anti-malarial drugs

[Boo-Rad]

I have compensated liver cirrhosis and am due to go on a long awaited holiday next week to The Gambia. My was unaware I may encounter problems with obtaining anti malarial tablets. I have tried everything and nobody will prescribe. Does anybody have a similar experience?

[Aotea2012]

I would have thought getting malaria would be a higher risk to be honest. You can buy antimalarial drugs over the counter at pharmacists- you would obviously need to talk to the pharmacist about your cirrhosis and discuss the risks. They are not covered under the NHS-so even if you didn’t have cirrhosis they wouldn’t prescribe them for you.

[tonicwater]

I went to the Gambia many years ago. There is a certain type of antimalarial drug that you have to take in the Gambia because of the type of malaria there. This drug is very hard on your liver, probably the reason they won't prescribe it for you. What I do remember is that the local guides always asked for tonic water when they helped you. The quinine in the tonic water is what they use to keep their risk lower. I believe the stuff off the shelves is useless in the Gambia, have you asked why they won't prescribe antimalarial drugs for you? You are taking quite a risk travelling to the Gambia with cirrhosis, Banjul belly is rife as are other diseases. You need a yellow fever shot and many others if you're going to Gambia. That said, it's a great place, have fun, stay safe!

[wp69 in reply to tonicwater]

Was it Larium , Neflequin maybe

[tonicwater]

I was prescribed Mefloquone, but I didn't have cirrhosis back then.

[tonicwater]

Mefloquine

[valks]

Be careful with mefloquine. It is hard on the liver and can have other side effects including permanent mood / temperament changes. It is the anti malarial prescribed to the forces in Basrah during the Gulf war and after a while they were limited to 3 months usage of it once the side effects of long term usage became better known. I took it for 2 years whilst working in Ghana before all of the side effects were widely known and the dr said that better to take it with known side effects than get that strain of malaria. As others have said, the off the shelf stuff is no good for malarial strains prevalent in Gambia and other places.

Having said all of that you're going for a holiday not long term so if your dr is happy to prescribe it, follow their advice

[Boo-Rad in reply to valks]

so are you saying that anything available at a pharmacy in the UK I.e. Malarone is ineffective in The Gambia?

[valks in reply to Boo-Rad]

No, not at all. You need to check exactly what anti-malarials are required for Gambia because they vary from region to region due to the differences in the strains of malaria in those regions.

Most of the off the shelf stuff is chloroquine based which is not effective against the strain in Gambia.

Looking online for malarone it says it contains atovaquone and proguanil and is not recommended for severe or complicated malaria. Also online the recommendations for Gambia are atovaquone, proguanil, doxycycline, mefloquine or tafenoquine however they all have cautionary notes.

Talk to your dr.

[Boo-Rad in reply to valks]

My Doctor said I would have to speak to my consultant. I made contact a month ago and have chased, still nothing. I have four days left and weighing up my options. I am so frustrated with the NHS.

[AyrshireK in reply to Boo-Rad]

I know you have been waiting for your consultant to make contact but you've also kind of left it a bit late in the day to now be chasing them up. With 4 days to go and a potential serious risk to your health to be considered with regards to appropriate medications you'll need to see if you can make a final concerted effort to chase them. Contact the PALS department (Patient Advisory and Liason Service) at your liver hospital first thing tomorrow, make them aware that you have asked this question of your liver doctor but gotten no reply and see if they can somehow glean some advice from your consultant in the next day or so. You kind of have left it pretty late though.

Have you had any/all other vaccinations and things you need to travel to a potential high risk country for your liver health?

Katie