Malaria tablets compared — Malarone vs doxycycline vs Lariam

Why this matters

Malaria remains one of the most serious health risks for UK travellers to many parts of sub-Saharan Africa, parts of Asia, Latin America, and some Pacific islands. UK guidance via NaTHNaC and UKHSA recommends chemoprophylaxis (preventive tablets) for travellers to most malaria-endemic regions, alongside bite-prevention measures. Picking the right drug for your trip, taking it correctly, and completing the post-trip course are the three things that determine whether prophylaxis actually works.

This guide compares the three standard UK options. It's not exhaustive (there are scenarios where other drugs are used, particularly in pregnancy or specific resistance contexts), but it covers what most travellers will be choosing between in a UK travel consultation.

Malarone (atovaquone-proguanil) — the modern default

Malarone is the brand name for the fixed combination atovaquone 250 mg / proguanil 100 mg, taken as one tablet daily with food. Generic atovaquone-proguanil is also available at lower cost. It's the most commonly chosen option for UK travellers in 2026 for several practical reasons.

How it works. Combines two drugs working at different points of the malaria parasite life cycle, including the early liver stage. The liver-stage activity is what allows the short post-trip course.

Dosing schedule.

• Start: 1–2 days before entering the malaria area.
• During: one tablet daily, with food, at roughly the same time each day.
• After: 7 days after leaving the malaria area.

Side effects. Generally mild: occasional GI upset, mild headache, occasional vivid dreams. Most patients tolerate it well. Should be taken with food to minimise GI upset and improve absorption.

Best for: Most travellers, especially shorter trips, last-minute travel, travellers concerned about side effects, those who prefer the shortest possible post-trip course.

Cost. Higher per-day cost than doxycycline. Generic atovaquone-proguanil is meaningfully cheaper than branded Malarone.

Doxycycline — the budget option that's also effective

Doxycycline is a tetracycline antibiotic, taken as 100 mg daily. It's the cheapest of the three by some margin and has a long track record in malaria prophylaxis.

How it works. Acts on the blood stage of the malaria parasite. No liver-stage activity, which is why the post-trip course is longer.

Dosing schedule.

• Start: 1–2 days before entering the malaria area.
• During: one tablet daily, taken with a large glass of water, sitting or standing upright for 30 minutes afterwards (to prevent oesophageal irritation).
• After: 4 weeks after leaving the malaria area.

Side effects. Sun sensitivity (high-SPF sunscreen and hat essential), oesophageal irritation if tablet sits in oesophagus, GI upset, candida overgrowth (thrush) particularly in women, occasional dental staining (though this is mainly a concern in children under 12).

Best for: Longer trips where Malarone cost mounts up, travellers without sun-sensitive skin or with good sun-protection discipline, doxycycline-experienced travellers, those who can reliably take it with water and stay upright afterwards.

Not suitable for: Children under 12 (dental staining), pregnant women, breastfeeding women (depends on infant age), people with significant oesophageal problems.

Cost. Cheapest of the three options. For long trips, the cost difference vs Malarone is substantial.

Lariam (mefloquine) — once a week, with caveats

Lariam is the brand name for mefloquine, taken as one 250 mg tablet weekly. It was the original 'long-trip' option due to weekly dosing, but its neuropsychiatric side effect profile has moved it down the typical first-choice list.

How it works. Acts on the blood stage of the parasite. Long half-life allows weekly dosing.

Dosing schedule.

• Start: 2–3 weeks before entering the malaria area (partly so any psychiatric side effects emerge before you're committed in the field).
• During: one tablet weekly, same day each week, with food.
• After: 4 weeks after leaving the malaria area.

Side effects. The MHRA has issued specific warnings about neuropsychiatric side effects: vivid dreams, sleep disturbance, anxiety, depression, occasional psychosis, rarely suicidal thoughts. GI side effects and headache also possible. The neuropsychiatric profile is the reason for the 2–3 week lead-in — if symptoms emerge you can switch before travel.

