Lariam news 46

About 800 Americans a year bring home a bad souvenir from a trip abroad: malaria. A few die, and the rest suffer weeks of miserable symptoms that usually hit shortly after they unpack.

Even as tourism in developing countries grows, too many travelers don't know to take anti-malaria medicines -- or skip them from worry about side effects. The number sickened each year because they didn't take those pills has risen by a few hundred since the mid-1990s.

The malaria parasite has developed resistance to that old standby drug, chloroquine, in most of the world. That leaves most travelers three options: Lariam, a newer and possibly safer drug called Malarone and the antibiotic doxycycline.

Each has pros and cons that make declaring a No. 1 choice for everybody all but impossible, cautioned Dr. Bradley Connor, a New York travel-medicine specialist.

"Your one-week business traveler vs. your teenage backpacker across Africa have very different risks," agreed Dr. Kevin Kain, director of the University of Toronto's Center for Travel and Tropical Medicine.

For example, Lariam isn't supposed to be used by anyone with depression, a history of other psychiatric disorders or epilepsy. Also, it's losing effectiveness in parts of Thailand, Cambodia and Myanmar. On the other hand, Lariam is the only once-a-week pill; the others require remembering a daily dose.

But the backpacker spending three months amid malaria-carrying mosquitoes may want the cheapest option, doxycycline. The busy executive may prefer Malarone because treatment ends one week after returning home; the other two drugs must be taken for a month after returning.

Adding to the complex decision, the Food and Drug Administration recently took two steps that may influence prescriptions:

It strengthened warnings that Lariam may cause psychiatric side effects ranging from anxiety and unsettling dreams to hallucinations, depression, occasionally even psychotic behavior. Those risks have long been known, but the updated warnings stress that people with active or recent depression shouldn't take Lariam.

However, the FDA cautions that the drug's alleged link to suicide has not been proven, and calls Lariam an important option. Travel-medicine specialists estimate serious side effects occur in one in 10,000 to one in 15,000 Lariam users.

Separately, the FDA added to competitor Malarone's label results of a new study of 1,000 travelers that favorably compared Malarone to Lariam. The drugs appeared equally effective, but 5 percent of Lariam users had side effects bothersome enough to stop the drug, compared with 1.2 percent of Malarone users, says Kain. The Toronto physician headed the study funded by Malarone maker GlaxoSmithKline.

Specialists advise people heading for developing countries to consult a travel clinic or other doctor with specific expertise in the destination; a regular doctor might not know they need anti-malaria pills, much less which one.

"It's not in any of our interests to make people sick with malaria drugs. What we're trying to do is stop people from coming back in body bags from their holiday," Kain said.

IF YOU'RE INTERESTED

Malaria information from the Centers for Disease Control and Prevention can be found at www.cdc.gov/travel/malinfo.htm