Malarone Side Effects: Complete Safety Guide

What Are Malarone Side Effects?

Side effects are unwanted reactions that can happen with any medication. Malarone’s side effects are listed by frequency in the patient information leaflet. Most are mild and do not require stopping the medicine.

Very common (affect more than 1 in 10 people)

• Headache
• Nausea and vomiting
• Stomach pain
• Diarrhoea

Common (affect up to 1 in 10 people)

• Dizziness
• Sleeping problems (insomnia)
• Strange dreams
• Depression
• Loss of appetite
• Fever
• Rash (may be itchy)
• Cough
• Anaemia (tiredness, pale skin)
• Low white blood cells (more infections)
• Low sodium levels
• Increased liver enzymes (seen in blood tests)

Uncommon (affect up to 1 in 100 people)

• Anxiety
• Palpitations (awareness of heartbeat)
• Swelling and redness of mouth
• Hair loss
• Hives (itchy, bumpy rash)
• Increased amylase (pancreas enzyme)

Rare (affect up to 1 in 1,000 people)

• Hallucinations (seeing or hearing things that aren't there)

Other side effects (frequency unknown)

• Liver inflammation (hepatitis)
• Blocked bile ducts (cholestasis)
• Fast heart rate (tachycardia)
• Inflammation of blood vessels (vasculitis)
• Seizures (fits)
• Panic attacks, crying
• Nightmares
• Severe mental health changes (psychosis)
• Indigestion, mouth ulcers
• Blisters, peeling skin
• Sensitivity to sunlight
• Pancytopenia (decrease in all blood cells)

When Do Malarone Side Effects Start?

Most side effects appear soon after starting the medication, typically within the first few doses.

• Nausea, headache, stomach pain: Often begin within hours of the first tablet, especially if taken on an empty stomach. Taking with food can prevent or reduce these.
• Dizziness, sleep disturbances: May start after a couple of days as the drug reaches steady levels.
• Allergic reactions: Usually occur soon after a dose, but can appear at any time. Stop taking and seek help immediately if you have signs of allergy.
• Liver or blood effects: These are only detectable through blood tests and do not cause immediate symptoms; your doctor may monitor if you are on long‑term treatment.

If you experience side effects that start later (e.g., after a week or more), it could be due to another cause – but always inform your doctor.

How Long Do Malarone Side Effects Last?

The duration varies by the type of side effect and individual factors.

• Mild gastrointestinal effects (nausea, diarrhoea): Usually last a few hours to a couple of days. Your body often adjusts, and they may lessen after the first few doses.
• Headache and dizziness: Can last a few hours; if persistent beyond 48 hours, consult your doctor.
• Sleep disturbances and dreams: May continue as long as you take the medication, but often improve over time.
• Rash: If mild, may resolve within days; if severe or spreading, stop and seek medical advice.
• Blood test abnormalities: Return to normal after stopping Malarone, usually within weeks.
• Serious reactions: Require immediate medical attention; duration depends on treatment.

If any side effect persists or worsens, speak to your pharmacist or doctor.

Side Effects Timeline

This rough timeline shows when you might experience certain side effects:

Everyone reacts differently. This is a guide, not a rule.

Contraindications: Who Should Not Take Malarone

Do not take Malarone if:

• Allergy: You are allergic to atovaquone, proguanil hydrochloride, or any of the other ingredients (see PIL section 6).
• Severe kidney disease: For malaria prevention, if you have severe kidney impairment (creatinine clearance <30 mL/min). For treatment, your doctor may still prescribe it with close monitoring.
• Children under 11 kg: Not recommended for prevention; for treatment in children <11 kg, specialist advice is needed.

Use with caution (tell your doctor):

• Mild‑to‑moderate kidney disease – dose adjustment may be needed.
• Pregnancy – only if clearly necessary and prescribed by a doctor.
• Breastfeeding – avoid because the drugs pass into milk.
• Liver disease – safety not fully established; your doctor will weigh risks.

Food Interactions & Drug Interactions

Food and drink

Take Malarone with food or a milky drink. This increases absorption of atovaquone and reduces nausea. Avoid taking it on an empty stomach.

Drug interactions (always tell your doctor about all medicines you take)

• Metoclopramide (for nausea) – may reduce Malarone absorption.
• Antibiotics: Tetracycline, rifampicin, rifabutin – can decrease Malarone effectiveness.
• HIV medications: Efavirenz, certain protease inhibitors – may alter levels.
• Warfarin and other blood thinners: Malarone may affect INR; more frequent monitoring needed.
• Etoposide (cancer drug) – potential interaction.

This is not a full list. Always check with your pharmacist or doctor before starting any new medicine while on Malarone.

Malarone Side Effects FAQs

Need Malarone for your trip?

If you are travelling to a malaria region, our UK‑registered doctors can provide a consultation and prescribe Malarone if suitable. We’ll also advise on managing side effects.

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