At Brixton Travel Clinic, we see travellers every week who are heading to parts of the world where malaria is a real and serious risk. They might be going on safari in Kenya, visiting family in Nigeria or Ghana, or backpacking through rural parts of Asia. Protecting yourself with antimalarial medication is one of the most important steps you can take before you go. One of the most commonly prescribed options is atovaquone proguanil, a combination tablet often known by its original brand name, Malarone.
In this guide, our team in Brixton, London explains exactly how to take atovaquone proguanil properly. We cover when to start and stop, what to do if you miss a dose or feel unwell, who should avoid it, and how to steer clear of the most common mistakes we see. If you would like advice tailored to your trip, book a consultation online, or simply drop in to our clinic on Coldharbour Lane.
Not Sure Which Vaccines or Antimalarials You Need?
Malaria risk varies hugely between countries, and even between regions of the same country. Before looking at atovaquone proguanil in detail, it is worth checking which vaccinations and precautions apply to your destination. Our travel vaccine tool below is a helpful starting point, although it cannot replace a proper review of your health history and itinerary.
What Is Atovaquone Proguanil?
Atovaquone proguanil is a combination of two medicines, atovaquone and proguanil hydrochloride, which work together to prevent and treat malaria. Each medicine attacks the malaria parasite in a different way, and together they are more effective than either one alone.
Importantly, atovaquone proguanil acts on the malaria parasite at the liver stage of its life cycle, before it has a chance to multiply in the blood. This is the reason you only need to continue it for 7 days after leaving a risk area, compared with 4 weeks for some other antimalarials.
It is highly effective against Plasmodium falciparum, the most dangerous species of malaria parasite and the one responsible for most malaria deaths. It is often chosen for travel to sub-Saharan Africa, parts of Asia and South America, including areas where the parasite has become resistant to older antimalarials such as chloroquine. Generic versions are widely available and work in exactly the same way as the branded product.
How Common Is Malaria?
Malaria remains one of the most significant health risks for travellers. According to the World Health Organization's World Malaria Report 2024, there were an estimated 263 million malaria cases and 597,000 malaria deaths worldwide in 2023, with the vast majority occurring in the WHO African Region (WHO). The NHS advises that malaria is a serious illness that can be fatal if not diagnosed and treated promptly, and that you should seek urgent help if you develop symptoms during or after travel (NHS).
Here in the UK, the UK Health Security Agency (UKHSA) publishes detailed malaria prevention guidelines for travellers, and notes that people visiting friends and relatives in their country of origin are among those most at risk (UKHSA). This is particularly relevant for many of our patients in Brixton and across South London, who travel regularly to see family in West Africa, East Africa and South Asia. Previous exposure to malaria does not give lasting immunity once you have lived in the UK for a while, so antimalarials are just as important for these trips.
Why Travellers Choose Atovaquone Proguanil
There are several antimalarials available in the UK, and the right one depends on your destination, health and preferences. Atovaquone proguanil is popular for a number of reasons:
- You only need to start it 1 to 2 days before you travel, which suits last-minute trips
- You only need to continue it for 7 days after leaving the risk area, rather than 4 weeks
- It is generally well tolerated, with side effects usually mild when they do occur
- It does not cause the sun sensitivity associated with doxycycline
- It is not associated with the mental health side effects linked to mefloquine
- Child-sized tablets are available, making it an option for families
The main downsides are that it must be taken every day and it tends to cost more than some alternatives, especially for longer trips.
Atovaquone Proguanil vs Other Antimalarials
| Feature | Atovaquone Proguanil | Doxycycline | Mefloquine |
|---|---|---|---|
| How often | Once daily | Once daily | Once weekly |
| Start before travel | 1 to 2 days | 1 to 2 days | 2 to 3 weeks |
| Continue after leaving | 7 days | 4 weeks | 4 weeks |
| Common side effects | Nausea, headache, stomach upset | Sun sensitivity, indigestion, thrush | Dizziness, sleep problems, mood changes |
| Points to consider | Higher cost on long trips | Not for children under 12 or in pregnancy | Not for people with a history of depression, anxiety or epilepsy |
When to Start Taking Atovaquone Proguanil
You should start taking atovaquone proguanil 1 to 2 days before you enter a malaria risk area. This allows the medication to reach effective levels in your body so that you are protected from the moment you arrive.
Remember that it is when you enter the risk area that matters, not simply your departure date from London. If you are spending the first few days of your trip in a malaria-free city before heading to a risk area, your clinician will help you work out the correct start date.
We recommend collecting your tablets at least a week before you travel. This gives you time to check you have the right number of tablets for the whole course, read the patient information leaflet and plan how you will fit the daily dose into your routine.
How to Take the Tablets
Atovaquone proguanil is taken once a day, ideally at the same time every day. Take each dose with food or a milky drink. This helps your body absorb the atovaquone component properly, and taking it on an empty stomach can reduce absorption and make stomach upset more likely.
