If you're planning a trip to a malaria-risk area, you've probably heard of Lariam - the brand name for mefloquine. It’s been around for decades, and for some people, it works fine. But for others, it’s a nightmare. Nightmares literally. Sleep disturbances, anxiety, dizziness, even hallucinations. The FDA added a black box warning in 2013 because of serious neuropsychiatric side effects. And yet, many travel clinics still hand it out like candy. Why? Because it’s cheap, and you only take it once a week. But are there better options? Absolutely.
Why Lariam Isn’t the Best Choice for Most People
Lariam (mefloquine) is a synthetic quinoline derivative. It’s designed to kill malaria parasites in the blood. You take one 250mg tablet weekly, starting one to two weeks before travel and continuing for four weeks after you return. Sounds simple, right? But here’s the catch: about 1 in 10 people report neuropsychiatric side effects. That’s not rare. That’s common enough to be a red flag.
Studies from the U.S. Centers for Disease Control and Prevention (CDC) show that 13% of travelers on mefloquine experience anxiety, depression, or vivid dreams. About 1 in 100 develop severe reactions like seizures or psychosis. These aren’t just "bad dreams" - they’re real, dangerous, and sometimes permanent. The World Health Organization still lists it as an option, but they’ve quietly downgraded its recommendation in high-risk areas where alternatives exist.
And it’s not just mental health. Lariam can cause vertigo, balance problems, and nausea. If you’re hiking in the Amazon or biking through Southeast Asia, losing your sense of balance isn’t a minor inconvenience - it’s a safety risk. One traveler I spoke to in Bristol, who took Lariam for a trip to Uganda, said she couldn’t walk a straight line for three weeks after returning. She didn’t realize it was the drug until her neurologist asked if she’d taken mefloquine.
Atovaquone-Proguanil (Malarone): The Modern Favorite
If you want a drug that actually matches modern expectations - effective, safe, and tolerable - Malarone is the gold standard. It’s a combination of atovaquone and proguanil, two drugs that work together to block malaria parasites at multiple stages.
You take one tablet daily, starting one to two days before travel and continuing for seven days after you return. That’s shorter than Lariam’s four-week tail. The side effects? Mild. Maybe a stomach upset or headache. Serious reactions? Extremely rare. In a 2021 meta-analysis published in The Lancet Infectious Diseases, Malarone had the lowest rate of discontinuation due to side effects of any antimalarial.
It’s more expensive than Lariam - about £3-£5 per tablet in the UK - but you’re paying for safety. And if you’re going to a high-risk area like sub-Saharan Africa, that’s worth it. Malarone is also effective against chloroquine-resistant strains, which cover nearly all malaria zones today. It’s the top pick for most travel clinics in Bristol, London, and Edinburgh.
Doxycycline: The Budget-Friendly Workhorse
If cost is your main concern, doxycycline is the most affordable option. It’s an antibiotic that also kills malaria parasites. You take a 100mg tablet daily, starting one to two days before travel and continuing for four weeks after.
It’s not perfect. Sun sensitivity is a big one - you can get a bad sunburn even with sunscreen. Stomach upset is common, so you need to take it with food and water, and never lie down right after. Women may get yeast infections. But for many travelers - especially those on a tight budget or going to remote areas where medical care is limited - it’s a solid, proven choice.
It’s also the only option besides Malarone that works in parts of Southeast Asia where mefloquine resistance is high. The CDC still lists it as a first-line option for travelers to Thailand, Cambodia, and Myanmar. It’s not glamorous, but it gets the job done.
Chloroquine and Hydroxychloroquine: Only in Rare Cases
Chloroquine was the go-to drug for decades. It’s cheap, safe, and easy to take. But here’s the problem: almost all malaria parasites in Africa and Southeast Asia are now resistant to it. That means if you’re going to Ghana, Nigeria, or Indonesia, chloroquine won’t protect you.
It’s only recommended in a few places today - like parts of Central America and the Middle East - where resistance hasn’t taken hold. Hydroxychloroquine is even less effective for malaria prevention. It’s mostly used for autoimmune diseases like lupus. Don’t confuse the two. If your travel clinic suggests chloroquine for Africa or Asia, ask why. They might be using outdated guidelines.
Primaquine and Tafenoquine: For Special Cases
Primaquine and tafenoquine are different. They don’t prevent the initial infection. Instead, they kill the dormant liver stage of the parasite - the kind that causes relapses in P. vivax and P. ovale malaria. These are common in South Asia and Latin America.
You take primaquine daily for 14 days after returning. Tafenoquine is newer - a single dose after your trip. But here’s the catch: both require a G6PD test first. If you’re deficient in this enzyme, these drugs can cause severe anemia. That’s not something you can skip. Many travel clinics in the UK now routinely test for G6PD deficiency before prescribing either.
