The human pin cushion for Africa trip

A couple of weeks ago, I headed down to the local health clinic to get the proper shots for my first trip to Africa.

As I walked in – I realized it was the first day before school and the waiting room was packed with kids waiting for their immunizations.

The lovely receptionist asked where I was traveling to. I told her I was traveling to Kenya, Nigeria, and Ghana for the first time. She typed furiously into her computer, clicked a bunch of buttons, and asked if I had ever had a massive lists of shots.

Back to the waiting room till my name was called. I headed back to the room, where the nurse had quite the arsenal laid out. Eight shots in all – in various vials, with needles galore. She was quite a pro – sticking me in my right arm, then my left arm, then mixing it up and doing a double in the right, and then a double in the left. It was a dizzying blur of pain in both arms. How can anyone do heroin?

I thought I was done, but she had saved the best for last. On top of all the shots, I also needed to take Malaria pills. She handed me a sheet and as I scanned my options, it looked pretty bleak.

Option #1 – Mefloquine. 250mg by mouth weekly, same day of each week. Possible Side effects: Headache, nausea, dizziness, difficulty sleeping, anxiety, vivid dream (aka nightmares), visual disturbances, GI disturbance, insomnia, depression, agitation, restlessness, mood change.

Pros: Well, you do only have to take it once a week and visual disturbances could be like legally experiencing LSD.

Cons: What kind of seat mate am I going to be if I’m going through agitation and GI disturbances on the plane? I love how they soften nightmares as “vivid dreams” and it seems I would be an emotional basket case as well with visual disturbances.

Option #2 – Chloroquine – 500 mg by mouth weekly, same day of each week. Possible side effects: Nausea, vomiting, headache, sleep disturbance, dizziness, blurred vision, itching may worsen symptoms of psoriasis, temporary hair loss.

Pros: Once again side effect of sleep disturbance. But I never sleep on planes anyway so it wouldn’t be that bad. Plus you only have to take it once a week again.

Cons: Temporary hair loss? I’ve been blessed with a full mane and I’m not sure I want to see that fall off. We have improved to only having to endure blurred vision and dizziness – no more visual disturbances.

Option #3 – Malarone. 250mg by mouth daily starting 1-2 days before. Take with food or a milky drink. Possible side effects: Stomach pain, nausea, vomiting, headache.

Pros:The list of side effects is dwindling though you do have to take the pills quite a few days in a row and who doesn’t want a milky drink?

Cons:I’m still not sure I can deal with vomiting on a plane though. Once I was traveling with my family to Denmark in a 5 seat row. The poor guy in the middle seat got sick half way through and had to use the airsickness bag pretty much the whole flight. He even had his Denmark flag shirt as he was meeting some girl he had met online.

Option #4: Doxycycline. 100 mg by mouth daily starting 1-2 days before, during and continue for 4 weeks after leaving area. Side effects: Sun sensitivity, nausea, stomach pain.

Pros: Seems to me the medicine with the least amount of side effects. I can probably deal with stomach pain.

Cons: If you miss one day of taking this one, it’s as if you haven’t taken it at all. Can I possibly remember to take a pill every day? Sun sensitivity? My skin type already burns after about 30 minutes in the sun – this will probably speed that up to 15.

Cast your vote in the comments section on which of the four I should take!

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  1. I took Mefloquine (Larium) for over 6 years and it was fine. A few bad dreams the first week but never after. A lot of my friends take Doxy since it’s cheap and seems to work ok. Also, mefloquine is very expensive. I buy it in Africa for $1/pill so it’s no problem.

  2. If you choose Doxy it def will give you nausea on an empty stomach but no problem with food. That’s why you take all of this early to see how your body reacts. Chloroquine is too bitter to take. Awful stuff.

  3. Remember that these are possible side effects. Obviously most of the side effects wouldn’t come true or no one would take them. Don’t you love how most anti-depressants list suicidal thoughts as a possible side effect, for instance?

    I took Malarone on recent South Africa trip and experienced no side effects other than a lightened wallet.

  4. I think Dave will enjoy you waking him up every 30 min on the plane thinking he’s a serial killer…

    I’d go for the sun sensitivity, there’s not much sun in Africa, is there?

  5. Inject yourself with a retrovirus carrying a Tet-regulated transgene that expresses green fluorescent protein. Then when you take the doxycycline, you’ll glow green under a UV lamp. (Better route yourself through eastern Europe on the way back!)

  6. I took malarone during my trip to India and I didn’t suffer from any of those side effects. Make sure you carry your medicine with you in your hand luggage!

  7. I was in South Africa and Zimbabwe in March and used Mefloquine without a problem. Ask your doctor for a 2 week trial and test it out before you travel, that way if you have rough issues you are home abduction your trip isn’t ruined. I had no issues withthis drug (none whatsoever) but my partner had horrible dreams. We both did a pre trip trial and it was a trip saver!

    Enjoy your trip, look forward to reading all about it.

  8. This is a YMMV thing. My fiance and I took Malarone and had terrible stomach issues. Someone I know took it, though and had no problems. I’ve also heard stories of folks on Mefloquine going batty. So good luck whichever you choose!

  9. I am a pharmacist and I actually just had travel clinic training. Chloroquine is not effective against malaria in any of those countries, I am suprised they gave that as an option. The remaining three are all effective. the Doxy is easily the least expensive, but outside of concern over the side effects, that has to be taken for four weeks after your trip (and that’s daily)! The mefloquine is a little easier in that sense, still take through 4 weeks after trip, but only once weekly. Malarone is once daily but you only have to take it through 1 week after return. It is also the most expensive. Everyone reacts differently to each drug. As suggested above consider doing a trial with 1 mefloquine. Also, check with your prescription insurance to see if they will cover these medications, sometimes they require special prior authorization, which can add a week to the process. Weigh the side effects, convenience, and cost considering they are all effective.
    Have a great trip!

  10. I just got back from Kenya/Tanzania and I took Malarone. You only need to take it the day before entering affected area… so let’s say if you fly into Nairobi and stay there overnight, then you can take it when you arrive. I didn’t experience any side affects. In fact, I also took some meclizine (motion sickness) when scuba diving in Zanzibar and did not have any side affects nor conflicts.

    Have a great trip.

  11. I took Mefloquine years back on a trip to Papua New Guenia. Vivid dreams is a great description. No nightmares but the dreams were crazy real feeling. Kind of enjoyed it.

  12. I have used Malarone for Ghana/Nigeria. Mefloquine (Larium) can be bad for some people. A colleague of mine experienced bizarre nightmares and had to stop taking it. I have taken Larium with no negative issues. Check the CDC web site for more information (http://wwwnc.cdc.gov/travel/).

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