re: Malarone

[Guest guest]

Does Malarone have any other name ie; trade name can't seem to find it on my

favorite online retail drug store

watch your six

Tom

>From: " Greg Irons " <greg.irons@...>

>Reply-

>< >

>Subject: Re: Re: Doxycycline

>Date: Sat, 21 Apr 2001 10:47:41 +0100

>

>Obviously the choice of antimalarial is dependent on the country being

>visited.

>For proguanil/chloroquine resistant areas the best choice is still

>mefloquine. It has an established usage profile, is cheap and costs

>little.Many people don't like it because of the side effects (sleep

>disturbance mainly) and the overplayed, rare neuro psychiatric effects.

>For

>this reason some jobs can't take it, divers for example, and I like to

>trial

>a new user about 3 weeks before their trip. Time constraints can be a

>problem here.

>Doxcycline is extremely cheap and has the advantage of usually being

>available in the less salubrious areas of the world. It has only been

>licensed for prophylaxis recently. Unfortunately it can cause

>photosensitivity, not the best thing in a malarial area.

>Malarone is rapidly becoming a major player even without licensed status.

>Its main advantage is the rapid onset of action and rapid discontinuation

>on

>return. Unless you're on a 6/6 cycle or longer you will never be " drug

>free "

>with the other products. Data about its use as prophylactic agent is

>limited

>it seems to be about 99% effective and in my experience (and I use it a

>lot)

>nobody has reported adverse side effects. One guy even wanted to stay on it

>when he home because it made his dreams " extremely interesting " . I didn't

>ask further. It is extremely expensive at the moment. It's apparently

>expensive to make and has to be dispensed in treatment packs ( 12 tablets)

>rather than in amounts for prophylaxis (probably 22 tabs) making it

>difficult to give out the correct amount for a trip. (Under European

>legislation medications can now only be dispensed in original blister

>packaging) The price should come down when it gets licensed and the GPs

>start giving it out to the holidaymakers.

>

>Greg

>

> Re: Doxycycline

>

>

> >

> > Hi Tony,

> >

> > Exxon Mobil have never insisted that people take doxycycline as malarial

>

>

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[Guest guest]

makes some excellent points lest we forget.........

>From: mtidy@...

>Reply-mtidy@...

> " Ian Sharpe " <ian_the_medic@...>

>Subject: Re: Malarone

>Date: Sat, 23 Jun 2001 17:56:19 00100

>

>Quite Ian

>The only truely safe options are:

>Doxycycline 100mgs daily couple of days before travel

>and 28 days after.

>Mefloquine weekly 1 wek before, if you have been

>taking it previously and know you are ok taking it and

>for 28 days after. If it is your first time, I advise 2-3

>weeks before travel. If you get a bad reaction you have

>the time to stop - get better - and try something else.

>

>The other thing that people forget - prevention is the

>first step. Don't get bitten in the first place! Medication

>is the second line of defence.

>This is a whols subject in it's own right. Proper clothing,

>right colour, avoid maximum biting times (mid night to

>04:00), Deet lotion - anything above 30% concentration

>is too strong, does not improve protection and increases

>skin reaction to the chemical. Location of you night

>quaters and proximity to source of infection - range of

>female mosi is about 1 mile max - she needs to take a

>blood meal from an infected person and then passes

>that on to you. Bed nets that are treated

>with 'knockdown' insecticide. Same for walls etc.

>Screens on windows and A/C units. Removal of habitat -

> standing water etc etc etc.

>

>The medication comes after all this, remeber if you

>don't get bitten you won't get malaria, but don't take

>chances and keep taking the tablets...

>

>In the Malabo area roughly 1 in 5 mosis carry P.

>faciparum and to a lesser exent p. vivax. This is not as

>bad as some places in Africa. The Aviation base is one

>of the worst places apparently.

>

>Unfortunately your combination madication has very

>little protective value any more.

>

>But don't worry, as you are going to play the genial host

>tomorrow, I will come as one bearing gifts - almost

>biblical 'aint it??

