Version July 2025
| Drug | Tablet size | Dose | Frequency* | Initiation (time before first exposure to malaria) | Discontinuation (time after last exposure) | Use in pregnancy | Additional comments |
| Drug regimens for primary prophylaxis¶Δ | |||||||
| Atovaquone-proguanil (Malarone) | 250 mg atovaquone and 100 mg proguanil | 1 tablet orally | Once daily | 1 to 2 days | 7 days | No; insufficient data on use in pregnancy | Cannot be used in patients with severe kidney impairment. Administer with food. |
| Doxycycline hyclate (Vibramycin, Vibra-Tabs, other brands, and generic agents); doxycycline monohydrate (Monodox, Adoxa, and generic agents) | 100 mg | 1 tablet orally | Once daily | 1 to 2 days | 4 weeks | No; teratogenic | Doxycycline can also prevent other infections (such as rickettsial infections, leptospirosis). Gastrointestinal adverse effects include abdominal discomfort, nausea, and vomiting. Photosensitivity reactions can occur. Avoid administration with calcium, magnesium, iron, or aluminum. |
| Mefloquine hydrochloride (Lariam and generic agents)Δ | 250 mg salt (228 mg base) | 1 tablet orally | Once weekly | 3 weeks preferable; 2 weeks acceptable | 4 weeks | Yes | Contraindicated for patients with neurologic and psychiatric disorders. Not recommended for patients with arrhythmia. |
| Tafenoquine (Arakoda)◊ | 100 mg | 2 tablets orally | Loading dose once daily for 3 days, then once a week starting 7 days after the last loading dose | Loading dose 3 days prior to trip | 1 week after trip | No; unknown G6PD status of fetus | Requires G6PD testing. Contraindicated in patients with history of psychosis. |
| Chloroquine phosphate (Aralen and generic agents; for areas with exclusively chloroquine-sensitive malaria§) | 500 mg salt (300 mg base) | 1 tablet orally | Once weekly | 1 to 2 weeks | 4 weeks | Yes | Can exacerbate psoriasis. |
| Hydroxychloroquine sulfate (Plaquenil; for areas with exclusively chloroquine-sensitive malaria§) | 400 mg salt (310 mg base) | 1 tablet orally | Once weekly | 1 to 2 weeks | 4 weeks | Yes | Can exacerbate psoriasis. |
| Primaquine phosphate◊ (for short duration travel to areas with principally Plasmodium vivax; off-label use¥) | 26.3 mg salt (15 mg base) | 2 tablets orally | Once daily | 1 to 2 days | 7 days | No; unknown G6PD status of fetus | Requires G6PD testing. May cause gastrointestinal upset; should be taken with food. |
| Presumptive antirelapse therapy (PART) to prevent relapse due to P. vivax or Plasmodium ovale‡ | |||||||
| Primaquine phosphate◊ | 26.3 mg salt (15 mg base) | 2 tablets orally | Once daily | Approach should be guided by agent used for primary prophylaxis‡ | 14 days | No; unknown G6PD status of fetus | Requires G6PD testing. |
G6PD: glucose-6-phosphate dehydrogenase.
* Drugs administered once daily should be taken at the same time each day; drugs administered once weekly should be taken on the same day each week.
¶ Chloroquine-resistant Plasmodium falciparum is widespread in endemic areas of Africa, Asia, and Oceania; for nonpregnant travelers to these regions, prophylaxis options include atovaquone-proguanil, doxycycline, mefloquine, or tafenoquine.
Δ Mefloquine-resistant P. falciparum has been confirmed in Southeast Asia on the borders of Thailand with Burma (Myanmar) and Cambodia, in the western provinces of Cambodia, in the eastern states of Burma on the border between Burma and China, along the borders of Burma and Laos, and in southern Vietnam. For these destinations, prophylaxis options are atovaquone-proguanil, doxycycline, or tafenoquine.
◊ A quantitative G6PD test must be done to rule out G6PD deficiency prior to the first administration of primaquine or tafenoquine. Note that qualitative G6PD testing can miss those with moderate deficiency and is not sufficient to establish normal G6PD activity. Refer to the UpToDate text for further discussion.
§ Chloroquine-sensitive P. falciparum exists in Haiti, the Caribbean, and in Central America west and north of the Panama Canal.
¥ P. vivax is the predominant species (>90%) in Mexico, parts of Central America, Cambodia, North Korea, and South Korea.
‡ Refer to UpToDate text for PART indications. Travelers should take primaquine for 14 days after leaving a malaria-endemic area, concurrently with their primary prophylaxis medication. If atovaquone-proguanil is used for primary prophylaxis, travelers can take primaquine during the final 7 days of atovaquone-proguanil, and then for an additional 7 days. If chloroquine, doxycycline, or mefloquine are used for primary prophylaxis, prescribe primaquine for travelers to take during the last 2 weeks of postexposure prophylaxis. If concurrent administration of primary and terminal prophylaxis is not feasible, instruct travelers to take primaquine after completing their primary prophylaxis medication. PART is not needed if primaquine or tafenoquine is used as primary prophylaxis.
