What’s your opinion on Lariam?

[clootie]

All the PNG macro is Nikonos V with a 1:3 extension tube (made by Sea & Sea), set to f22 - including the cuttlefish profiles, which it works for, and the pygmy seahorse, which it doesn't quite. The Barrier Reef page is earlier in time, taken on various Sea & Sea MKIIs, which I hired off the boats I was on, but by the time I did the PNG trips I had upgraded.
On the Kavieng trip my camera didn't work too well, as the shutter wasn't synching properly - very frustrating, because there is a truly amazing night dive there, teeming with macro and I was with fantastic spotters for buddies who kept calling me over to show me something new - the roll was all black apart from about 4 pics, and the crocodile fish is about the only shot on that roll that came out really well. The cone shell should have had much better exposure.

Sorry, we seem to have gone a bit off the original dive medicine topic!

 

[DocVikingo]

It think that your statement, "Docs in the US no help they just said they all have side effects your choice," is overly general & inaccurate. Have you seen all of the doctors in the US regarding this issue?

Perhaps more defensible would be, "The docs that I saw were not as helpful as I had hoped."

Best regards.

DocVikingo

 

[ssra30]

First of all, I am not an expert in malaria but I do have some interest in it since Thailand is not an ideal place to catch one.
Malarone is probably the way to go for prophylaxis since it generally has less side effect than mecloquine (lariam) and are better tolerating. Beside, sadly enough mecloquine resistant strain starts to emerge as well, especially around Thailand-Cambodia border so if you come this way....
One thing about malarone though, it does not prevent the liver-stage of P. vivax and P. ovale so if you come to any area that also have these 2 strains of malaria, you can still end up with the infection. Granted it is not nearly as severe as P. falciparum but it is still not fun. Sometimes primaquine is recommended as an added prophylaxis. Now primaquine will open up a new can of worm as far as side effects go.

 

[cdiver2]

Hi Doc
I stand corrected and apologies for my statement, I assumed that anyone with the gray matter to get onto the internet and read the statement would 1/ ( like you ) know that that I had in fact not spoken to every doctor in the US 2/ Know I was generalizing in my statement 3/ Assume from that statement that I had spoken to other agency's in other country's. My crime was I did not allow for the idiot factor.
You said a more defensible statement would be "The doctors that I spoke to were not as helpful as I had hoped", while this may be politically correct it did not say what I wanted to say.
When I go to a doctor and tell him I want anti malaria medication, these are the medications and the side effects that I know about and he tells me " They all have side effects your choice" then he has been of no help at all and I have wasted my time and money.
I have had more help from a agency in Australia and the internet including you, than the doctors I have spoken to in the US.
Iwould expect a doctor with access to my health records to have a little more input as to what drug would be best for me. As stated above I have spoken to a diving agency in Australia and received very good medical advice but they are not in possession of my health records.
I hope you dont take this statement wrong but I am tired of trying to be politically correct to allow for the idiots in the world. To my knowledge no-one has misinterpreted any of my statements. Finally you and many others on this board have been very helpful with the flow of information and I thank you all.
David

 

[ssra30]

Cdiver2

I agree that your doctor could have been a bit more sympathetic and try to be a bit more helpful. I did have all of my medical training in the US not too long ago and I can tell you that, unless you go to a traveler clinic and see an infectious disease specialist, you are not going to find a lot of help in the US. Most general internal medicine doctors there would have learned a bit about malaria in microbiology and learned a bit about the medication in their pharmacology class but that would be just about it. I don't even recall anything about lariam when I was a medical student. If you did your homework about all the various medications and prophylaxis and walked into a regular clinic, chances are you already know as much if not more than your doctor. Of course, this is assuming that your doctor does not deal with a lot of people who travel abroad regularly especially into the more exotic and remote area.
A friend who plans to come to Thailand frequently went to see his MD in the US for check up and mentioned that he is going to be coming to SE Asia frequently. Nothing was done until I told him to tell his doctor that he should get his hepatitis A, B vaccine, etc.
I think if you are planning to travel especially to rural area in Asia, Africa, etc, you best bet is to get to traveler's clinic. I think most University Hospital would have such clinic. They would be more helpful and have more up to date information on what prophylaxis, vaccination etc you would need.
Most general internal medicine doctor/family medicine doctor in the US probably would know only that you should take cipro with you if you travel to Mexico and have diarrhea, as far as travel medicine is concerned. But that's about it.

I don't mean to say that MDs in the US are ignorant but malaria and tropical disease are virtually non existant there. Just like any knowledge, if you don't use it, you'll forget it. Unless the MD has some personal interest in it, chances are he or she is not going to remember or stay up to date with it since they don't really use it.
When I was in the US, if a patient came to see me in my clinic and asked about malaria prophylaxis, I would have to tell him that I need to do a bit of research first and will get back to him or her within a day or two. I doubt that I would have all the neccessary information right then and there.

