Octathorpe! Some light on this murky area. Dav I think he meant a permithrin impreganated net. Deet is used more on the skin as it is less dangerous. I didn't know it was banned in any country.?