Question: I have only just started my course of Malarone today, as I am due to enter a malaria infected area in 2 days time. I have also therefore just now had the cause and opporunity to read through the instructions and guidance enclosed with my tablets. I am now concerned that it clearly states not to take Malarone for a course in excess of 37 days and to seek advice in case of trips in excess of 28 days. In such situations it is advised to seek medical advice prior to such travel. Please advise
Answer: There are many medicines which are prescribed "off-license" or for a period longer than indicated on their packaging and this is done by assessing the potential risk of taking the medications for a condition other than that recommended or for a longer period of time than that recommended versus the risk of developing illness. Malarone is not licensed for use for more than 28 days however, the risk of catching malaria and either developing associated complications or dying from it are far greater than any of the side effects listed in the medicine's leaflet. For this reason many doctors prescribe the medicine for over 28days. Of all the anti-malaria medications Malarone is the newest, it has comparably fewer listed side effects and is taken for the shortest period of time either side of entering the malaria risk zone. It is safe for you to continue taking these medicines. Further information is available from: http://www.nathnac.org/pro/misc/faq_malaria.htm#long Atovaquone/proguanil (Malarone®) Both components of Malarone® have been used individually on a long term basis, although there is little experience of long-term use of the combination. Many countries do not restrict the length of time atovaquone/proguanil can be taken although the UK product license states it can only be taken for travel up to 28 days. There is a report of atovaquone/proguanil use for periods from 9 to 34 weeks, in which there was no excess of adverse effects and no appearance of unexpected adverse effects [4]. The ACMP concludes that there is no evidence of harm in long-term use and suggests that it can be taken confidently for travel up to one year or longer. Nevertheless, long-term use of atovaquone/proguanil should be prescribed with careful consideration until additional post licensing experience is available.
