Long-term anti-malarial tablet use?

TinTin1976

Hi all,

I'm moving from London to Delhi in October to work for an NGO. I'll probably be living in or around Kalkaji, but my job may take me to all parts of India throughout the year. i will be living in India for at least 1 year, but probably several years.

Do most expats living in India take anti-malaria tablets on a long-term basis? I have been prescribed malrerone - is this safe to take on a long-term basis? Should I only take it during 'risky' times of the year or when travelling to risky areas?

Is it fairly easy and cheap to buy anti-malarials in India?

Any advice hugely appreciated.

Thanks,

TinTin

zenia

Tin-tin,

That's an excellent question....
I've been here for 2 year without anti-malarials because I don't want to take them long term, but sometimes I wonder if that's irresponsible.

You'd probably be okay to, as you said, take it during the risky seasons and areas and simply protect yourself from mosquitos the rest of the time. However, I can't give advice about it since I'm not from a medical background.

Medications are usually MUCH cheaper here than in the U.S., and I assume UK, so I'd say get them here.

To find out whether it's safe or get the best advice, you could go to a travel health clinic or log on to the CDC website to get the answers, (and I should do the same ; )

Just make sure that if you do take anti-malarials, that it is the right kind, as there are different medications for different strains of malaria - and the strains differ from country to country, and the patterns shift.

I hope that helps,

Cheers

Tapestry

I did not take any anti-malarials for four years of living there and I traveled all around. If I lived there for 50 years I would not take any anti-malarials. I have taken Malarone in the past (not in India) and personally I had bad stomach trouble (to put it lightly) with it, but I'm sensitive to meds, so I am sure there are lots of people who have taken it with no probs. You can do a search on this site to see other people's opinions on the malaria and malarone issues, there are plenty of threads.

edwardseco

Long term is a difficult issue. I tolerate Doxy but would be reluctant to take it so long. Malarone is not contraindicated for long term but also not tested for such. In any case its too expensive for me to consider. Chloroquine may have the least long term impact from studies. But, there is resistance to it in some areas of India, I believe principally in the NE. Larium I don't consider because of the higher level of risk (some people thrive on it). One thing I am convinced of is that there is no one size that fits all, its very individual.

Long term I took my chances. My environment meant that there was no way I could use a net or slather on that much Odomos..

ianscott

My first few trips here I took anti-malarials, and was sick as a dog! Been here since last November and am not taking any now, but take the usual precautions about long-sleeves, socks (esp. if you wear sandals) and plaster on the Odomos (mozzie repellant). Buying the plug-in mozzie repellant has also been a great investment, and if you can get them the electric 'tennis' bats to zap/fry any strays (mozzies that is!) is great fun too.

Nick-H

TinTin1976... Strongly recommend that you download and study UK's HPA's document on malaria and travellers. It is aimed at doctors, but contains plenty of explanation for laymen It gives a pretty balanced view and, although it covers the whole world, it divides India in to sections; I wouldn't trust anything that just lumps it all together as: India; Malaria present.

You can find it -->here. (PDF)

You should check out the HPA's site for updates too. For instance, parts of Goa have been upgraded to a higher risk level since the main document was published.

you will find many opinions here on Indiamike, and some controversy. This is hard to avoid, as even people quoting from their different country's official recommendations may well disagree!

The personal answer:

I took anti-malarials when I was here for six months. I took chloroquine, once a week, because I was advised by a local doctor that it was fine for where I lived.

When I returned to India to stay here for the foreseeable future, I took (and still take) nothing. I agreed with the same local doctor about this.

When I feel really and totally dreadful, I get a Malaria test. Last time I was put on anti-malarials before the test results came through (correct procedure) because it really looked like it. It wasn't. The antimalarials made me feel double and triple dreadful and horrible, but I would do the same again next time.

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zoltan

If you are there long-term, it is not recommended that you take anti-malarials. They may cause your body to have adverse side-effects over a long period.

The better option (imho) would be to obtain malarone tablets and if you feel that you have malaria coming on (get a blood test to confirm), then, take the malarone tablets as a counteractant.

