Paludrine

Malaria is a potentially fatal disease caused by various types of parasites known as Plasmodium. Plasmodium are carried by mosquitoes and are injected into the bloodstream during a bite from an infected mosquito. Once inside the blood the parasite travels to the liver, and then out again into the bloodstream where it invades the red blood cells and reproduces. An actual attack of malaria develops when the red blood cells burst, releasing a mass of parasites into the bloodstream. The attacks do not begin until a sufficient number of blood cells have been infected with parasites.

Proguanil hydrochloride prevents malaria by stopping the parasite from reproducing once it is inside the red blood cells. It does this by blocking the action of a compound that is found in the Plasmodium parasite. This compound is an enzyme called dihydrofolate reductase, and is involved in the reproduction of the parasite.

Dihydrofolate reductase normally converts folic acid into folinic acid in the parasite, which is a step essential for the parasite to produce new genetic material (DNA). New DNA is necessary for the parasite to reproduce. By blocking it's production, proguanil prevents any malarial parasites that have entered the red blood cells from reproducing, increasing in number and causing malaria attacks.

Proguanil hydrochloride is usually taken in combination with another antimalarial medicine called chloroquine to prevent malaria. However, the malaria parasite is resistant to these medicines in certain areas of the world, and it is important to check with your pharmacist which medicines are currently recommended to prevent malaria in the country you are travelling to. You can also check in the travel section of this site.

If proguanil is recommended it should preferably be started a week before travel to the malarious region, but if this is not possible, then at least two days before. It should then be taken throughout the stay, so that if you are bitten by an infected mosquito there will be medicine in your blood to prevent malaria developing. Proguanil should be continued for a further four weeks after leaving the malarious area, so that there is still medicine in the blood to kill any parasite that is released from the liver in this time. You should try and take the medicine regularly at the same time every day.

What is it used for?

- Prevention of malaria (proguanil can be bought from pharmacies without a prescription for this purpose; it is not prescribable on the NHS for preventing malaria).

Warning!

- To prevent malaria, this medicine should be taken once a day after food, preferably at the same time each day, starting preferably one week, but at least two days before travelling to the malarious area. It should be taken regularly thoughout the stay and continued for four weeks after leaving the malarious area.
- To prevent malaria it is important that you take this medicine regularly and try not to forget a dose. You should still take precautions to avoid being bitten by mosquitos, such as using mosquito repellants and sleeping under mosquito nets. This is particularly important if you have vomiting or diarrhoea, as this could affect the absorption of this medicine from the gut. If you fall ill within one year of your return, and especially if within three months of your return, you should consult your doctor immediately and let him know that you have visited a country where malaria is endemic.

Use with caution in

- Decreased kidney function

Not to be used in

- Allergy to any ingredient

This medicine should not be used if you are allergic to one or any of its ingredients. Please inform your doctor or pharmacist if you have previously experienced such an allergy. If you feel you have experienced an allergic reaction, stop using this medicine and inform your doctor or pharmacist immediately.

Pregnancy and Breastfeeding

Certain medicines should not be used during pregnancy or breastfeeding. However, other medicines may be safely used in pregnancy or breastfeeding providing the benefits to the mother outweigh the risks to the unborn baby. Always inform your doctor if you are pregnant or planning a pregnancy, before using any medicine.

- Malaria in pregnant travellers increases the risk of maternal and neonatal death, miscarriage and stillbirth, and pregnant women are advised to avoid visiting malarious areas if possible. When travel cannot be avoided, it is very important to take effective preventive measures against malaria and be extra diligent with measures to avoid mosquito bites. Proguanil has a long history of safe use during pregnancy, but it should only be used after seeking medical advice from a doctor. It is recommended that pregnant women who take this medicine also take a daily 5mg supplement of folic acid.
- This medicine passes into breast milk but is not harmful to a nursing infant. However, the amount of medicine that passes into the milk is not sufficient to prevent malaria in the nursing infant. The child will also need to be given antimalarial medicine, and you should seek medical advice from your doctor or pharmacist with regards to what medicine and what dose to give.

Label warnings

- Take this medication with or after food.

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