OMG SYRIA

[brigdh]

As I am preparing to go to OMG SYRIA (about which, seriously, I will post in more detail soon), today I picked up my necessary medications to bring, including anti-malarias.

See, the thing is, every single person I know who has gone on anti-malarias has had bad reactions to them, in each case severe enough to stop taking them. Generally the stories I've heard have been about psychological reactions- severe paranoia, mood swings, vivid nightmares, etc. But I also know a girl who had been taking them for about a month when she had a severe physical reaction to them caused by an overdose (she's a very petite woman, and so had probably been taking much more than she needed for her height/weight, since they give everyone the same amount. This aspect of the story does not comfort me at all, since I am also fairly small, and tend to react strongly to painkillers- though I have no idea if that's a parallel I can extend to something like anti-malarias). Anyway, she stopped taking them, since once you have that sort of reaction you will have it again if you ever try to take the same medicine, but stayed at the project she was on, and then caught malaria. Fun times!

I am already paranoid about the side-effects of medicines, so now I'm very worried. On the other hand, of course I do not want to catch malaria. Though, in truth, it's not really that common in Northern Syria.

Does anyone know anything about anti-malarias? If I do something like take them every other week instead of once a week, or take a half-dose each time instead, will that work, or will that just be harder on my body? I've got chloroquine, if it makes a difference. Alternately, does anyone have stories of time when anti-malarias did not go horribly wrong? I will be reassured by hearing of people who took them without problems.

Comments

[p-zeitgeist.livejournal.com]

I don't know off the top of my head, but I'll see what I can find out. I would guess, if I had to, that you can and perhaps even should titrate the dose to your body weight, especially given your history of hypersensitivity to drugs. It doesn't make a lot of sense to me that a hundred-pound woman would need the same dose of a drug that a 200-pound guy would need.

You're planning on bringing bed nets, right? Using them consistently and carefully cuts down the risk a lot -- or at least, so I've heard in connection with travel in Africa. I imagine the relevant mosquito species may be different in Syria, and therefore have different behavior patterns. But I still think it's worth doing, even if you are taking anti-malarials diligently.

[wordsofastory.livejournal.com]

I do have mosquito nets- they make it much easier to sleep, even if disease isn't at all an issue. And I've got general bug repellent and so forth, though of course the main time the mosquitoes come out is at night.

All the information that came with the medicine just says to take "as your doctor recommended", which is pretty obvious, but I want more information.

[telophase.livejournal.com]

I lived in Tanzania for two years as a kid. We started being sloppy about taking the antimalarials. I caught malaria. We stopped being sloppy about taking antimalarials. :)

That being said, if you find you're getting unacceptable side effects, then stop taking the meds. What's unacceptable is up to you - a friend of mine who went on a dig in Belize continued taking his even though it gave him hallucinations and made him hear voices,* because he considered the alternative of getting malaria worse.

But do use the mosquito net properly and consistently, and try to wear long sleeves and long pants at night, to cut down the number of mosquitoes biting you. If you get malaria and get it treated promptly, provided you don't get the nastiest strain, you'll probably be fine and not have relapses. I got my treatment shortly after the symptoms showed up**, we managed to knock it out, and I've never had a relapse. 12 years without relapses and they consider you cured.


ETA: I don't remember any side effects, but it was long enough ago that you'll be taking anti-malarials that have almost no relation to the ones we took, so my experience isn't relevant.

* He said he liked lying in bed and night watching the fish swim around the ceiling, but the voice that occasionally told him to kill himself wasn't so much fun.

** The decisive symptom being throwing up on the doctor.

[hazard-us.livejournal.com]

I don't know how long you are going, but I have gotten away with two to three week trips to malarial countries and not contracted malaria by being diligent about using DEET bug spray and insecticide-treated bed nets.

Have fun though! I'm really jealous!

