Phew my brain HURTS! After an obscene amount of research I finally feel like we can make an informed decision about what antimalarial medication to take and in what countries we need to take it.
First, I have to say that I find it frustrating when you ask a pharmacist what the difference is between the various antimalarial medications and they respond that they are all basically the same.
Second, I am constantly thankful for the internet. It puts so much power in our hands. The three most valuable resources I have come across in my quest for information about malaria and antimalarial medications are: CDC, The Travel Doctor and IAMAT.
So, I have learned that all antimalarial medications are not created equal. There are several factors you need to consider when choosing which may be the best option for you. In no particular order, you need to consider the following: how long will you be in malarious areas, cost of the medication, what countries/specific areas you will be staying in, will you be in a chloroquine (an antimalarial medication) resistant area, whether you are pregnant, breast feeding, your current health concerns, what altitude you will be at, are you planning on scuba diving and your age. Remember to always consult a doctor. You will need a prescription for malaria medication so looping your doctor in on the decision will be important.
For Latin America I had to factor in that there are large areas that are chloroquine resistant. Meaning that the plasmodia that cause malaria have developed a resistance to chloroquine. We are going to be gone for 7 months total but will only be spending about 4 months in countries that have malarious areas which means we may choose any of the antimalarials on the market. Not all antimalarials may be taken for long periods of time, more than 6 months. For the countries that we will be traveling in they recommend you take Atovaquone-Proguanil, Doxycycline or Mefloquine hydrochloride. Atovaquone-Proguanil (Brand names: Malarone, Malanil and others; generics are also available) can be very expensive for long-term travel. We were given an estimate of $1,000 per person for a 6 month supply. Since our medical insurance will not cover antimalarials this is definitely a factor for us to consider. Doxycycline (Brand names: Vibramycin and others; generics are also available) is an antibiotic. When taking Doxycycline you need to avoid exposure to direct sunlight and use sunscreen with protection against UVA to minimize risk of photosensitive reaction. If you don’t take it with a large amount of water you can end up with esophageal and stomach irritation. Mefloquine hydrochloride (Brand names: Lariam, Mephaquin, Mefliam and others; generics are also available) has some scary side effects including nausea, headache, dizziness, ringing of the ears, loss of balance, anxiety, depression, mistrustfulness and hallucinations. Neurological side effects (dizziness, ringing of the ears and loss of balance) can occur any time during use and can last for long periods of time or become permanent even after the drug is stopped. YIKES! So, I opted not to include Mefloquine hydrochloride as an option for us.
When we went in to see our doctor on Friday, September 23 and I presented him with the two antimalarial drugs I had narrowed down to, his eyes lit up. He immediately, gravitated toward Doxycycline. He felt that it was not only a good option as an antimalarial but that I might also gain some other benefits from it regarding my rheumatoid arthritis.
As I was sitting in the doctor’s office having a Myers’ IV, a vitamins and minerals cocktail to give my immune system an additional boost to cope with all the vaccines, a thought occurred to me. Doxycycline is an antibiotic used to treat a large number of conditions and I am pretty sure that our prescription insurance will cover an antibiotic. We recently started using the direct mail order service provided by our prescription insurance so we had our doctor submit the prescription requests to them.
Sure enough not only is our prescription insurance going to cover the Doxycycline but we can also get a vacation override and have the full 6 month supply sent to us before we leave so that we may travel with it.
prices below are per person
TDaP (Tetanus, Diphtheria, & Pertussis)$64 08/22/2016
- MMR (Measles, Mumps, & Rubella) $86.42
Hepatitis A (Round 1)$71.09 08/29/2016
- Hepatitis A (Round 2) $71.09
- Hepatitis A (Round 3) $71.09
- Rabies* (Round 1) $370.50
- Rabies* (Round 2) $370.50
- Rabies* (Round 3) $370.50
Malaria* (6 month supply) $94.08 post insurance Typhoid* (Oral, every other day for 7 days) $63.34 09/14/2016 – 09/20/2016 Yellow Fever* $159.09 09/06/2016
Total paid out of pocket per person so far, $451.60
* prescription required