Swallow the tablet whole with water where possible. For children who find it hard to swallow tablets, the tablet can be crushed and mixed with a small amount of food or a milky drink just before it is taken. Keeping your timing consistent helps maintain steady levels of the medicine in your body.
Atovaquone Proguanil Dosing at a Glance
Atovaquone proguanil comes in two strengths: an adult tablet and a paediatric tablet. The dose for prevention is based on body weight, and your prescriber will confirm the correct dose for each member of your travelling party.
| Body weight | Daily dose for prevention |
|---|---|
| Under 11kg | Specialist advice needed |
| 11kg to 20kg | 1 paediatric tablet |
| 21kg to 30kg | 2 paediatric tablets, taken together |
| 31kg to 40kg | 3 paediatric tablets, taken together |
| Over 40kg | 1 adult tablet (250mg atovaquone / 100mg proguanil) |
How Long to Keep Taking It
It is important to continue taking atovaquone proguanil for 7 days after leaving the malaria risk area. Parasites from a bite near the end of your trip may still be developing in your liver after you get home, and stopping the tablets too soon can leave you unprotected.
The typical course looks like this:
- 1 tablet daily for 1 to 2 days before entering the risk area
- 1 tablet daily every day while you are in the risk area
- 1 tablet daily for 7 days after leaving the risk area
Even if you feel well, or your trip ends earlier than planned, do not stop the course until those 7 days are complete.
What to Do If You Miss a Dose
If you forget to take a dose, take it as soon as you remember, ideally with food or a milky drink, and then carry on taking your tablets at the usual time. Never take two doses at once to make up for a missed one.
Missing doses can reduce protection, so it helps to build the tablet into a daily habit, such as breakfast or your evening meal, and to set a reminder on your phone. If you have missed several doses, speak to a pharmacist or doctor for advice, and take extra care with bite avoidance in the meantime.
What If You Vomit After Taking a Dose?
Stomach bugs are common when travelling, so it is worth knowing what to do. If you vomit within 1 hour of taking a dose, take another dose as soon as you can. If you have ongoing vomiting or diarrhoea, the medicine may not be absorbed properly and your protection could be reduced. In this situation:
- Seek medical advice locally, particularly if symptoms last more than a day or two
- Keep sipping fluids and use oral rehydration salts if available
- Be extra careful with mosquito bite prevention until you are well again
- Remember that fever, vomiting and diarrhoea can also be symptoms of malaria itself
Are There Any Side Effects?
Atovaquone proguanil is generally well tolerated, especially compared with some other antimalarials. However, like all medicines, it can cause side effects in some people. These may include:
- Nausea, stomach pain or indigestion
- Headache
- Diarrhoea
- Dizziness
- Mouth ulcers
- Vivid dreams or trouble sleeping
- Coughing
Taking the tablet with food usually reduces the chance of stomach upset. Rarely, more serious reactions can occur, such as an allergic reaction, a severe skin rash, or yellowing of the skin or eyes. If you notice any of these, stop taking the tablets and seek urgent medical help.
If you have any concerns about side effects, speak to one of our travel health specialists before you travel. We can talk you through what to expect and, if needed, suggest an alternative.
Can Everyone Take Atovaquone Proguanil?
Atovaquone proguanil is suitable for most adults and for children weighing 11kg or more. However, it may not be appropriate if you:
- Are pregnant, as it is generally only used if there is no suitable alternative
- Are breastfeeding, where it is usually avoided unless there is no suitable alternative
- Have severe kidney problems (creatinine clearance below 30 mL/min), in which case it is not recommended for prevention
- Have liver problems, which need to be reviewed by a clinician first
- Have had an allergic reaction to atovaquone, proguanil or any ingredient in the tablet
- Take certain medicines that may interact with it
During your pre-travel consultation at Brixton Travel Clinic, we will review your health history and current medicines to make sure atovaquone proguanil is safe and suitable for you and your trip.
Medicines That Can Interact with Atovaquone Proguanil
Some medicines can reduce how well atovaquone proguanil works, or be affected by it. Always tell your clinician about everything you take, including over-the-counter and herbal remedies. Medicines of particular note include:
- Warfarin and similar blood thinners, as proguanil may increase their effect
- Rifampicin and rifabutin, which can lower atovaquone levels
- Metoclopramide, an anti-sickness medicine that can reduce atovaquone absorption
- Tetracycline antibiotics
- Some HIV medicines, including efavirenz and boosted protease inhibitors
- Etoposide, a chemotherapy medicine
Travel Tips for Malaria Prevention
While atovaquone proguanil is highly effective, no antimalarial offers a complete guarantee. UK guidance recommends the ABCD approach: Awareness of risk, Bite prevention, Chemoprophylaxis (antimalarial tablets) and prompt Diagnosis and treatment. Malaria-carrying mosquitoes mainly bite between dusk and dawn, so you should always combine your tablets with other protective measures:
- Use an insect repellent containing DEET, reapplying regularly and after swimming
- Sleep under an insecticide-treated mosquito net, especially in rural areas
- Wear long sleeves and trousers after sunset
- Keep windows and doors screened or closed in the evenings
- Use plug-in insecticide vaporisers or air conditioning where available
Prevention is always better than cure, and malaria is a serious, potentially life-threatening illness.