>

>Better get back to the sick bay now - still having

>variable luck with the internet - up in the departure

>room at the minute.

>Regards

>

>

> >>From: mtidy@...

> >>Reply-mtidy@...

> >> " Ian Sharpe " <Ian@...>

> >>Subject: Re: Malarone

> >>Date: Sat, 23 Jun 2001 11:43:50 00100

> >>

> >

> >>Have just been told that Malarone has been licensed

>in

> >>the UK for prophylactic use - previously unlicensed for

> >

> >>Chloraquine and Paludrin combination prophylaxis is

> >>considered to be almost worthless in West Africa, as

> >>most strains of p. vivax and p. falciparum are

>resistant...

> >>

> >True enough but if you can't take Mefloquine what

>choice do you have.

> >Malarone although its still newly licensed is still not yet

>fully available.

> >Even if the GP's are willling to prescribe the costs are

>going to be

> >enoumous.

> >

> >Rgs

> >

> >Ian

> >____________________________________________________

>_____________________

> >Get Your Private, Free E-mail from MSN Hotmail at

>http://www.hotmail.com.

> >

> >

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>From: Wellservicer Medic/RO <wellservicer.medicro@...>

>Reply-

>

>Subject: Malarone

>Date: Sun, 24 Jun 2001 12:11:00 +0100

>

You're back then! Come back Wendi all is forgiven!

To answer your question yes I believe it is licensed for prophylaxis but at

present is still only avialable in treatment size packs. I think someone

(Possibly Greg) mentioned it is only licensed for prophylaxis agains p

falciparum and not p vivax.

Rgs

Ian

>Is Malarone now licensed in the UK for prophylaxis? I know that a few

> months ago it was not available but was being considered by the

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[Guest guest]

You're right Ian. Malarone is now licensed for prophylaxis but still comes

in treatment packs. Falciparum only but I reckon vivax and ovale will follow

once the trials are done. Definitely expensive (no antimalarials on the NHS)

but hopefully this will come down over time. Lariam is still the drug of

choice but not good for rotational posts (no time off drugs). If you need to

persuade your supplier I'll happily supply the relevant data

Greg

Malarone

> >Date: Sun, 24 Jun 2001 12:11:00 +0100

> >

> You're back then! Come back Wendi all is forgiven!

>

> To answer your question yes I believe it is licensed for prophylaxis but

at

> present is still only avialable in treatment size packs. I think someone

> (Possibly Greg) mentioned it is only licensed for prophylaxis agains p

> falciparum and not p vivax.

>

> Rgs

>

> Ian

>

>

> >Is Malarone now licensed in the UK for prophylaxis? I know that a few

> > months ago it was not available but was being considered by the

> _________________________________________________________________________

> Get Your Private, Free E-mail from MSN Hotmail at http://www.hotmail.com.

>

>

>

[Guest guest]

Thanks Greg,

I pay for (or rather OMSI pay for) my malarial prophylaxis anyway so cost

shouldn't be an issue. I have a new GP at home and I've yet to discuss my

job and travel needs with him. My wife tells me he is far more " modern " than

my last GP so I don't forsee a major problem but I if I need to take you up

on the offer of the data I'll be sure to get in touch.

Thanks again,

Ian

>From: " Greg Irons " <greg.irons@...>

>Reply-

>< >

>Subject: Re: Malarone

>Date: Mon, 25 Jun 2001 00:11:23 +0100

>

>You're right Ian. Malarone is now licensed for prophylaxis but still comes

>in treatment packs. Falciparum only but I reckon vivax and ovale will

>follow

>once the trials are done. Definitely expensive (no antimalarials on the

>NHS)

>but hopefully this will come down over time. Lariam is still the drug of

>choice but not good for rotational posts (no time off drugs). If you need

>to

>persuade your supplier I'll happily supply the relevant data

>Greg

> Malarone

> > >Date: Sun, 24 Jun 2001 12:11:00 +0100

> > >

> > You're back then! Come back Wendi all is forgiven!