[lynndyre.livejournal.com]

From this (http://en.wikipedia.org/wiki/Chloroquine), it seems like the volume of distribution and diffusion into adipose tissue means that your body fat level would affect how much of it you needed to be taking. (Also, conveniently, there are chloroquinine-resistant strains of malaria in all malarial areas of the world, so mosquito-net vigilance is key regardless)

I would suggest ringing up your/a doctor and asking them how/if doses can be varied without ill effect?

[wordsofastory.livejournal.com]

I'll be there for nine weeks, which is certainly long enough to contract it. But also long enough to really worry about too much of the drug building up! So, quandaries.

Thank you, though!

[miep.livejournal.com]

can't you just drink a lot of gin and tonics instead? secretly?

[rm.livejournal.com]

Yeah sounds like your weight and your BMI are both at issue here.

[backwards7.livejournal.com]

Chloroquine is relatively benign and you are unlikely to have problems with it. However it's no longer terribly effective against Malaria. You need to check whether the malaria in the regions you will be visiting is Chloroquine resistant.

Other more potent anti-malarials can have nasty longterm side effects. It's hobson's choice and one you alone have to make. I've never used anything stronger than Chloroquine but I made that decision in the knowledge that malaria, if you catch it, can kill you very quickly.

Alos bear in mind that malaria is one of many equally nasty mosquito-borne diseases. Use a mosquito net (I would bring your own because the ones you find in hotels are likely to be torn) and apply an effective insect repellent.

[mme-furiosa.livejournal.com]

How long are you going to be there?

I just returned from 3 months in SE Asia, and I have done much longer stints in other tropics. I'm cursed, because mosquitoes really, really like me. I am also super-tiny. Plus I hate pharmaceuticals.

I have never once taken an antimalarial.

I have seen a lot of people have really bad reactions. My recommendation is that you take a lot of B vitamins, use a net, and slather on your repellent of choice (which you have to bring with you from home).

This has never failed me.

[p-zeitgeist.livejournal.com]

Given the reported issues with vision, it does sound as if you should discuss the use of this anti-malarial with an opthamologist familiar with your medical history before you take any of it. It could well be that even though other anti-malarials have a worse side-effect profile in general, one of them would be safer for you in particular. That the others have less of an issue with resistance is only an incidental bonus.

But seriously, if I were you I'd check that out. You don't want to suddenly need an opthamologist or specialist surgeon when you're out on a dig in Syria.

[feyandstrange.livejournal.com]

(Hi there! archaeologist's daughter here via rm)

according to this, the risks are pretty low:
http://www.fitfortravel.scot.nhs.uk/destinations/malariamaps/syria.htm

which I picked for the handy map, but other sources (like WHO: http://www.who.int/ith/countries/syr/en/)seem to confirm that if you aren't on the northern border, the risk is pretty low. I'd be more worried about water purification than malaria, but bed nets and pesticide never hurt.

It also looks as if the little malaria present in Syria isn't Chloroquine -resistant. The dose for Chloroquine in children 8.3 mg/kg salt (5 mg/kg base) once weekly; adult dose is 500 mg of the salt per week. Usually that's one tablet with a meal, ideally on a day where a little nausea is okay. Take the dose with food and water and some of the side effects will be a lot less. Obviously, check with a doctor or health pro familiar with malaria if you can, and especially the dosage levels. And don't forget to keep taking it before and after, and ask your doc if you should take any further actions if you feel like you have malarial symptoms - I think chloriquine is the one which you can take a bigger dose of if you feel ill and sometimes ward of a full attac.

http://www.travmed.com/trip_prep/medications.htm
http://www.travmed.com/trip_prep/malaria.htm

[graene.livejournal.com]

Or just a lot of tonic water? Maybe with lime as I'm doing for a while longer yet.

[random-girl.livejournal.com]

The British used to use the quainine in tonic water in their gin and tonics to prevent getting it. If you have to go off your meds, you can certainly try just the tonic water (not sure if you really need the gin).