 

[cdiver2]

Thanks ssra30. As you said if a patient came to you and asked for advice you would tell them you would look into it and get back to them and I assume you would also take into account the patient's history,thats all I was looking for. From my research I did have the same knowledge as my doctor but I was not sure what was right for me.
I have come to the conclusion after recent major surgery and lots of doctor and specialist visits that if they can-not get you in and out of the examining room in five minute's then your a bother and have over run your $50 time limit. Thats just how I feel about them.
Thanks again ssra30
David

 

[threemonths]

Hope someone is still following this thread. I found it because my wife and I just got prescribed Lariam for our upcoming trip. We need it because we are going to Africa, but will then go on to Australia and Fiji, where we intend to dive.

From the conversation above it sounds like you shouldn't dive while taking Lariam, but what about just after? We intend to start diving about two weeks after the end of the Africa part of our trip. Our doctor said to take Lariam for four weeks after, but I see above that some recommend only two.

Any thoughts?

 

[ssra30]

threemonths once bubbled...
Hope someone is still following this thread. I found it because my wife and I just got prescribed Lariam for our upcoming trip. We need it because we are going to Africa, but will then go on to Australia and Fiji, where we intend to dive.

From the conversation above it sounds like you shouldn't dive while taking Lariam, but what about just after? We intend to start diving about two weeks after the end of the Africa part of our trip. Our doctor said to take Lariam for four weeks after, but I see above that some recommend only two.

Any thoughts?

I assume that you are going to start weekly dose of lariam 1-2 weeks before your trip. In that case, you can try and see if you notice any symptom. The main concern for lariam and diving is the neuropsyciatric symptoms, anything from seizure to vivid dream, anxiety,restlessness, depression or confusion. You also should not use lariam if you have or prone to arrythmia. The best thing to do is to discuss with your doctor about your concern with lariam. Lariam is not recommended for flight pilot and I would think that diving would be similar.
However, the good news is that if you start lariam early ie a week or two before your travel and develop some side effects, the alternative such as doxycycine and malarone only need to be started 1-2 days prior to your travel.

 

[DocVikingo]

I did not see where any of the above posts suggested that Lariam only needed to be taken for 2 weeks following departure from the malaria risk area.

biscuit7 indicated that he gave up on his medication (unspecified) after 2 weeks because of intolerable side effects, but that is different.

In any event, the manufacturer indicates that Lariam is to be taken for 4 weeks following departure from the malaria risk area, and there is good medical reason for this having to do with the parasite's life cycle.

Do be advised that many persons take Lariam without adverse reactions that would pose a risk to safe scuba. You will want to discuss your concerns with your physician, and perhaps even share with him my article as cited earlier in this thread.

S/he may then wish to take precautions, such as starting you on the drug 2-3 weeks prior to departure to observe how you react, or switching to one of several other effective drugs that generally have more benign adverse reaction profiles.

This is educational only and does not constitute or imply a doctor-patient relationship. It is not medical advice to you or any other individual, and should not be construed as such.

Hope you found this informative.

DocVikingo

 

[DocVikingo]

[RE: See my RSD article on Lariam posted above & this from the FFDA---> http://www.fda.gov/bbs/topics/NEWS/2003/NEW00921.html]


.... antimalarials that have relatively benign side effect profiles:

"The Impact of Malarone® and Primaquine on Psychomotor Performance
Michel A. Paul, Anne E. McCarthy, Neil Gibson, Gord Kenny, Tim Cook, and Gary Gray

Aviat Space Environ Med 2003; 74:738-45

Abstract

Introduction: Recent evidence has established the effectiveness of Malarone® and primaquine for chemoprophylaxis against Plasmodium falciparum malaria. Both have the advantage of providing causal prophylaxis and therefore require continued dosing for only 1 wk after departure from a malaria endemic area. Canadian Forces aircrews are often placed in situations that put them at risk for malaria infection but the safety of these drugs for use in aircrew has not been ascertained. This study was undertaken to determine whether or not Malarone or primaquine impact psychomotor performance.

Method: Twenty-eight subjects (20 men and 8 women) ranging from 21 to 52 yr of age were assessed for psychomotor performance on 2 psychomotor test batteries at the end of a 7-d dosing protocol for each of placebo, Malarone, and primaquine treatment, in a double-blind crossover design with counter-balanced treatment order. All subjects were also assessed for psychomotor performance once per week during the 3-wk washout intervals. The daily Malarone dose was atovaquone 250 mg/proguanil 100 mg and the daily primaquine dose was 30 mg of base. In order to verify subject compliance with the medication dosing protocol, blood samples were drawn from all subjects at the end of each of the three 7-d loading protocols. All three medications were packaged in identical gelatin capsules for blinding purposes. At each psychomotor test session, all subjects completed a drug side-effect questionnaire, a mood questionnaire, and a sleepiness/fatigue questionnaire.

Results: There was no significant impact of Malarone or primaquine on serial reaction time, logical reasoning, serial subtraction, or multitask performance. With respect to drug adverse effects there were no significant main effects or interactions for the documented adverse effects of these medications (abdominal cramps, epigastric distress, nausea, vomiting, anorexia, headache, coughing and dizziness).

Conclusions: There was no impact of either Malarone or primaquine on psychomotor performance, mood, sleepiness, or fatigue. The usual adverse effects of these medications were not significantly manifested in our subjects. These findings support the possible use of either Malarone or primaquine in aircrew for malaria chemoprophylaxis."

It's not a test under increased atmospheres of pressure, but it's good news nonetheless.

Best regards.

DocVikingo