So my boyfriend and I are traveling to Singapore on the 25th of February and from there making our way through Southeast Asia plus India, China, and Japan but as of now do not have a supply of Malaria pills. We were told by our doctor that they are cheaper, more readily available and sometimes even better in southeast asia, but we are aware of the risks of counterfeit pills. Does anyone have any advice of where to look to buy legitimate malaria pills preferably in Malaysia or Thailand (the sooner in our trip the better I am guessing)...any advice about not getting malaria in general? or what type of pills have the best results and least side effects, Cheers!

It's worth it to see a reputable doctor (check a guidebook for help in this, they usually list locations of medical services) or clinic to be pointed in the right direction for this. That's how I managed it in Beijing - I went to the doctor in the Swissotel and was given pills for about $25 USD, enough to last me for a year of travel (I was only traveling for several months).

If you were coming to Taiwan I could tell you where to get Lariam reputably, unfortunately you're not...

As for the different medications, the three main ones are:

malarone
doxycycline
Lariam (Palenquil)

Malarone has the fewest side effects, but is also not effective against all strains of malaria - I believe that a few resistant strains in the Mentawai Islands of Indonesia have been reported, as have a few strains in India. Malarone's only main side effect is increased sensitivity to sunlight, so you have to redouble efforts with hats and sunblock. I've taken it and had no such side effect, but have spoken with people who have. There have also been reports of upset stomach, but that could just be Delhi Belly! Malarone is in the middle of the price scale - more expensive than doxy but cheaper than Lariam.

Doxycycline (an antibiotic) is a great option for men, although some men claim a general run-down, low-fever feeling when taking it. I do NOT recommend it for women. It is an antibiotic also used to treat some STDs, and as such has an...shall we say...interesting effect on the female systems down there. You'll already be in places where it'd be easier to contract a yeast infection (thrush), and doxy raises the chances of that considerably by lowering your defenses to it. Your periods are likely to be thrown off (which happens with travel anyway) and period pains worse than whatever you currently experience. Violent, PMS-like mood swings are what happened to me, not to mention bruising more easily and increased vaginal sensitivity/irritation.

Lariam is the 'bugbear' of the big three medications - it's got the dubious honor of being the most effective but at the same time having the worst side effects. People of both genders complain of headaches, vivid, LSD like dreams, mood swings, occasional daytime hallucinations (usually of light or light patterns) and for people with any kind of previous mental illness/counseling/medication, it can cause psychosis and worsen existing mental issues.

I've taken Lariam the most out of the three (malarone is not available here, doxy wreaks havoc on my moods and gives me a neverending period) and while at first I experienced vivid dreams and mood swings, later use of it proved to have no side effects whatsoever. Lariam protects against the largest number of strains of malaria, but is also the most expensive.

Some tips when going to the doctor:

- learn the other chemical names or known names of malaria drugs so when given something, you know what it is.
- only see a reputable medical clinic to obtain this medication, counterfeiting does happen
- when traveling, continue to use DEET-based spray, use mosquito nets when provided, sleep near a fan to keep mosquitoes off, wear light-colored clothing that covers well when possible, avoid too many sweets

One place where you do not have to worry about malaria is China - if in Xishuangbanna (south Yunnan)or Hainan Dao you should be taking it, but it's safe everywhere else.

*sigh*

You do not need to take Malaria prophylaxis in SEA.

No, elAdi, you probably don't need them in larger urban areas, resort areas, higher altitudes and a lot of other areas, but malaria can be a dreadful disease and sometimes it's wise to take precautions.

Anti malarials (not lecturing you here, elA as you obviously know what you are doing, but making a general observation) are an antibiotic, they don't really prevent it but they zap it if it does happen to enter your bloodstream. I've currently got a fridge full of Lariam because we judged that we really didn't need it on a recent trip, but I don't regret having bought it.