> >

> > To answer your question yes I believe it is licensed for prophylaxis but

>at

> > present is still only avialable in treatment size packs. I think someone

> > (Possibly Greg) mentioned it is only licensed for prophylaxis agains p

> > falciparum and not p vivax.

> >

> > Rgs

> >

> > Ian

> >

> >

> > >Is Malarone now licensed in the UK for prophylaxis? I know that a few

> > > months ago it was not available but was being considered by the

> >

>_________________________________________________________________________

> > Get Your Private, Free E-mail from MSN Hotmail at

>http://www.hotmail.com.

> >

> >

> >

[Guest guest]

Hi all,

Ian, I've just picked up my prescription for Malarone from my GP. I'm just

off to the chemist (who informed me that they will have to order it and are

unsure of availability). Will get back to you with the cost but GP reckons

it will be approx GBP£2 per tablet.

See you tomorrow,

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[Guest guest]

,

I have been into a number of sites and they all seem to recommend

that Malarone be taken for a maximum period of 28 days, so you seem

to be on the safe side, I suggest to all offshore medics that you

double check what prophylaxis your staff are on and try and divert

them from the nasties such a mefloquine. Furthermore you will find

that I posted a message entitled Malarone study and it seems that

this drug as a prophylaxis may in fact not be the best way to go,

then again it also depends on where you are working.

Regards

Andy Gill

[Guest guest]

,

IIRC from the LSTM course the US and UK views may be different. I also

vaguely remember it being not advised for long term use but my advice

would be to give Dr. Sharon Wells a call at the LSTM travel clinic. She

is pretty much one of the UK experts on anti malarial.

Cheers for now

Ian

Malarone

Hi Chaps,

Does anyone know of any research published that roccommends Malarone

(Atovaquone \ Proguanil) for malaria Prophylaxis long term, ie more than

a

year and for rotational folks on a 28\28 schedule who would take for

five

weeks and have a three week break before starting again??.

I called the CDC malaria hotline and they said for a max of 5 months ..

Cheers,

.

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[Guest guest]

,

Are the personnel land based or off shore on a rig?

In Equatorial Guinea the rigs are far enough off shore to be classed as

quassie malaria free zones so people only have to take anti malarial cover

for when they are passing through town to and from the rig.

Whilst on the subject our guidlines state that Malarone only needs to be

taken for 1 - 2 days before travel and continued for 1 week after leaving

the malarial area. (This is also what it states in BNF 44 (Sept 02) -

slightly out of date but the latest that I have available.) As a result

People would take it for 1 - 2 days before travel, during travel and for a

week after getting to the rig. They would then have a break and restart it

about 1 - 2 days before they are due to go off.

If any of the above has changed please let me know.

Regarding the long term use my copy of the BNF states that (in the UK)

Malarone is licensed for 28 days but can probably be used for up to three

months. specialist advice should be sought for long term use.

Hope that this helps,

Gareth

>From: " paul brash " <pbrash@...>

>Reply-

>

>Subject: Malarone

>Date: Fri, 06 Jun 2003 13:28:15 +0000

>

>Hi Chaps,

>

>Does anyone know of any research published that roccommends Malarone

>(Atovaquone \ Proguanil) for malaria Prophylaxis long term, ie more than a

>year and for rotational folks on a 28\28 schedule who would take for five

>weeks and have a three week break before starting again??.

>

>I called the CDC malaria hotline and they said for a max of 5 months ..

>

>Cheers,

>

>.

>

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[Guest guest]

Mark et all,

Thanks for your comments etc. I attended the ISTM conference last month and

Marks info is about all I could glean on the subject of malarone, Apart from

being the new wonder drug. All the experts told me it was safe to use

indefinitely though no publications of use longer than 5 months ( Danish

military) was available.

I was told there was a study using malarone for 2 years in HIV patients for

prophylaxis against Pneumocysti carini but cannot seem to locate this.