I also would advise to steer clear of larium. I've met two people in India who were taking them and were constantly having mood swings and personality issues.

Your best option is avoidance - when going to bed, use a net & either incence or coils burnt to repel the biters.

During the daytime (morning & dusk is when they are most active), use repellants.

Cheers
Zoltan

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Nick-H

Not often that I have to disagree with Zoltan's good advice, but I do on this one.

If you suspect malaria, see a doctor. Do not self-prescribe or self-diagnose on this one; get proper medical attention. You can get all the drugs you need here, including artemesian (sp?), the latest anti-malarial from Chinese medicine. There is no need to carry this (or quite a lot of the other stuff people seem to like to have just in case*)

If you really do have malaria, you may even be better off in hospital for a few days. The drugs I took last time I didn't-actually-have it made me incredibly sick, and I was told this can be avoided by getting them intravenously.




*When I go to UK, I carry a course of Amoxycillin at least, bought in India for a few rupees, to avoid the high UK prescription costs. I don't get stuff like that to bring here!

skk

I follow the US CDC advice ( on these matters, unlike say - gun-deaths, they can't be regarded as political) as per:
http://wwwn.cdc.gov/travel/destinationIndia.aspx

So, when I visit my internist on Monday, if he doesn't prescribe one of the three CDC recommended anti-malaria drugs : atovaquone/proguanil, doxycycline, or mefloquine (primaquine in special circumstances and only after G6PD testing), for my upcoming trip, there will be HELL to pay.

-skk

edwardseco

Now the interesting question is whether your insurance will pay for that. Its insane but mine won't..

bruce3404

I don't know that ANY insurance in the U.S. will pay for anti-malarials and, yes, it is ridiculous. Guess they'd rather treat people for the rest of their lives for malaria than pass out a few pills. I could go off on a rant about the need for Universal Health Care here, but I'm sure I'd be preaching to the choir. To SKK, if you can tolerate doxys, that's the cheapest route ($10 for a 90 day supply at Walmart); if you have to go with Malarone, you'll need to buy it in the states. I shopped hard and found them for $5.35 each (my wife can't tolerate doxys).

billyshake

bit off topic, but as a vocal member of 'the choir', I'm awful happy to be living in India where doctor visits and health insurance are affordable! Medications -- though at times, I hear, can be fake -- are extremely affordable. I take crazy pills to keep my head in check which cost a fortune in the U.S. ($110 monthly) because I had no insurance. Same pills in India cost $6 for two months! Though, frankly, I'm still nuttier than a fruitcake in space.

On topic, when I moved to Cambodia, doctors told me not to take any type anti-malarials long term. He said it would be hard on my body and that if I were to get malaria, I'd be given those drugs anyway as a treatment. An older American man who raised money for my orphanage came to Cambodia to visit. He was taking anti-malarial pills but got Dengue Fever instead. It was horrible. His skin dried out, his joints literally froze up. I was quite worried he wouldn't make it. But a couple weeks in bed and he came through all right.

zenia

Good point about Dengue...there are some mosquito-borne illnesses for which there is no vaccination or medication
to take before hand -Dengue or Chicken-Gunnia (sp??), for
example.The only protection from those illnesses is protecting
oneself from mosquito bites and being extra careful when in
risky areas and/or seasons.

Nick-H

Malaria, always assuming of course that it doesn't kill you within the first few days , is treatable and curable.
It may have been true once that it lasted a lifetime, but it is not now.

I'm sure that the myth that once you have malaria you have it for life sells a lot of drugs; it certainly causes a lot of fear. I have no idea how long it has been untrue, I only found out about it within the past couple of years.

From my favourite Malaria info source:
That is no reason not to take the illness extremely seriously, there are strains that can kill swiftly, and, for traveller, it, as would any serious illness, is going to be a real trip spoiler. It is better to be afraid for the right reasons, rather than the worng ones!

TinTin1976

Great range of sound opinions and advice here, thanks very much to everyone. I think I'm going to take the malerone when I first arrive for peace of mind, then after settling in will re-assess the best way forward.