Planning a trip to a malaria risk destination? Anti-malaria tablets are one of the most important things to sort out before you travel.
Choosing the right one can feel confusing. There are several different tablets, they're taken on very different schedules, and the right choice isn't the same for every traveller or every destination.
This guide explains the main anti-malaria tablets available in the UK, and how they differ in dosing, side effects and cost. It also covers how a prescriber decides which one suits you, when to start and stop taking them, and why no tablet replaces good bite prevention.
No antimalarial is 100% effective. Tablets and bite prevention work as a pair, so plan for both.
Do you actually need anti-malaria tablets?
Whether you need antimalarials at all depends entirely on where you're going. Malaria risk varies hugely between countries, and even between regions and seasons within the same country.
Some destinations carry no risk. Some only carry risk in certain areas. And some are high risk throughout.
So there's no substitute for checking your exact itinerary against up-to-date guidance. The NHS Fit for Travel and TravelHealthPro (NaTHNaC) websites give country-by-country malaria advice, including which tablets are recommended where.1
Check the advice for every stop on your route, including stopovers. Risk can change from one region to the next.
Resistance patterns differ by region too. A tablet that protects you in one country may not work in another.
It's worth remembering that tablets are only half of prevention. No antimalarial is 100% effective, so bite prevention matters everywhere. Use an insect repellent containing up to 50% DEET, cover up in the evening when mosquitoes feed, and sleep under an insecticide-treated net if your room isn't properly screened.2
The main anti-malaria tablets available in the UK
A handful of antimalarials are used for prevention in the UK (known clinically as chemoprophylaxis). Here's how each one works.
Atovaquone/proguanil (Malarone and Maloff Protect)
Malarone is a once-daily tablet that combines two active ingredients, atovaquone and proguanil. It's widely used because it tends to be well tolerated. And you only need to keep taking it for 7 days after you leave a malaria area, which makes it a practical choice for shorter trips and last-minute travel.3
The same combination is available as a generic, atovaquone and proguanil, and as Maloff Protect. Maloff Protect can be sold from a pharmacy after a short consultation, rather than needing a prescription.
Take it with food or a milky drink to help your body absorb it. It's generally avoided in pregnancy and in people with significant kidney problems.
Doxycycline
Doxycycline is a tetracycline antibiotic that's also licensed to prevent malaria. It's usually the cheapest option and is taken once a day, which suits some travellers.
The main drawback is the tail. You must keep taking it for 4 weeks after leaving the malaria area, which is easy to forget once you're home.4
Doxycycline can make your skin more sensitive to sunlight, so good sun protection matters. It can also cause stomach upset, and thrush in some women. It isn't suitable during pregnancy or breastfeeding, or for children under 12.
On the plus side, doxycycline also offers some protection against a few other travel-related infections, such as leptospirosis (Weil's disease).
Mefloquine (Lariam)
Mefloquine is taken just once a week, which some people prefer for longer stays. It needs to be started 2 to 3 weeks before you travel, partly so any side effects can be picked up before you go.4
Its most important consideration is the risk of neuropsychiatric side effects, such as anxiety, low mood and vivid dreams. That's why it must not be used by people with a history of depression, anxiety, other psychiatric conditions or epilepsy.
Feeling anxious, low, confused or restless on mefloquine? Stop taking it and get medical advice straight away.
Chloroquine and proguanil (Avloclor and Paludrine)
These older tablets were once the standard choice. They're now rarely recommended, because the most dangerous malaria parasite is widely resistant to them.
They're only suitable for a small number of lower-risk destinations. Both are pharmacy medicines rather than prescription-only.
Is there a "best" anti-malaria tablet?
It's a natural question, but there's no single best malaria tablet. The right one depends on where you're going and the local resistance pattern, how long you'll be away, whether a daily or weekly tablet fits your routine, your medical history and cost.
A tablet that's ideal for a two-week holiday may be the wrong choice for a three-month backpacking trip. Here's how the main options compare at a glance:
| Tablet |
Dosing |
Start before travel |
Continue after leaving |
Worth knowing |
| Atovaquone/proguanil (Malarone, generic, Maloff Protect) |
Daily |
1 to 2 days |
7 days |
Well tolerated, short course, suits shorter trips |
| Doxycycline |
Daily |
1 to 2 days |
4 weeks |
Cheapest, but long tail and sun sensitivity |
| Mefloquine (Lariam) |
Weekly |
2 to 3 weeks |
4 weeks |
Weekly dosing, but not for those with psychiatric or seizure history |
| Chloroquine and proguanil (Avloclor, Paludrine) |
Weekly and daily |
1 week |
4 weeks |
Rarely used now due to resistance |
Because so much depends on your destination and health, this is a decision to make with a prescriber or pharmacist. They'll match the tablet to your trip, rather than picking a one-size-fits-all option.
When do you start and stop taking malaria tablets?
Timing is one of the most important parts of getting protection, and it differs between tablets. Malarone and doxycycline are both started just 1 to 2 days before you enter a malaria area. Mefloquine needs a longer run-up of 2 to 3 weeks, and chloroquine-based options are usually started a week ahead.2
What often catches people out is the period after travel. Most antimalarials don't stop the parasite getting into your body. They work on it once it comes out of your liver, which can happen in the weeks after you get home.