Even if you're on antimalarials it still pays to wear long sleeves and trousers around dusk and use plenty of insect repellent. I've not used a mosquito net since I was a kid, but in the right (or maybe wrong) environment I would again.

Groo is right, there is a malaria risk in rural areas in SE Asia. But to my knowledge, only doxycycline is an antibiotic (I've taken that in SE Asia).

Malaria prophylaxis is advised in India too.

I don't know what happened to the handy risk maps I used to link to--most maps/advice are now for single countries--but the CDC has released an new interactive risk map (which takes ages to load)here.

I don't say that there is NO risk. But as a tourist, the likelihood that you get it in SEA is marginal. Additionally, due to financial aspect + a generally better immune system as a westerner, you will most likely survive and be cured of Malaria.

quote:

they don't really prevent it but they zap it if it does happen to enter your bloodstream.

That is exactly why it doesn't make much sense, in my opinion, to take prophylaxis. If you get it anyway, you can as well poison your body only when it's really necessary.

Per example, we'll head for Indonesia next year. We'll spend 5 - 6 months in Indonesia (and Eastern Malaysia). Would you really consider taking malaria prophylaxis for 8 (EIGHT!!) months. That is crazy.

First, I don't recommend the pills. Taking anything that you don't need in the short term can have detrimental long term effects on your body and mind.

If you still want to take the pills I recommend going to Bangkok Nursing Home Hospital and seeing a doctor there to get a recommendation on the type you should take. The best part about that hospital is that it is better than most western hospitals I have ever seen. Also it is in Silom area of BKK and it is right next to the Irish Exchange where you can get a real pint of Guiness and a Steak. So after you go see a doctor to get a good bill of health you can go get a steak and Beer to wash those pills down with.

Personally, I don't think any of us should really be giving medical advice on whether or not to take the pills if we're not a doctor familiar with that region. My advice is get medical advice.

However, we cannot resist to tell our personal stories...so here is mine... My husband was hospitalized for malaria in Africa even though he was taking anti-malarial pills. He was told that there are different strains(?) of malaria and that the type he had contracted would have gone to his brain and killed him if he had not been taking the anti-malarial pills. The good news was that the strain of malaria he got is one that does not recur unlike some other strains.

um i believe a girl we knew on these boards died last year from malaria...

no one should be giving medical advice, I would hate to hear a loved one coming on this board to tell us all that their brother, mother, father, sister etc died from malaria after they were told you don't need it in South East Asia, Africa, India, or anywhere else...

Sure I spent time last year in SEA and didn't see one mossie, but I wasn't going to take the risk...

One thing that I can tell people is to read the side effects of malarone and larium vs. Doxycycline...

Doxy might give you a rash or an upset stomach the other two have the chance 5-10% of having some severe side effects, but again everyone is different...

Also doxy can be cheaper overseas and easy to obtain...For example I bought doxy like 60 pills at a clinic in Hong Kong for like 20 bucks...here in america that would run like 250 or something insane.

Currently I am in debate as to what to do myself with malaria pills...I am going to India, middle east and Africa...I need malaria pills and I have to find out if I can take Doxy as opposed to the other two because I am scared of the side effects and how many I need...It could end up costing me hundreds of dollars since you need to take doxy every day and 2-4 four weeks after you leave the infected region...

Taking malaria pills does not provide any guarantee that you will not get malaria..might reduce the risk. The key is know what strains of malaria are prevelant in the area you are going...differnt type of pills work on differnt areas.Same pills cannot be taken in all places

Best advice one can give you is talk to your doctor, know your body reactions and also if you have any allergies etc that affect the medication. Also, know the side effects of these drugs and let others around you know what you are taking. I was totally taken back when a fellow travaler started behaving strangely and was having nightmares because of some malaria medication.

Also, know what medications to buy in foreign countries. There are some fake medications out there...one has to be careful.

