Table 4. Drugs for the self-treatment of malaria
| Drug, generic (trade) name |
Adult dosage |
Pediatric dosage |
Advantage |
Disadvantage |
Adverse effects |
Healht Canada approval
status |
| Chloroquine (Aralen®) Tablet: 150 mg base | 1.5 g base over 3 days 600 mg base, then 300 mg base in 6 hours, then 300 mg base daily x 2 days | Treatment: 25 mg base/kg total over 3 days 10 mg base/kg, then 5 mg base/kg in 6 hours, then 5 mg base/kg daily x 2 days |
Safe in pregnancy Safe for children Long-term safety data |
Widespread resistance Should not be adminis tered to people using chloroquine for prevention | Frequent: nausea, emesis, headache Occasional: skin eruptions Rare: nerve deafness, photophobia, myopathy, blood dyscrasias, psychosis and seizures |
Approved by Health Canada for treatment of
chloroquine-sensitive malaria (Central America and Haiti) Not recommended for self-treatment in other regions because of risk of mixed infection with P. falciparum |
| Atovaquone/proguanil (Malarone®) Adult tablet: 250 mg atovaquone plus 100 mg proguanil | 1000 mg atovaquone AND 400 mg proguanil (4 tablets) once daily x 3 days | 20 mg/kg atovaquone AND 8 mg/kg proguanil daily x 3 days 11-20 kg: 1 tablet daily 21-30 kg: 2 tablets daily 31-40 kg: 3 tablets daily > 41 kg: 4 tablets daily |
Safe for children > 5 kg Resistance rare Fixed combination allows for simple treatment regimen Excellent safety profile |
Not approved in pregnant women or breast-feeding mothers Contraindicated in presence of renal failure (creatinine clearance < 30 mL/min) Nausea and vomiting common with malaria and as side effect of medication Emesis may interfere with success of treatment May need to premedicate with Gravol |
Frequent: nausea, vomiting, abdominal pain, diarrhea, increased transaminase levels Rare: seizures, rash |
Approved by Health Canada for treatment of chloroquine- resistant malaria |
| Quinine sulfate PLUS Doxycycline | Quinine 250 mg base, 2 tablets three times daily x 7 days Doxycyline 100 mg twice daily x 7 days | Quinine 7.5 mg base/kg three times daily x 7 days Doxycycline 1.5 mg/kg twice daily x 7 days < 25 kg or < 8 yrs: contraindicated 25-35 kg or > 8 yr: 50 mg bid 36-50 kg: 75 mg bid > 50 kg: adult dose |
Resistance to combined therapy rare Rapid parasite clearance Readily available Cheap |
Children < 8 yr cannot receive doxycycline Contraindicated in pregnancy Complicated regimen reduces compliance Adverse reactions to quinine common and interfere with tolerance and effectiveness |
Frequent: Cinchonism (tinnitus, nausea, headache, blurred vision), hypoglycemia, nausea, emesis Occasional: hypersensitivity, nerve deafness, esophageal ulcer (doxycycline) Rare: hemolysis |
Approved by Health Canada for treatment of chloroquine- resistant malaria |
| Co-artemether Coartem Riamet ™ Novartis ™ |
Artemether 20 mg AND Lumefantrine 120 mg 6 dose regimen stan- dard for non-immune travellers at 0 and 8 hours on day 1 and twice daily on days 2 and 3 4 tablets per dose |
Artemether 20 mg AND Lumefantrine 120 mg 6 dose regimen stan- dard for non-immune travellers at 0 and 8 hours on day 1 and twice daily on days 2 and 3 5 kg to < 15 kg: 1 tab/dose 15 to 24 kg: 2 tabs/dose >35 kg:4 tabs per dose |
Safety profile from data available suggests safe for children
> 5 kg Resistance not documented Rapid parasite clearance Drug widely distributed in Africa More readily available and less expensive than Malarone® Better tolerated than artesunate plus mefloquine No adjustment of dose required for elderly and renal failure Lumefantrine does not cause cardiac conduc- tion disturbance |
Not in pregnant women and breast-feeding mothers Two regimens (4 dose and 6 dose) described on product monograph is confusing; NOTE: the 4 dose regimen for semi-immunes only |
Frequent: nausea, vomiting, abdominal pain, fatigue Occasional: fever, rigors, anemia (some adverse events reported may be due to malaria) |
Not approved by Health Canada but endorsed by WHO (Roll Back Malaria Program) |
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