I am particularly interested mark in your statement... " In the UK the new

>guidelines out in October will state no upper limit on use of mefloquine

>and Malarone "

Who will be publishing these guidelines ? Is there a contact address, phone

number or e mail I could use ??

Ian I will as you sugest call the lstm and see what their opinions are,

Cheers chaps and thanks,

PS Mark are you Harkers alternate ??

>From: mark.forrest@...

>pbrash@...

>Subject: Malarone

>Date: Sat, 7 Jun 2003 01:18:31 +0100

>

>

>,

>

>How you doing. Firstly, please excuse me if I am going on about details you

>are familiar with. I am not sure if you have used Malarone before. We

>currently use Malarone as our 1st choice of Prophylaxis because of the

>Problems with Falciparum Malaria endemic in our area (Equ Guinea). We only

>allow 3 anti-malarials. This only relates to Expat personnel. Nationals are

>not placed on any Anti-Malarial because it is detremental to their

>semi-immune status.

>

>Malarone

>Lariam

>Doxy

>

>Our rotators are generally all on 4/4 some on 6/6 some 6/3. Almost all our

>guys are currently on Malarone. We had been asking numerous questions about

>the usage of Malarone and whether personnel could take it long term.

>Obviously guys start to worry about possible long term effects.

>

>Most personnel prefer Malarone for several reasons. They feel more secure

>because of it's high percetage of protection 98%. They have been frightened

>by the numerous anectdotal stories about Lariam, then there is the dosage

>regime.

>

>1 tablet 1-2 days prior to entering Malarial region

>1 tablet every day whilest in the region

>1 tablet for 7 days after leaving the region

>

>Guys on rotation at least get the benefit of time off the medication when

>they are home.

>

>Lariam and Doxy provide a high level of cover. Unfortunately they have to

>be taken for 4 weeks after leaving the region. Unfortunately guys on these

>2 are basically on them constantly if they do 4/4.

>

>We encountered numerous problems when personnel began to change over to

>Malarone 2 years ago in that GP's would not supply personnel or prescribe

>Malarone. Most were still following redundant guidelines which only allowed

>Malarone for use as a treatment. I had several conversations with

>personnel's GP's informing them that Malarone was in fact approved for

>Prophylaxis in the UK 2 years ago now May 2001.

>

>Even then, they would only supply it for short periods. We found that

>numerous personel were having to go to travel clinics, who were more up to

>date in order to get re-supplied with the Malarone.

>

>In view of this we spoke to the Head of our medical department in London.

>Below is a direct quote from the response he gave me, following his

>research into the same matter.

>

>In practice the 3 drugs can be used for long periods. In the UK the new

>guidelines out in October will state no upper limit on use of mefloquine

>and Malarone, but a 2 year on doxycycline. The latter is not because of any

>special problems but just gaining experience.

>

>In the current BNF there is no indication or note specifying the length of

>time Malarone can be given. Lariam still states up to 1 year. As the above

>comment states, it looks like this will now change in the future also.

>

>I spoke to GSK the makers recently. They have a drug info line for US

>Healthcare professionals. It is supposed to be for US based Personnel

>only. I told them I was looking after US residents and they were extremely

>helpful.

>

>They detailed 2 trials. 1 lasting 6 months and the other 5 months. During

>this time personnel were taking Malarone continously in Malarial areas. The

>6 month trial was for US troops based in Africa. It had a 100% efficiency

>for those personnel against P/Falciparum. The 5 month trial showed a 96%

>efficiency, it was on travellers to the region.

>

>their number is a freephone number in the US 1888 825 5249. Hope I have

>given you some help.

>

>

>Cheers,

>Mark

>

>

>

>

>

>

> " paul brash "

> <pbrash@... To:

>

> m> cc:

> Subject:

> Malarone

>

> 06/06/03 02:28 PM

> Please respond to

> RemoteSupportMedic

> s

>

>

>

>

>

>Hi Chaps,

>

>Does anyone know of any research published that roccommends Malarone

>(Atovaquone \ Proguanil) for malaria Prophylaxis long term, ie more than a

>year and for rotational folks on a 28\28 schedule who would take for five

>weeks and have a three week break before starting again??.

