Malarone (Atovaquone/Proguanil)

What is Malarone?

Malarone is a fixed-dose combination antimalarial medicine containing two active ingredients: Atovaquone (250 mg) and Proguanil hydrochloride (100 mg). Developed in the 1990s as an alternative to Chloroquine and Mefloquine, Malarone rapidly became a preferred choice for malaria prophylaxis among travellers to malaria-endemic regions.

The combination of Atovaquone and Proguanil is highly effective against Chloroquine-resistant Plasmodium falciparum — the most dangerous malaria species — and has a favourable safety and tolerability profile compared to Lariam (Mefloquine). It is approved by the European Medicines Agency (EMA) for both the prevention and treatment of malaria in adults and children above a minimum weight threshold.

A paediatric formulation, Malarone Paediatric, is available for children weighing between 11 kg and 40 kg.

How does Malarone work?

Malarone’s efficacy against malaria comes from the synergistic action of its two components:

• Atovaquone: A hydroxynaphthoquinone that inhibits mitochondrial electron transport in Plasmodium parasites, disrupting the parasite’s ability to generate energy. Specifically, Atovaquone targets ubiquinol-cytochrome c oxidoreductase (cytochrome bc1 complex) — a component essential to parasite metabolism that is distinct in structure from its human counterpart, providing selective toxicity.
• Proguanil: A biguanide that is converted in the body to cycloguanil, which inhibits dihydrofolate reductase (DHFR), an enzyme essential for nucleotide synthesis and parasite replication. Proguanil also potentiates the mitochondrial membrane potential-disrupting effects of Atovaquone, making the combination more effective than either agent alone.

Crucially, Malarone provides causal prophylaxis — it acts against the liver-stage (hepatic schizont) forms of Plasmodium as well as blood-stage parasites. This is why only a 7-day post-travel course is required, rather than the 4-week course needed by drugs acting on blood stages only.

Who is Malarone for?

Malarone is appropriate for the majority of adult travellers and eligible children visiting malaria-endemic regions. It is particularly well-suited for:

• Travellers to sub-Saharan Africa, South and Southeast Asia, Central and South America, and other high-risk malaria regions
• Travellers who cannot tolerate or have contraindications to Mefloquine (Lariam) or Doxycycline
• Short-trip travellers who benefit from the shorter pre- and post-travel dosing period
• Travellers who prioritise minimal neuropsychiatric side effects
• Travellers to destinations where both Chloroquine and Mefloquine resistance is documented

Malarone is not recommended for:

• Patients with severe renal impairment (creatinine clearance below 30 mL/min)
• Pregnant women (use only if essential and under close medical supervision)
• Breastfeeding women (Atovaquone levels in breast milk are unknown)
• Children weighing less than 11 kg (paediatric formulation lower weight limit)

Dosage

For malaria prophylaxis in adults, the EMA-approved schedule is:

Phase	Adult Dose	Timing
Pre-travel	1 tablet (250/100 mg) daily	Start 1–2 days before departure
During travel	1 tablet daily	Continue throughout stay
Post-travel	1 tablet daily	Continue for 7 days after leaving malaria area

Malarone should be taken at the same time each day with food or a milky drink — taking with food significantly improves Atovaquone absorption and reduces gastrointestinal side effects.

For children, Malarone Paediatric dosing is based on body weight and must be determined by a qualified medical professional.

Side effects

Common side effects

• Abdominal pain: The most commonly reported side effect; often reduced by taking with food
• Nausea: Mild to moderate; generally manageable
• Vomiting: If vomiting occurs within 1 hour of taking Malarone, a repeat dose should be taken
• Diarrhoea
• Headache
• Dizziness

Less common side effects

• Rash or itching
• Mild liver enzyme elevations (usually asymptomatic and reversible)
• Anaemia

Serious but rare side effects

• Severe allergic reactions: Including anaphylaxis and Stevens-Johnson syndrome (very rare)
• Significant liver enzyme elevations: In rare cases, hepatotoxicity has been reported

Compared to Lariam, Malarone has a substantially lower incidence of neuropsychiatric adverse effects (anxiety, depression, hallucinations), which is a significant advantage for many travellers.

Malarone vs alternatives

Medicine	Dosing	Post-travel	Neuropsychiatric Risk	Cost
Malarone	Daily	7 days	Very low	Higher
Doxycycline	Daily	4 weeks	Low	Lower
Lariam (Mefloquine)	Weekly	4 weeks	Significant	Moderate
Chloroquine	Weekly	4 weeks	Low	Low (limited use)

Key advantages of Malarone:

• Shortest post-travel course (7 days vs 4 weeks for Doxycycline and Lariam)
• Can be started just 1–2 days before travel (vs 2–3 weeks for Lariam)
• Minimal neuropsychiatric side effects
• Effective against Chloroquine and Mefloquine-resistant strains

Key consideration: Malarone is generally more expensive than Doxycycline per day, which can be a factor for longer trips.

How to get Malarone online in Europe

Malarone is a prescription-only medicine in all EU member states. Prescrivia operates as a technology intermediary — we do not prescribe medicines, employ doctors, or sell medicines. Our platform connects patients with independent EU-registered doctors who can conduct online travel health assessments.

The process is as follows:

1. Complete a travel health assessment: Provide information about your destination, travel dates, planned activities, and full medical history including kidney function if known.
2. Doctor review: An independent EU-registered doctor reviews your assessment. If Malarone is clinically appropriate for your destination and health profile, they may issue a prescription.
3. Prescription and fulfilment: If a prescription is issued, it is forwarded to a licensed EU pharmacy partner for dispensing and delivery.

Important: Prescrivia does not guarantee that a prescription will be issued. All prescribing decisions are made independently by qualified medical professionals based on your individual clinical circumstances.

Important safety information

Do not take Malarone if you:

• Have severe kidney disease (creatinine clearance below 30 mL/min)
• Have a known hypersensitivity to Atovaquone, Proguanil, or any excipient in the tablet
• Are pregnant, unless the potential benefit outweighs the risk and it is agreed by a doctor
• Are breastfeeding (use with caution — limited safety data available)

Tell your doctor if you:

• Have mild to moderate kidney impairment (dose adjustment may be needed)
• Are taking Rifampicin, Rifabutin, Metoclopramide, or Tetracyclines (can reduce Atovaquone plasma levels significantly)
• Are taking Warfarin or anticoagulants (Malarone may enhance anticoagulant effect)
• Have liver disease

If you vomit within 1 hour of taking a dose: Take another dose as soon as possible.

Drug resistance: Malarone resistance is currently uncommon but has been documented in isolated cases. Do not use Malarone to treat established malaria without guidance from a doctor.

Sources

Medical information on this page is based on the following sources:

• European Medicines Agency (EMA). Malarone (Atovaquone/Proguanil) — Summary of Product Characteristics. ema.europa.eu
• World Health Organization (WHO). International Travel and Health: Malaria. who.int
• WHO. Guidelines for the Treatment of Malaria, 3rd edition. Geneva: WHO, 2015.
• Overbosch D, et al. Atovaquone-proguanil versus mefloquine for malaria prophylaxis in nonimmune travelers. Clin Infect Dis. 2001;33(7):1015-1021.

This content is provided for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional for travel health advice relevant to your individual circumstances and destination.