That's why doxycycline, mefloquine and chloroquine must all be continued for 4 weeks after you leave. Malarone is the exception, needing only 7 days, because it also acts on the parasite while it's in your liver.5
Stopping early is one of the most common reasons prevention fails. Whichever tablet you take, finish the full course after you get back, even once the holiday feels like a distant memory.
Set a phone reminder for your final tablet before you fly home. It's the easiest way to finish the course.
Common side effects
Every antimalarial can cause side effects, though many people take them without any trouble. The most common ones tend to be mild and settle as your body adjusts:
- Atovaquone/proguanil - stomach upset, nausea, headache and occasionally mouth ulcers.
- Doxycycline - sensitivity to sunlight, stomach irritation and thrush in some women. Taking it with plenty of water and staying upright afterwards helps lower the risk of throat irritation.
- Mefloquine - dizziness, sleep problems and vivid dreams, and less commonly changes in mood or anxiety.
- Chloroquine and proguanil - nausea, diarrhoea and, rarely, itching.
You'll find a full list of side effects in the patient information leaflet that comes with your medicine. If you get any side effect that worries you, speak to your pharmacist or prescriber.
Do not take doxycycline just before lying down or going to bed. Take it sitting or standing, with plenty of water.
How much do anti-malaria tablets cost, and do you need a prescription?
The cost of malaria tablets depends on which one you take and how long your trip is, rather than one fixed price.
Doxycycline is usually the cheapest per day, but its 4-week course after travel means you need more tablets overall. Malarone costs more per tablet, but its shorter course can make it competitive for shorter trips, and the generic version brings the price down.
Antimalarials can't be prescribed on the NHS for travel, so you'll need to pay for them privately. Malarone, doxycycline and mefloquine are prescription-only medicines, which means you need a prescription or an online consultation with a prescriber.
Maloff Protect (the same combination as Malarone), Avloclor and Paludrine are pharmacy medicines, so they can be supplied after a short assessment with a pharmacist.6 Either way, a brief consultation is there to make sure the tablet you buy will actually protect you where you're going.
Building a wider travel health kit? It's worth sorting your antimalarials at the same time.
When to seek medical advice
Malaria is treatable, but early diagnosis is what keeps it that way. Contact a doctor urgently if you develop a fever or flu-like symptoms such as chills, headache or aching from about a week after you could have been exposed and up to a year after returning.
Do not assume these symptoms are a cold or jet lag. Contact NHS 111, your GP or A&E the same day, and tell them clearly that you have been in a malaria area so they can arrange the right tests without delay.
Fever after a trip to a malaria area is a medical emergency until proven otherwise. Get checked the same day.
Frequently asked questions
Can you buy anti-malaria tablets over the counter in the UK?
Some of them. Maloff Protect (atovaquone and proguanil) and the Avloclor and Paludrine options are pharmacy medicines, so a pharmacist can supply them after a short assessment. Malarone, doxycycline and mefloquine are prescription-only, so you need a prescription or an online consultation with a prescriber.
Is generic atovaquone and proguanil the same as Malarone?
Yes. Malarone, its generic version (atovaquone and proguanil) and Maloff Protect all contain the same two active ingredients at the same strength, so they work in the same way. The generic is usually cheaper, and Maloff Protect can be bought from a pharmacy without a prescription.
Can you take anti-malaria tablets during pregnancy?
It depends on the tablet, and this always needs individual advice. Doxycycline must not be used in pregnancy or breastfeeding, and atovaquone/proguanil (Malarone) is generally avoided unless the benefit clearly outweighs the risk. Pregnant travellers are usually advised to avoid malaria areas where possible, so speak to a clinician before booking.
Which anti-malaria tablet has the fewest side effects?
There is no single answer that suits everyone. Atovaquone/proguanil (Malarone) is generally well tolerated, with side effects that tend to be mild. Doxycycline can cause sun sensitivity, and mefloquine carries a risk of mood-related effects. The best-tolerated option for you depends on your health and medical history.
Can you still get malaria while taking anti-malaria tablets?
Yes. No anti-malaria tablet is 100% effective, which is why bite prevention matters alongside your tablets. Taking the full course correctly, including the days or weeks after you get home, gives you the best protection. See a doctor urgently if you develop a fever up to a year after travel.
How much do anti-malaria tablets cost?
There is no fixed price, because the total depends on which tablet you take and how long your trip is. Doxycycline is usually the cheapest per day but needs a 4-week course after travel, while Malarone costs more per tablet but only continues for 7 days after you leave. Generic atovaquone and proguanil brings the cost down.
References
- National Travel Health Network and Centre (NaTHNaC). Malaria. TravelHealthPro. travelhealthpro.org.uk
- NHS. Malaria: Prevention. nhs.uk/conditions/malaria/prevention
- GlaxoSmithKline. Malarone (atovaquone/proguanil) Summary of Product Characteristics. Electronic Medicines Compendium (eMC). medicines.org.uk/emc
- National Institute for Health and Care Excellence (NICE). Malaria prophylaxis. Clinical Knowledge Summaries. cks.nice.org.uk/topics/malaria-prophylaxis
- Freedman DO. Malaria Prevention in Short-Term Travelers. New England Journal of Medicine. 2008;359(6):603-612. doi:10.1056/NEJMcp0803572
- UK Health Security Agency. Malaria prevention guidelines for travellers from the UK. GOV.UK. gov.uk
This article is intended for informational purposes only and does not replace professional medical advice. Always read the patient information leaflet supplied with your medication and speak to a healthcare professional if you have specific concerns.