From the Guidelines
Malarone (atovaquone-proguanil) is the preferred medication for malaria prophylaxis due to its better safety profile and efficacy against most drug-resistant strains of malaria. When considering Mefloquine vs Malarone for malaria prophylaxis, it's essential to weigh the benefits and risks of each medication. Malarone should be taken once daily with food, starting 1-2 days before travel to a malaria-endemic area, throughout the stay, and for 7 days after return, with an adult dose of one tablet (250mg atovaquone/100mg proguanil) daily 1.
Key Considerations
- Mefloquine is taken weekly, starting 2-3 weeks before travel, during the trip, and for 4 weeks after return, with an adult dose of 250mg once weekly, but it carries a higher risk of neuropsychiatric side effects including anxiety, vivid dreams, and rarely, serious psychiatric reactions 1.
- Malarone typically causes fewer side effects, though it may cause mild gastrointestinal issues and headaches, making it a better option for most individuals 1.
- The choice between these medications should consider the specific travel destination, duration of stay, individual medical history, and potential drug interactions, with special consideration for pregnant women, children, and those with psychiatric or seizure disorders 1.
Medication Comparison
- Malarone is effective against most drug-resistant strains of malaria, making it a preferred option for travelers to areas with high resistance rates 1.
- Mefloquine is not recommended for use against P. falciparum acquired in Southeast Asia and is not considered a treatment option in some guidelines due to its side effect profile and resistance patterns 1.
From the FDA Drug Label
Fewer neuropsychiatric adverse experiences occurred in subjects who received atovaquone and proguanil hydrochloride than mefloquine. Fewer gastrointestinal adverse experiences occurred in subjects receiving atovaquone and proguanil hydrochloride than chloroquine/proguanil Compared with active comparator drugs, subjects receiving atovaquone and proguanil hydrochloride had fewer adverse experiences overall that were attributed to prophylactic therapy
Mefloquine vs Malarone for Malaria Prophylaxis:
- Malarone (atovaquone and proguanil hydrochloride) had fewer neuropsychiatric adverse experiences than mefloquine.
- Malarone had fewer gastrointestinal adverse experiences than chloroquine/proguanil.
- Malarone had fewer adverse experiences overall compared to active comparator drugs, including mefloquine. 2
From the Research
Mefloquine vs Malarone for Malaria Prophylaxis
- Malarone, a combination of atovaquone and proguanil, is effective as prophylaxis and for the treatment of falciparum malaria, with a protective effect of > 95% 3.
- Mefloquine is one of four antimalarial agents commonly recommended for preventing malaria in travelers to malaria-endemic areas, but its use is controversial due to psychological side effects 4.
- Studies have shown that mefloquine users are more likely to discontinue their medication due to adverse effects compared to atovaquone-proguanil users (RR 2.86,95% CI 1.53 to 5.31) 4.
- Mefloquine users are also more likely to report abnormal dreams, insomnia, anxiety, and depressed mood compared to atovaquone-proguanil users 4.
- Atovaquone-proguanil is the most frequently prescribed antimalarial chemoprophylaxis, and mefloquine is occasionally prescribed for patients with comorbidities listed as contraindications 5.
- A study found that atovaquone-proguanil compared to doxycycline had similar adverse events reported, but atovaquone-proguanil users had fewer reports of any adverse effect compared to mefloquine users (RR 0.72,95% CI 0.6 to 0.85) 6.
- Atovaquone-proguanil (Malarone) has been shown to be an effective treatment for uncomplicated Plasmodium falciparum malaria in travelers, with mild adverse effects 7.
Comparison of Efficacy and Safety
- The efficacy of mefloquine and atovaquone-proguanil is similar, but atovaquone-proguanil has a better safety profile 4, 6.
- Mefloquine is associated with adverse neuropsychiatric outcomes, while atovaquone-proguanil and doxycycline are the best tolerated regimens 6.
- The choice of antimalarial agent depends on individual travelers' assessment of the importance of specific adverse effects, pill burden, and cost 4.
Prescribing Patterns
- Atovaquone-proguanil is the most frequently prescribed antimalarial chemoprophylaxis, followed by mefloquine, doxycycline, and chloroquine and/or proguanil 5.
- Mefloquine is occasionally prescribed for patients with comorbidities listed as contraindications, but most practitioners observe contraindications 5.