If you’re traveling to India, Nepal, or Papua New Guinea, and your doctor doesn’t mention this, ask. It’s not optional. It’s life-saving.
What About Natural Remedies or Herbal Supplements?
You’ve probably seen ads for citronella, garlic, vitamin B12, or even essential oils as "natural malaria prevention." None of them work. Not even close.
There’s no credible evidence that any herbal supplement prevents malaria. The WHO, CDC, and UK Health Security Agency all say the same thing: don’t rely on anything but proven antimalarial drugs. Mosquito nets and DEET are your first line of defense - but they’re not enough on their own. If you skip the pills, you’re gambling with your life.
One traveler I spoke to in Bristol took "malaria herbs" because she didn’t trust pharmaceuticals. She got falciparum malaria in Kenya. She spent three weeks in intensive care. She survived. But she won’t make that mistake again.
Choosing the Right Drug for You
There’s no one-size-fits-all answer. The best drug depends on your destination, health, budget, and tolerance for side effects.
- Go with Malarone if you want the safest, most reliable option - especially for Africa, Southeast Asia, or South America.
- Choose doxycycline if you’re on a budget and don’t mind daily pills and sun sensitivity.
- Avoid Lariam unless you’ve taken it before without side effects, and you’re traveling somewhere with no other options.
- Ask for G6PD testing if you’re going to South Asia or the Pacific Islands.
- Never skip the test if you’re considering primaquine or tafenoquine.
Also, talk to a travel clinic - not just your GP. Travel clinics know the latest resistance patterns and local guidelines. They update their advice every year. Your GP might still be working from a 2015 handbook.
What to Do If You’ve Already Taken Lariam
If you took Lariam before and had strange dreams, anxiety, or dizziness, don’t take it again. Ever. These side effects can get worse with repeated use. Even if you thought it was "just stress," it was probably the drug.
If you’re currently on Lariam and feel off - mood swings, trouble sleeping, dizziness - stop taking it and see a doctor. Don’t wait until you get to your destination. There are safer alternatives you can switch to quickly.
And if you’re planning a trip and your clinic pushes Lariam without asking about your mental health history, walk out. That’s not good care. That’s outdated practice.
Malaria is serious. But the drugs we use to prevent it shouldn’t be riskier than the disease. You deserve better than Lariam. You have better options.
Is Lariam still prescribed for malaria prevention?
Yes, but rarely. Lariam (mefloquine) is still listed as an option by the WHO and CDC, but most travel clinics in the UK and US now avoid it due to its high risk of neuropsychiatric side effects. It’s typically only used if other drugs aren’t suitable - for example, if someone is allergic to doxycycline or can’t afford Malarone. Even then, it’s not recommended for people with a history of depression, anxiety, seizures, or heart rhythm problems.
Can I take Malarone instead of Lariam?
Absolutely. Malarone (atovaquone-proguanil) is the preferred alternative to Lariam for most travelers. It’s more effective against resistant strains, has far fewer side effects, and requires a shorter post-travel dosing period (just seven days vs. four weeks). The main downside is cost - it’s more expensive - but for most people, the safety and convenience make it worth it.
Does doxycycline work as well as Lariam?
Yes, and often better. Doxycycline is effective against the same malaria strains as Lariam, and it has a much lower risk of serious side effects. While you have to take it daily and it can make you sun-sensitive, it doesn’t cause anxiety, hallucinations, or balance problems. It’s the go-to choice for budget travelers and those who can’t take Malarone.
Why is Lariam still available if it’s so risky?
It’s cheap and easy to use - one pill a week. Pharmaceutical companies still sell it, and some clinics stick with it out of habit. But the medical community has largely moved on. The FDA’s black box warning and growing evidence of long-term neurological effects mean it’s no longer considered a first-line option. Its continued availability is more about cost and availability than medical superiority.
Are there any new malaria drugs coming out?
Tafenoquine (Krintafel) is the newest option - a single-dose drug taken after travel to prevent relapses from P. vivax malaria. It’s not for everyone - you need a G6PD test first - but it’s a big step forward. Researchers are also testing new combination drugs and long-acting injectables, but none are approved yet. For now, Malarone and doxycycline remain the best choices.
If you’re preparing for travel, talk to a travel health specialist. Bring your itinerary, medical history, and any concerns about side effects. Don’t let outdated advice put you at risk. Malaria is preventable - but only if you choose the right protection.
Andy Slack
November 4, 2025 AT 04:50Lariam gave me panic attacks in Cambodia. I thought I was losing my mind. Turned out it was the drug. Switched to Malarone and slept like a baby. Don't be that person who ignores the black box warning.
Rashmi Mohapatra
November 5, 2025 AT 18:54doxycycline is the real MVP for budget travelers. yeah u get sunburn but at least u dont hallucinate ur tuk tuk driver is a ghost. i took it in nepal and lived to tell the tale. also cheaper than my coffee habit.