From the Research
Malarone (atovaquone/proguanil) is generally considered safe for patients with Myasthenia Gravis (MG) who need malaria prophylaxis. Unlike some other antimalarial medications such as chloroquine and mefloquine that can worsen MG symptoms, Malarone has not been reported to exacerbate myasthenia gravis 1. The standard adult prophylactic dose is one tablet daily (250mg atovaquone/100mg proguanil), starting 1-2 days before entering the malaria-endemic area, continuing throughout the stay, and for 7 days after leaving. For patients with MG, it's advisable to start Malarone at least one week before travel to monitor for any unexpected reactions. Malarone works by interfering with the parasite's mitochondrial electron transport and nucleic acid synthesis, mechanisms that don't typically affect neuromuscular junction function where MG pathology occurs 2, 3. However, individual responses can vary, so patients should monitor for any worsening of MG symptoms and maintain regular dosing of their MG medications. If traveling to areas with chloroquine-resistant Plasmodium falciparum, Malarone is particularly appropriate as it provides effective protection without the neuromuscular risks associated with alternative antimalarials.
Some key points to consider when prescribing Malarone for patients with MG include:
- The efficacy of Malarone in preventing malaria, with a reported efficacy rate of 95-100% in semi-immune individuals 2
- The safety profile of Malarone, with few reported adverse events and no significant association with any specific adverse event 3, 4
- The importance of monitoring for any unexpected reactions or worsening of MG symptoms, and maintaining regular dosing of MG medications 1
- The potential benefits of starting Malarone at least one week before travel to allow for monitoring and adjustment of treatment as needed.
Overall, Malarone is a suitable option for malaria prophylaxis in patients with Myasthenia Gravis, due to its efficacy, safety profile, and lack of reported exacerbation of MG symptoms 2, 3, 1.