Key Takeaways: Using Malarone Correctly

Start 1‑2 days before travel – take one tablet daily at the same time.
Continue for 7 days after return – essential to kill any remaining parasites.
Always take with food or a milky drink – this doubles absorption of atovaquone.
If you vomit within 1 hour, take another full dose immediately.
Not for prevention in severe kidney disease – your doctor will advise alternatives.
Children’s doses are weight‑based – use the correct tablet strength.

Malarone is a prescription‑only antimalarial that combines atovaquone and proguanil hydrochloride. Using it correctly – right dose, right timing, and with food – is essential to protect you from malaria. This guide explains exactly how to take Malarone, whether for prevention or treatment.

Important Medical Advice

If you experience signs of a severe allergic reaction (rash, swelling of face/lips, difficulty breathing), severe skin blistering, or if vomiting occurs within 1 hour of a dose during prevention, seek medical help immediately. Always carry your Malarone with you and take it exactly as prescribed.

How to Take Malarone: Step‑by‑Step Usage Guide

Follow these steps for malaria prevention. If you are treating malaria, see the dosage guide below.

Before you travel: Start taking Malarone 1 or 2 days before you enter a malaria‑risk area. This builds up protective levels in your blood.
During your stay: Take one tablet every day, at the same time each day. Choose a time you will remember – for example, with breakfast or dinner.
With food: Swallow the tablet whole with a meal or a milky drink. This is very important for the medicine to work.
After you return: Continue taking one tablet daily for another 7 full days after leaving the malaria area. This kills any parasites that might still be in your liver.
If you miss a dose: Take it as soon as you remember, then continue the next day at your usual time. Do not take two doses on the same day.
If you vomit: If vomiting happens within 1 hour of taking a dose, take another full dose straight away. If vomiting continues, contact your doctor – you may need extra protection (insect repellent, bed nets) or a different medicine.

🗒️ Key point: The full 7‑day course after return is essential – stopping early can leave you unprotected.

Dosage Guide: Prevention & Treatment

Malarone comes as 250 mg atovaquone / 100 mg proguanil hydrochloride tablets. For children or adults weighing less than 40 kg, there is also a paediatric tablet (62.5 mg/25 mg).

Prevention (prophylaxis)

Body weight	Daily dose (prevention)	Duration
Adults ≥40 kg	1 adult tablet (250/100)	Start 1‑2 days before travel, continue during stay, then 7 days after return
Children 31‑40 kg	3 paediatric tablets* once daily	same schedule
Children 21‑30 kg	2 paediatric tablets* once daily	same schedule
Children 11‑20 kg	1 paediatric tablet* once daily	same schedule
Children <11 kg	Not recommended for prevention	–

*Paediatric tablet = 62.5 mg atovaquone / 25 mg proguanil.

Treatment of uncomplicated malaria

Body weight	Daily dose for 3 days
Adults ≥40 kg	4 adult tablets once daily for 3 days
Children 31‑40 kg	3 adult tablets once daily for 3 days
Children 21‑30 kg	2 adult tablets once daily for 3 days
Children 11‑20 kg	1 adult tablet once daily for 3 days
Children <11 kg	Seek specialist advice; alternative formulations may be used

⚠️ Treatment doses are higher than prevention doses. Always follow your doctor’s prescription.

Who Should Use Malarone

Travellers to malaria‑endemic regions – especially areas with Plasmodium falciparum resistant to other drugs.
People who cannot take other antimalarials (e.g., mefloquine or doxycycline) due to side effects or interactions.
Short‑term travellers (up to a few months) because it is well tolerated and only needs 7 days post‑travel.
Children weighing at least 11 kg (using weight‑appropriate dosing).
People with mild‑to‑moderate kidney or liver impairment – but your doctor may adjust the dose.

Who Should NOT Use Malarone

Allergy to atovaquone, proguanil hydrochloride, or any tablet ingredient (see section 6 of the PIL).
Severe kidney disease (creatinine clearance <30 mL/min) – for prevention. (For treatment, the doctor may still use it under close monitoring.)
Children under 11 kg for prevention; under 5 kg for treatment (limited data).
Pregnancy – only if clearly needed and recommended by a doctor (see special conditions).
Breastfeeding – avoid because the drugs pass into milk.

To Be Taken With Food (and Without Food)

Atovaquone is a fat‑soluble drug. Its absorption increases about 2‑ to 3‑fold when taken with food, especially fatty food. Without food, blood levels may be too low to prevent malaria.

Always take Malarone with a meal or a milky drink. This could be breakfast, lunch, or dinner – whichever suits your routine.
If you cannot eat, at least drink a glass of full‑fat milk or a yoghurt drink.
Avoid taking it on an empty stomach; if you forget and have no food available, take the dose with whatever you have, then try to have a snack soon after.

🍽️ Practical tip: Pair your daily dose with a main meal – it also helps you remember to take it.

Special Conditions: Pregnancy, Breastfeeding & More

Pregnancy

Malarone is not usually recommended in pregnancy because there is limited safety data. However, if you are travelling to a high‑risk malaria area and other antimalarials are not suitable, your doctor may prescribe it after discussing the risks and benefits. Malaria in pregnancy can be very serious for both mother and baby.

Breastfeeding

Both atovaquone and proguanil pass into breast milk in small amounts. Because the effect on a nursing infant is unknown, you should not breastfeed while taking Malarone. If you are breastfeeding and need malaria prevention, discuss alternatives like mefloquine with your doctor.

Kidney impairment

For prevention: Malarone is not recommended if you have severe kidney disease (eGFR <30 mL/min).
For treatment: It can be used with caution; your doctor may monitor drug levels.

Liver impairment

Mild‑to‑moderate liver disease is not a problem. In severe liver disease, your doctor will decide based on your individual situation.

Elderly

No special dose adjustment is needed, but kidney function should be checked.

Drug interactions

Tell your doctor if you take: metoclopramide, tetracycline, rifampicin, rifabutin, efavirenz, certain HIV protease inhibitors, warfarin, or etoposide. These can affect how Malarone works.

Malarone Usage FAQs

Can I take Malarone if I am already in a malaria area and haven't started?

Yes, you can start immediately, but you will not be fully protected for the first 2 days. Use extra precautions (repellent, nets) and continue for 7 days after leaving.

What if I forget a dose during my trip?

Take it as soon as you remember, then resume your usual schedule the next day. Never double the dose. If you miss several doses, contact a doctor.

Can I split or crush the tablet if I have trouble swallowing?

Tablets should be swallowed whole. If swallowing is difficult, talk to your pharmacist – there is no liquid form, but you may be able to crush and mix with a small amount of food (milk, yoghurt) and take immediately.

Is Malarone safe for long‑term use (e.g., expats)?

Yes, Malarone can be used for up to a year. However, if you live in a malaria area, you should also consider other preventive measures. Regular check‑ups are advised.

Do I still need insect repellent if I take Malarone?

Absolutely. No antimalarial is 100% effective. Always use insect repellent, wear long sleeves after dusk, and sleep under a treated net.

Need Malarone for your trip?

If you are planning travel to a malaria zone, speak to a UK‑registered doctor through a confidential online consultation. We can prescribe Malarone and arrange next‑day delivery.