Malarone

[ceejay]

Could anyone tell me please if Malarone tablets are available without prescription in pharmacies in Pattaya or Bangkok? I am going on to Cambodia on the next trip, and I need antimalarials for there. They are expensive in the UK - more than 200 baht/tablet equivalent, plus a prescription charge. It would need to be a very reliable supply, please - I don't want to put myself in the position of being without them.

Many thanks

[rincondog]

Malarone is not available in Thailand.

[ceejay]

Thank you. I'll get it before I go.

There are four types of malaria, of which three are prevalent throughout Cambodia: Plasmodium falciparum, Plasmodium vivax and Plasmodium ovalae. Malarone is only approved for the treatment and prevention of Plasmodium falciparum (which can lead to cerebral malaria, which killed a British colleague of mine, within 24 hours, while I was working there). Although this is the most prevalent and dangerous type you should not ignore the others - try talking to a specialist, who will probably recommend doxycline also.

I am surprised that Malarone is not available in Thailand, as it has been tested extensively here as the generic atovaquone/proguanil, however it may only be available to order or through certified pharmacies. If you PM me I will try to check, though I may not be able to do so for a few weeks.

Ceejay, why worry about the cost? If I was facing the same situation I would get the supply in the UK where I could be sure I would be getting the best.
If my memory is correct, the last time I was on anti malarial medication, I had to start taking it at least one week before I began my stay to allow the medication to begin to be effective, and then again for a week after I returned.
If this is still the case then you will need to start before you arrive in Thailand.
Why risk your life for a few pounds? The money you save buying in Thailand will be of no use to you when you are dead.

[ceejay]

GF
Thank you for your kind offer. I think though that I will be getting the Malarone here in the UK. If it's not readily available, then I don't want to spend time in Thailand looking around for it. I have been to a specialist travel clinic already - they suggested Malarone only, but I will ask again about their recommendation for any additional preventative measures. Doxycycline is not recommended for me - I am sesnsitive to sunburn.

Thanks also for your comments ahobni. You are. of course right - saving a few pounds isn't worth dying over. I'm not mean (I hope!) but I do get grumpy when I think I am being charged over the odds. I will actually be spending a week in Thailand before I go on to Cambodia, so I will be starting the antimalarials around about the time I arrive in Bangkok.

Remember you only have to start take Malarone 1 day before you enter a malaria area, one of my friends working for an international aid organizasion in the countries around Thailand take it the same morning he is travelling into the areas. Malarone is still quite expensive compared to the other anti-malaria drugs. But I prefer it because it only have to be taken so short before you are going into the area and what I know there have not untill now not been seen any serious side effects.
BTW I have been travelling to both Burma, Laos and Cambodia and the tropical clinic suggested me only to take Malarone in all cases. But maybe they are wrong.

Any problems getting meds in pattaya pop into twoguys and see stewart or cho - they seem to know where you can get almost anything.

[rincondog]

ceejay, as I previously posted Malarone is not available in Thailand. Why? part of the pharmaceutical plot to keep prices high. Probably.

You need to take Malarone for 2 days before entering the malarial area and then continue for a week after leaving the area. To determine the number of tabs needed add those times with the time you will be in the malaria area. I think having the proper insect repellent with Deet as an ingredient will help reduce any risk of bites.

P.S. if anyone offers Malarone in Thailand it would probably be counterfeit, I'm sure the Chinese can shape melamine into phony tablets quite easily. Occasionally other travelers have some they have not used and they have been known to offer them for sale on travel forums, however, this would be time consuming to find them. Just get them in your home country and travel safely.

GF
Thank you for your kind offer. I think though that I will be getting the Malarone here in the UK. If it's not readily available, then I don't want to spend time in Thailand looking around for it. I have been to a specialist travel clinic already - they suggested Malarone only, but I will ask again about their recommendation for any additional preventative measures. Doxycycline is not recommended for me - I am sesnsitive to sunburn.

ceejay,

I was actually able to check the position today and rincondog is absolutely correct. A few pharmacies here with a special licence are able to supply some drugs (such as Roaccutane) which are only normally available at hospitals, by prescription, and I thought this may be the case here. Apparently it is not and Malarone is not available at all here as it has not been approved by the Thai FDA yet; I find this surprising, but there it is.

