which antimalarial?

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scottishscuba

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My father will be working in West Africa in the weeks before a trip to Dahab, Egypt for a diving holiday (he will be undertaking his OW). Are there any antimalarials that he should avoid? He usually takes Malarone on these trips as the lead in time is only a few days and its generally thought to be the best antimalarial for that region. Are there any problems with Malarone and depth?

Many thanks for your help.

SS
 
Malarone sucks. One of the common side effects is strange dreams/night terrors. I took Malarone in PNG until I couldnt stand the nights and nausea just after taking them - other parts of the world ive used doxycycline as a preventative. Luckily i later found out I have a blood disorder so im pretty much immune to malaria.....but id consider alternatives to malarone if possible.
 
Chloroquine is what I take when I go to the third world. I've never dove on it, so can't comment on that side of it.
 
Malorone gives me weird dreams for weeks after I'm off it. Quit using it after second trip. Too weird.
 
I suspect that there is no scientific data on the issue because there is no financial incentive for anyone to organize and pay for double-blind tests with a large sample group for the limited purpose of determining the effects of the drug at depth.

So the custom seems to be to rely on a rule of thumb that anything that affects you mentally at the surface might be worse at depth.

I spoke to a dive doctor about the issue of anti-depressant medications and diving and he told me that although the rule of thumb would suggest that taking them daily and diving would be a bad idea, there are a lot of divers on anti-depressant medications and few reports of incidents.

But if I had a choice between two medications, one that gave me bad dreams and one that didn't, I'd opt for the one that didn't, even if I weren't diving.
 
In the US, the CDC (Center for Disease Control) has a website that travelers can access to get specific information for disease prophylaxis for the country which is their destination. For example, I just went and looked at the Ivory Coast, where chloroquine resistance is high, and several alternative medications are suggested.

To my knowledge, there are no data on the effect of any malaria chemoprophylaxis on diving. Any medication you intend to use while diving is something you should be quite familiar with on land. If the medication has any effect on cognition or alertness, it is not a good idea to dive while taking it.
 
Malarone and diving do not mix. Some of the side effects can mimic DCS. As others have also pointed out, it can cause other psychological problems. We saw a bloke in PNG who was quite crazy and later disappeared on the way back to Australia. He was using malarone and from all reports, was previously normal. He was later found safe.
 
Malarone (atovaquone/proguanil) has an overall neuropsychiatric adverse reaction rate of ~0.05%. Looking specifically at nightmares, the rate is ~1.93%. On balance, it is one of the most effective, and safest, antimalarials on the market.

OTOH, the antimalarial mefloquine (e.g., Lariam) is notorious for neuropsychiatric side effects, including strange or vivid dreams, frank nightmares, delusions, anger episodes, psychosis, depression, mania, mood swings, panic attacks & suicidal ideation.

Here is an article from my "Ask RSD" column in a past issue of Rodale's Scuba Diving magazine you might find informative.

"Lariam (mefloquine) is a very effective drug in preventing and treating malaria, but can give rise to unwanted side effects, including vivid and disquieting dreams, hallucinations, anxiety, depression, confusion and forgetfulness. The US package insert directs that "...caution should be exercised with regard to driving, piloting an airplane, and operating machinery as dizziness, a disturbed sense of balance, neurological or psychiatric reaction have been reported during and following the use of Lariam," and states that "dizziness, sensory & motor abnormalities, headache and fatigue have been recorded in patient's taking the drug." These cautions are consistent with suggestions by some in the medical and dive communities that mefloquine may produce side effects which mimic DCS. Interestingly, the German package insert adds it should not be used for "certain activities which have a need for full attention and undisturbed motor activity," with a specific direction that pilots should not use Lariam for the prevention of malaria during their work.

Of most concern to the diver are the positions of some medical professionals that the drug simply should not be taken for malaria prophylaxis by those who are actively diving. These sources include Rodale's Diving Doc," Dr. Samuel Shelanski, and the German Society for Tropical Diseases. This later group, whose policies can be used as a basis for professional and legal action in cases of harm resulting from a physician's failure to follow them, states that people with a special need for three-dimensional orientation, for example pilots, scuba divers and others, should not take mefloquine as prophylaxis. Similar advice regarding scuba diving is provided by Dr Bridget Farham, B.Sc (hons), Ph.D, MB.ChB., an expert on tropical medicines, and appears in the package insert accompanying mefloquine dispensed in South Africa.

The above information suggests it would be prudent to take this drug only after detailed discussion with a physician who is fully aware of its current status, and to closely monitor for any adverse reaction."

The FDA has come out with the following warning regarding mefloquine: FDA Drug Safety Communication: FDA approves label changes for antimalarial drug mefloquine hydrochloride due to risk of serious psychiatric and nerve side effects .

Regards,

DocVikingo
 
Maybe PNG and Malarone and diving especially dont mix :D I was on a boat full of people I had dreamed skinned me alive and used my skin to send faxes......
 

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