- Pack your tablets in your hand luggage, not your checked bag, in case your suitcase goes missing
- Keep them in their original packaging with a copy of your prescription
- Take a few spare tablets in case your trip is extended
- Write down the date you leave the risk area and count 7 days from there
- Link your dose to a meal you eat every day, such as breakfast
- Store tablets in a cool, dry place away from direct sunlight
What to Do If You Develop a Fever During or After Travel
Symptoms of malaria can appear as early as a week after being bitten, but can also take much longer. UK guidance advises that anyone who develops a fever or flu-like illness within a year of returning from a malaria risk area, and especially within the first 3 months, should seek urgent medical attention. Symptoms can include:
- A high temperature, sweats and chills
- Headache and muscle pains
- Feeling or being sick, or diarrhoea
- Generally feeling unwell
Always tell the doctor or nurse where you have travelled, even if you took your antimalarials perfectly. Malaria can be diagnosed with a simple blood test, and early treatment makes a significant difference to outcomes.
Frequently Asked Questions
Can I drink alcohol while taking atovaquone proguanil?
Moderate drinking is not known to interact with atovaquone proguanil. However, heavy drinking can cause vomiting, which may stop the tablet being absorbed properly, and it also makes it easier to forget a dose. If you do drink, take your tablet with food at your usual time and keep your intake sensible. Remember that alcohol can also make you less careful about applying repellent and using your mosquito net in the evening.
Can I get atovaquone proguanil on the NHS?
Antimalarials taken to prevent malaria while travelling are not usually available on an NHS prescription. Instead, they are supplied privately following a consultation with a pharmacist or doctor, who will check that the medicine is suitable for you. At our Brixton clinic, we can assess your itinerary and health history and supply atovaquone proguanil or an alternative on the same day in most cases.
How effective is atovaquone proguanil?
Atovaquone proguanil is highly effective at preventing malaria when taken correctly, including against strains of Plasmodium falciparum that are resistant to older medicines. However, no antimalarial is 100% effective. Missing doses, stopping early, or not absorbing the medicine because of vomiting can all reduce protection, which is why bite prevention and prompt medical attention for any fever remain essential.
Can my children take atovaquone proguanil?
Yes, children weighing 11kg or more can take atovaquone proguanil using paediatric tablets, with the dose based on their weight. For children who struggle to swallow tablets, the tablet can be crushed and mixed with food or a milky drink just before giving it. For babies and toddlers under 11kg, specialist advice is needed. Children are particularly vulnerable to severe malaria, so it is worth bringing the whole family to your consultation.
Can I take atovaquone proguanil for a long trip?
Atovaquone proguanil is most often used for short and medium trips, but UK guidance supports its use for longer stays where appropriate. The main consideration on long trips is usually cost, as you need a tablet every day. If you are travelling for several months, your clinician will talk you through the options and help you choose the antimalarial that best fits your plans, budget and health.
Can I switch to atovaquone proguanil from another antimalarial?
Switching is sometimes possible, for example if you develop side effects from another medicine. However, the rules for switching depend on which antimalarial you are taking, how long you have been taking it and where you are in your trip, and getting it wrong can leave a gap in protection. Always speak to a pharmacist or doctor before changing medicines, and never stop one antimalarial without a plan in place.
What should I do if I feel ill after coming home?
If you develop a fever, chills, headache, aching muscles or a flu-like illness after returning from a malaria risk area, seek urgent medical help the same day, even if you completed your course of tablets. Contact NHS 111 or your GP, or go to A&E if you feel very unwell, and make sure you mention your recent travel. This applies for up to a year after your trip, and especially in the first 3 months.
Book Your Travel Consultation Today
At Brixton Travel Clinic, we provide comprehensive travel healthcare services, including private prescriptions for atovaquone proguanil and other antimalarials. Our experienced pharmacists and clinicians will assess your itinerary, health history and personal preferences to make sure you are fully protected, and can also review any vaccinations you may need for the same trip.
This guide is intended as general information and is no substitute for a personal assessment. Don't leave malaria protection to the last minute. You can reserve your appointment online, visit us in Brixton at 222 Coldharbour Ln, London SW9 8SA, or speak to our team on 02077334075 if you would like to talk through your plans first.
You are also welcome to use the form below to book directly with us.