I do not wish to run down the expertise of others in this field posting here (the consequences could be far too serious for any sort of "point scoring") but, as always here, be careful about following any advice posted here - including mine. Copies of most drugs are widely available here, which can vary from identical, to useless, to dangerous; be very wary of anyone who can "get almost anything" for you - they may be well intentioned, but that may have little or no bearing on what you are getting. Your doctor should also have told you what is clearly given on the Malarone web site: "тАжdosing begins 2 days before departing for your trip. тАж 1 more week of treatment is required when you get home". What anyone else does is up to them (and all of Cambodia is considered a malarial area, including Angkor Wat, etc, except for Phnom Penh and the Tonle Sap).

I quite understand that you are one of the 1 in 10 who are unfortunate to have a photosensitive skin reaction to doxycycline, but if you do not want to take doxycycline as a prophylactic against Plasmodium Vivax and Plasmodium Ovalae. then your alternatives are limited (actually non-existent, as far as I am aware!). These types are less prevalent than Plasmodium falciparum, which is the major killer, but you should be aware of the risks and weigh these up against the danger of sunburn. Chloroquine and Lariam are both out: mosquitoes are resistant to Chloroquine throughout Cambodia, as they are to Lariam (Mefloquine) in most areas, and Lariam also has some particularly nasty and permanent side-effects.

One million Cambodians are infected with malaria each year - the highest infection rate in the world; of those infected, between 1.5 and 10 percent (in some remote provinces) die. The choice is yours.

I am not an expert on the subject, nor am I qualified to advise you, but I do have some expertise in this particular area and some experience - sufficient, for example, to have been selected as the Field Leader for a major part of the largest international entomological expedition in the last 100 years (ever, in terms of the number and programmes of the scientists taking part), While it is true that you have more chance of being involved in a traffic accident there, and many of those visiting Cambodia can truthfully say that they have never known anyone on holiday there to catch malaria, I can equally truthfully say that of the group of 20 Brits who I went to Cambodia with for several months a number of years ago, three caught malaria, one of whom died; he was the only one who had not heeded my advice on malarial prophylaxis, which were available free...

You are probably already well aware that in addition to malarial prophylaxis you should use an effective mosquito repellent, either DEET based (15% minimum, 50% is better) or Bayrepel (20% strength), also known as Icaridin, Bayrepel, Saltidin, or Picaridine, (or even KBR 3023, or hydroxyethyl isobutyl piperidine carboxylate!). I posted on this in a thread in July, which you also posted on; Bayrepel is widely available in Australia, but I am afraid that I cannot help in the UK as I have been out of the country for some time.


The London School of Hygiene & Tropical Medicine no longer give travel advice to individuals, and I have no contacts there now, but you could try the Travellers Healthline Advisory Service, which is part of the Hospital for Tropical Diseases - all are actually part of the NHS and University College London Hospitals, but they do charge for consultations, etc. Telephone: 020 7950 7799 for the Healthline or 0207 388 9600 for the hospital. They also have quite a useful on-line shop.

Enjoy your holiday!!

About Malarone, I am just looking at my last pack: Take it daily from 1 to 2 days before arrival and after 7 days departure. If I was worried I would take it 2 days before, but I take it just 1 day before, and not as my friend who takes it at the same day, but he was not adviced by an ignorant. It look likes there are different opinions on this both from doctors and countries. And GlaxoSmithKline. Never the less you can be treated from most Malaria if you feel you have got it, but be in a hurry. They use the same drugs to heal you, as you take agains getting it. If you take you medicine I would be more conserned about the denguefever, no drugs against it.

Prices charged in the UK can vary quite a lot.

Last year I bought mine from the Asda pharmacy, which was competitive with the best online prices at the time.

I've taken Doxycycline twice and each time I had migraines almost everyday I took them. I usually go six months without getting one. I got them at the British Airways Travel Clinic (now closed) in London's Oxford Street. The doctor there thought the side effect was just a coincidence but I wouldn't take them again.

There's a similar Travel Clinic for those in London now run by a private company called MASTA. Not cheap but you can see a doctor and get advice.

Thank heaven anti-malarials are not required for Thailand. A lot of the drugs on offer seem to carry a risk of nasty side effects. I wouldn't fancy taking any of them long term.

That said, the official health advice in UK is that malaria tablets are required for Thailand if travelling outside the main tourist areas. When I said I wasn't going to bother, they got quite huffy, and made me sign a form acknowleding that the advice had been given.

There's a similar Travel Clinic for those in London now run by a private company called MASTA. Not cheap but you can see a doctor and get advice.The US side of the business is known as BATION

[Hmmm]

Coincidentally, today's entry on ANU's 'New Mandala' South-East Asia blog provides a sobering reminder of malaria's effects. Interestingly, dog meat is recommended to aid recovery ....

http://rspas.anu.edu.au/rmap/newmandala/2008/10/05/drip/