Contraindications. Personal or family history of depression, anxiety disorders, epilepsy, psychosis, schizophrenia, or other significant psychiatric conditions. Not for travellers requiring fine motor coordination (pilots, divers requiring precise tasks).

Best for: Travellers who've previously tolerated mefloquine well, very long trips where weekly dosing is preferred over daily, scenarios where Malarone and doxycycline aren't suitable. Less commonly first-choice for new users in 2026.

Cost. Middle ground between Malarone and doxycycline.

The practical comparison table

Summary at a glance:

• Dosing: Malarone daily · Doxycycline daily · Lariam weekly
• Start before trip: Malarone 1–2 days · Doxycycline 1–2 days · Lariam 2–3 weeks
• Continue after trip: Malarone 7 days · Doxycycline 4 weeks · Lariam 4 weeks
• Total tablets for a 2-week trip: Malarone ~16–18 · Doxycycline ~30 · Lariam ~7–9 doses over ~7 weeks
• Main side effects: Malarone mild GI · Doxycycline sun sensitivity, thrush · Lariam neuropsychiatric
• Cost (rough order): Doxycycline cheapest · Lariam middle · Malarone most expensive (generic cheaper than branded)
• Children: Malarone from 5 kg · Doxycycline not under 12 years · Lariam from 5 kg with caution
• Pregnancy: Specialist advice for each — see consultation

Decision framework

The questions worth working through with a clinician:

1. What's your destination's specific malaria pattern? Some regions tilt toward specific drugs.
2. What's the trip length? Longer trips amplify cost differences and tolerability matters more.
3. Any medical contraindications? Psychiatric history rules out Lariam; pregnancy or under-12 children rule out doxycycline; etc.
4. Past experience? If you've tolerated one well, that's usually the right choice.
5. How sun-sensitive are you? Doxycycline can amplify sunburn risk.
6. How disciplined are you with daily tablets? Daily dosing requires consistency.
7. Budget? Real factor for long trips and family groups.

Bite prevention — not optional

Chemoprophylaxis reduces malaria risk substantially but doesn't eliminate it. Bite prevention measures are essential alongside, not instead of, tablets:

• DEET-based repellent (20–50%) on exposed skin, reapplied as instructed.
• Long sleeves and trousers, especially at dusk, dawn, and night.
• Treated bednets for accommodation without screens.
• Air-conditioned or well-screened rooms where possible.
• Avoid standing water around accommodation.

What about when you're already in the malaria area?

If you forget a dose, take it as soon as you remember (within the normal dosing window). Never double up. If you've missed more than 24 hours of a daily medication, or your weekly dose by more than 24 hours, contact a clinician.

If you develop a fever during or up to 12 months after travel to a malaria area, mention the travel and seek medical assessment quickly. Malaria can present long after exposure and is potentially life-threatening if untreated.

Pregnancy, breastfeeding, and children

Specialist advice is needed in each case:

• Pregnancy: Malarone usually avoided in first trimester (limited data); doxycycline contraindicated; Lariam may be considered after the first trimester in specific scenarios.
• Breastfeeding: Depends on infant age and drug.
• Children: Malarone available in paediatric doses from 5 kg body weight; doxycycline not under 12 years; Lariam from 5 kg with caution.

If you're pregnant, breastfeeding, or travelling with young children to a malaria area, talk to a clinician early — the options narrow and you may need additional measures.

How this fits with the wider travel consultation

Malaria prophylaxis is one component of travel health planning. Your consultation will also cover vaccines for your destination, food and water safety, insect-bite prevention, altitude considerations where relevant, and chronic medication planning. For destination-specific guides see India, Bangladesh, Pakistan, and East Africa.

The next step

The most useful single step is a travel consultation 4–6 weeks before departure. We have all three options in stock and can prescribe and dispense same-day for eligible patients. Bring your itinerary, medical history, and details of any previous travel meds you've taken.