Paludrine/Avloclor

How does it work?

The Paludrine/Avloclor antimalarial travel pack contains two types of tablets used for preventing malaria. The Paludrine tablets contain the active ingredient proguanil hydrochloride, and the Avloclor tablets contain the active ingredient chloroquine phosphate.

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.

Chloroquine works by attacking the parasites once they have entered the red blood cells. It kills the parasites and prevents them from multiplying further.

It is not fully understood how chloroquine kills the parasites, but it is thought to work by blocking the action of a chemical that the parasites produce to protect themselves once inside the red blood cells. When inside the red blood cells, the malaria parasites digest the oxygen carrying pigment haemoglobin that is found in these cells. This divides the haemoglobin into two parts; haem and globin, and the haem part is toxic to the malaria parasite. To prevent itself from being damaged by haem, the malaria parasite produces a chemical that converts haem into a compound that is not toxic to them. Chloroquine blocks the action of this chemical. This causes the levels of the toxic haem to rise, thus killing the malaria parasites.

Proguanil also works by stopping the malaria parasite from reproducing once it is inside the red blood cells. It does this in a different way - by blocking the action of an enzyme called dihydrofolate reductase that is found in the Plasmodium parasite. This enzyme 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 and chloroquine are taken in combination to prevent malaria. The proguanil is taken every day and the chloroquine is taken once a week. 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 these medicines are recommended for prevention they should be started a week before travel to the malarious region. They 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. Both medicines 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 remaining parasites released from the liver into the red blood cells during this time.

What is it used for?

Prevention of malaria (the Paludrine/Avloclor travel pack 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 started one week before travelling to the malarious area. It should be taken regularly thoughout the stay and continued for four weeks after leaving the malarious area. The Paludrine tablets should be taken once a day after food, preferably at the same time each day. The Avloclor tablets should be taken once a week, on the same day each week.

To prevent malaria it is important that you take this medicine regularly and try not to forget a dose. You may find it helpful to make a note of the day you take your weekly Avloclor dose in your diary or calender. You must 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.

The Avloclor tablets may cause visual disturbances when you first start taking them. If affected you should use caution when driving or operating machinary.

Avloclor can sometimes cause eye problems when used for long periods of time. For this reason, you should have an eye examination regularly every three to six months if you have been taking Avloclor on a continuous basis every week for more than three years to prevent malaria. Stop taking Avloclor and seek medical advice immediately if you notice any deterioration in your vision that lasts for longer than 48 hours.

People taking Avloclor for long periods of time should also have regular blood tests to monitor the amounts of the different types of blood cells in their blood. This is because chloroquine may rarely cause a decrease in the normal amounts of blood cells in the blood. Consult your doctor if you experience any of the following symptoms while taking Avloclor: unexplained bruising or bleeding, purple spots, sore throat, mouth ulcers, high temperature (fever), feeling tired or general illness. Your doctor may want to take a blood test to check your blood cells.

Use with caution in

Elderly people

Liver disease

Kidney disease or decreased kidney function

Disorders affecting the brain, nerves or spinal cord (neurological disorders)

Abnormal muscle weakness

Severe gut disorders

Rare hereditary blood disorders called porphyrias

Lack of the enzyme G6PD in the blood (G6PD deficiency)

Psoriasis

Not to be used in

Allergy to any ingredient.

People with a history of epilepsy should not take chloroquine for preventing malaria.

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 and chloroquine have a long history of safe use during pregnancy, but they should only be used after seeking medical advice from a doctor. It is recommended that pregnant women who take proguanil also take a daily 5mg supplement of folic acid.

Chloroquine and proguanil pass into breast milk but are 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

Do not take indigestion remedies at the same time of day as this medication.

Your Paludrine tablets should be taken with or after food.

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