Personally for me none of the malaria medication was not agreeable. I was given signs to recognise malaria and get my butt into a hospital at the first sign. Also, i took all the normal precautions...long sleeves,long pants, light colors, showering twice a day, using mosquito net etc etc.

In the end its a personal choice and a matter of trust..do you trust your doctor advice.

Ask your doctor for the scientific name for the medications and then ask for the same in the countries you are traveling in. I always do that for my US medications and in India we look up the names in the Pharmacy book and then get the local ones.

Lol there is quite a lot on the news about this in Asia at the moment. I wouldn't recommend buying anti-malarials out here. Its big business, and as such very professional now a days. They make drugs that are identical in size and shape, but contain potentially lethal substances. The packets are also identical to the real thing.

Buy it in the US, atleast then you know what your getting. Better safe than sorry, they recon over 50% of anti-malarials here aren't the real stuff

quote:

Per example, we'll head for Indonesia next year. We'll spend 5 - 6 months in Indonesia (and Eastern Malaysia). Would you really consider taking malaria prophylaxis for 8 (EIGHT!!) months. That is crazy.

Actually no, it isn't crazy if you travel to high-risk areas. This from CDC health information about Indonesia:

quote:

Malaria risk area in Indonesia: Risk in rural Sumatra, Sulawesi, Kalimantan and Nusa Tenggara Barat. No risk in urban areas.Risk in all areas of eastern Indonesia (provinces of Papua Indonesia, Irian Jaya Barat, Nusa Tenggara Timur, Maluku, and Maluku Utara).

No risk in Jakarta, resort areas of Bali and the island of Java, except for the Menoreh Hills in central Java.

Also see that site for more information and links re. antimalarial drugs. I would welcome it if members did so before posting general 'advice'!

In general, everybody planning to travel to affected regions should see a travel doc/clinic about recommended vaccinations and malaria prophylaxis. If you can afford to go on a trip, you can afford to take the necessary precautions. Don't let anecdotal advise on travel forums convince you otherwise--nobody here is qualified to give medical advice!

I figured out a rough estimate for the amount of malaria pills I may need for my rtw and it worked out to about US $1,200! As I am not about to spend a month of travel on pills I've decided that I'll be buying them in Egypt, where they are much cheaper.

If you make sure you go to a reputable place, don't buy pills off the street,

If you're going to rural SE Asia, you most certainly do need to take malaria pills. At the risk of sounding blunt, if you go to one of the areas where malaria is still reported (even a few cases, even sporadically) and don't take pills, you're an idiot. Harsh, but really.

Parts of Laos, Cambodia, even rural Vietnam, a good chunk of Sumatra including the Mentawai Islands and some other rural bits of Indonesia and rural Palawan have all reported cases of malaria in the recent past.

If you go to more beaten-trail spots (Thailand, for example, most of the Philippines excluding Palawan which has still had a few reported cases) you don't really need it.

It's not 100% effective, true, but the protection % is high enough (especially with Lariam) that if you combine it with mosquito bite prevention, you're basically set. The risk of contracting malaria under those circumstances is about the same as getting pregnant while on the Pill. Take out the pill, and the risk shoots up considerably.

As for long-term effects? Lariam is suspected of having long-term negative effects in some people, which is why many people wisely choose to stay away from it. Doxy is just another antibiotic and will pass out of your system as though you've taken something for an infection. Tests have been done - it does not weaken your immune system and it does not have long-term negative effects. I am not as certain about malarone so I won't say anything on that one.

"Long term negative effects" is a common excuse among travelers not to take malaria meds when they really should be taking them - I'm not sure where it comes from, because it has no basis in scientific study.

quote:

Would you really consider taking malaria prophylaxis for 8 (EIGHT!!) months. That is crazy.

Um, YES! I would, and did! I spent about that amount of time in southern India and you bet your bum I took malaria prophylaxis for the full duration of my stay.

The side effects of the pills (if there are any - plenty of people experience none) are nothing compared to what would happen if you actually got malaria.