>

>I called the CDC malaria hotline and they said for a max of 5 months ..

>

>Cheers,

>

>.

>

>_________________________________________________________________

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>

>

>

>

>Member Information:

>

>List owner: Ian Sharpe Owner@...

>Editor: Ross Boardman Editor@...

>

>ALL list admin messages (subscriptions & unsubscriptions) should be sent to

>the list owner.

>

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>

>Please visit our website http://www.remotemedics.co.uk

>

>Regards

>

>The Remote Medics Team

>

>

[Guest guest]

Just spent a week in EG on Jade area....

Exon/Mobile expect all their personnel to take some type of Malaria

preventative medication.

If they contract Malaria and are not taking anything...even

offshore, they do not take kindly to it and possibly not invited out

there again!

Tony

[Guest guest]

,

Maybe a complete cheat, but did a quick medline

search and found a few papers that may mention the

long term use.

1. Berman JD, Nielsen R, Chulay JD, Dowler M, Kain

KC, Kester KE, et al. Causal prophylactic efficacy

of atovaquone-proguanil (Malarone) in a human

challenge model. Trans R Soc Trop Med Hyg

2001;95(4):429-32.

2. Butcher GA, Sinden RE. Persistence of

atovaquone in human sera following treatment:

inhibition of Plasmodium falciparum development in

vivo and in vitro. Am J Trop Med Hyg

2003;68(1):111-4.

3. Camus D, Dutoit E, Masson V, Inglebert P,

Delhaes L. [Clinical studies using the combination

atovaquone-proguanil as malaria prophylaxis in

non-immune adult and child travelers]. Med Trop

(Mars) 2002;62(3):225-8.

4. Kofoed K, sen E. The Efficacy of

Chemoprophylaxis against Malaria with Chloroquine

plus Proguanil, Mefloquine, and Atovaquone plus

Proguanil in Travelers from Denmark. J Travel Med

2003;10(3):150-3.

5. Llanos-Cuentas A, Campos P, Clendenes M,

Canfield CJ, Hutchinson DB. Atovaquone and

proguani hydrochloride compared with chloroquine

or pyrimethamine/sulfodaxine for treatment of

acute Plasmodium falciparum malaria in Peru. Braz

J Infect Dis 2001;5(2):67-72.

6. Malvy D, Djossou F, Vatan R, Pistone T, Etienne

G, Longy-Boursier M, et al. [Experience with the

combination atovaquone-proguanil in the treatment

of uncomplicated Plasmodium falciparum

malaria--report of 112 cases]. Med Trop (Mars)

2002;62(3):229-31.

7. Overbosch D, Schilthuis H, Bienzle U, Behrens

RH, Kain KC, e PD, et al.

Atovaquone-proguanil versus mefloquine for malaria

prophylaxis in nonimmune travelers: results from a

randomized, double-blind study. Clin Infect Dis

2001;33(7):1015-21.

8. Overbosch D. Conclusions. J Travel Med 2003;10

Suppl 1:22-3.

Cheers,

Ross

> Re: Malarone

>

>

> ,

>

> I have been into a number of sites and

> they all seem to recommend

> that Malarone be taken for a maximum

> period of 28 days, so you seem

> to be on the safe side, I suggest to

> all offshore medics that you

> double check what prophylaxis your

> staff are on and try and divert

> them from the nasties such a

> mefloquine. Furthermore you will find

> that I posted a message entitled

> Malarone study and it seems that

> this drug as a prophylaxis may in fact

> not be the best way to go,

> then again it also depends on where you

> are working.

>

> Regards

>

> Andy Gill

>

>

>

>

[Guest guest]

Thank you to all who responded to me,

Hugs,

Connie, Michigan