Alternatives to Malarone If You Can't Fill Your Prescription

Malarone (atovaquone/proguanil) is the most popular antimalarial for travelers — but it's not always easy to find at your local pharmacy, and it's not always the right choice for every traveler. Whether you can't locate it in stock, can't afford it, or have a medical reason to avoid it, there are effective alternatives your doctor can prescribe.

The four antimalarials currently recommended by the CDC for travel prophylaxis are atovaquone/proguanil (Malarone), doxycycline, mefloquine, and chloroquine. The right choice depends on your destination, trip length, medical history, and budget. Here's a plain-English breakdown.

Why You Might Need a Malarone Alternative

There are several valid reasons to consider a Malarone alternative:

• It's unavailable at pharmacies near you (Malarone is stocked at only about 75% of US pharmacies)
• The cost is too high (brand Malarone runs $260+; alternatives like doxycycline cost much less)
• Medical contraindications: severe kidney disease, pregnancy, or allergy to components
• You're traveling to a region where atovaquone resistance has been documented

Doxycycline: Most Available and Affordable

Doxycycline is the closest practical alternative to Malarone for most travelers. It's an antibiotic that also prevents malaria by inhibiting protein synthesis in the Plasmodium parasite.

Pros: Widely available at virtually every pharmacy; cheapest antimalarial option; effective against chloroquine-resistant strains; can be started 1-2 days before travel; good for sun-exposed environments when used carefully.

Cons: Must be continued for 4 weeks after leaving the malaria area (compared to 7 days for Malarone); causes photosensitivity (increased sunburn risk); can cause stomach upset and esophageal irritation if not taken with food and water; not safe for pregnant women or children under 8 years old; can disrupt vaginal flora in women.

Dosing: 100 mg once daily for adults. Start 1-2 days before travel, take during trip, and continue 4 weeks after.

Cost: Usually under $30 for a 30-day supply with a coupon — the most affordable antimalarial option by far.

Mefloquine (Lariam): Convenient Weekly Dosing, Serious Warnings

Mefloquine (brand name Lariam) is taken once weekly, which some travelers find more convenient than daily pills. It was widely used before Malarone became available, but its use has declined significantly due to neuropsychiatric side effects.

Pros: Weekly dosing is easier to remember; lower cost for longer trips than Malarone; effective in most malaria-endemic regions.

Cons: FDA boxed warning for neuropsychiatric adverse reactions, including vivid dreams, anxiety, depression, dizziness, and in rare cases hallucinations or psychosis. These effects can persist after stopping the drug. Must be started 2 weeks before travel (less convenient for last-minute trips). Not recommended for people with a history of depression, anxiety, seizures, or cardiac arrhythmias.

Not effective in: Parts of Southeast Asia, especially the Greater Mekong Subregion (Thailand, Myanmar, Cambodia), due to documented mefloquine resistance.

Chloroquine: Only for Limited Destinations

Chloroquine was once the gold standard for malaria prevention, but widespread resistance has made it ineffective in most of Africa, Asia, and South America. Today it's only useful for travelers going to areas where malaria parasites remain susceptible — including parts of Central America (north of the Panama Canal) and the Caribbean.

Pros: Taken weekly; inexpensive; considered safe during pregnancy in areas where it remains effective; widely available.

Cons: Completely ineffective in most malaria-endemic regions due to resistance; must be started 2 weeks before travel; can cause serious side effects with long-term use including heart rhythm problems and vision changes.

Side-by-Side Comparison: Malarone vs. Alternatives

Here's a quick comparison to help guide your conversation with your doctor:

• Shortest post-travel dosing: Malarone (7 days) and chloroquine (4 weeks) vs. doxycycline (4 weeks) and mefloquine (4 weeks)
• Best for last-minute travel: Malarone and doxycycline (start 1-2 days before); mefloquine and chloroquine (start 2 weeks before)
• Best for long trips (cost): Doxycycline or mefloquine (weekly)
• Safe for children under 8: Malarone (pediatric tablets available), mefloquine, chloroquine — NOT doxycycline
• Safe in pregnancy: Chloroquine (in sensitive areas only), mefloquine (2nd and 3rd trimester with caution) — NOT Malarone or doxycycline

Talk to Your Doctor Before Switching

Never switch your antimalarial without consulting your prescriber first. The right choice depends on your specific destination, health history, and the resistance patterns in the region you're visiting. If you're having trouble locating Malarone, read why Malarone is hard to find — it may just be a matter of calling the right pharmacy.

And if you need help locating Malarone or any antimalarial at pharmacies near you, medfinder can call pharmacies on your behalf and text you results.