Have you talked to your doctor? If you have time before you leave, maybe you can start on the meds before you go with enough time to see if any side affects occur BEFORE your thousands of miles from help.

[rezendi.livejournal.com]

I have travelled very extensively in malarial regions and wouldn't bother with antimalarial drugs in northern Syria. Malaria is really not as scary as it sounds: it's rarely any worse than a bad flu, it's eminently curable, and the WHO always makes the odds of catching sound higher than they are.

That said, how recent are these tales of psychological reactions to antimalarials? Because this is certainly true of Lariam, aka mefloquine, an older drug - but Malarone, a more recent (last few years) antimalarial, has occasionally been accused of causing headaches and abdominal pain, but I haven't heard anything about psychological effects. Similarly, chloroquine and paludrine are considered relatively harmless.

I'd say about 50% of the (many) people I've known/met who took Lariam for extended periods (including me) had some level of negative psychological side effects. 0% of the (equally many) people who took the other drugs.

[wordkink.livejournal.com]

For a trip to Honduras I was made to take Malaria pills with no ill effects, but we weren't there long enough to really risk anything.

Having had Denge Fever twice, however, is not on my short list for anyone else to try and enjoy so I very, very much agree with all the mosquito netting advice. I also suggest that you avoid DEET insect repellents in combination with any kind of synthetic material based clothing. It will actually eat through the plastic that makes up the fabric.

Also, as someone who sells travel and outdoor gear for a living let me suggest ExOfficio brand BuzzOff (http://www.rei.com/Search.do?x=0&y=0&vcat=REI_SEARCH&query=buzz+off&cat=4500013&hist=x%2C0%5Ey%2C0%5Equery%2Cbuzz+off%5Ecat%2C4500013%3AWomen%27s) clothing. We sell it at REI for a fairly competitive price and the stuff works like gang busters. If that's out of your price range (totally understandable!) then the Sawyers brand of wash in Permethrin (http://www.rei.com/product/734901) (sp?) is also very effective.

Having already cautioned you away from DEET I should mention that in my family we live by the Burt's Bees brand insect repellent (http://www.rei.com/product/751054). It works fantastically well and doesn't have any of the negatives of DEET, though you do have to apply it a bit more frequently. Though this, for the most part, means applying it twice a day verses once, and even then you're supposed to wash off DEET as frequently as possible.

...Um. Yes. If there's any kind of mosquito-fighting alternative you'd like to know more about, just ask. I know unreasonable amounts concerning these kinds of things, so fire away.

Also I'm so jealous of how awesome your trip is going to be! Heh!

[moem]

Hi... found this post through rm's journal.
I have traveled across Africa by motorcycle in 2000.
I took Lariam. It's one of those prophylaxes you keep hearing scary stories about. I can honestly tell you that neither me nor my travel companion had any adverse side effects at all.
I found that my dreams were a bit more vivid and easier to remember. They weren't nightmares; just normal dreams. That's all!
So it's possible.

It's good to know that you should never drink any drink that has quinine in it if you're on Lariam. No tonic, no bitter lemon.

[wordsofastory.livejournal.com]

I've called my doctor, but she's out of the office until Monday, and I figured it couldn't hurt to see if the accumulated experience of LJ had anything to say.

[wordsofastory.livejournal.com]

Hee! That would be awesome.

[wordsofastory.livejournal.com]

Ah, but it's not quite as much fun without the alcohol!

[wordsofastory.livejournal.com]

Chloroquine is still effective in Syria, and is the recommended medicine for that area.

[wordsofastory.livejournal.com]

I'll be there for 9 weeks.

I'd never heard that about B vitamins before, thank you.

[wordsofastory.livejournal.com]

Heh, true.

I'm not worried about having an allergic reaction to the medicine- what I'm worried about is the build-up of the drug in my system over time, as that's the problem most people I know have had with it. Regardless, though, you are supposed to start anti-malarias a week before you leave.

[wordsofastory.livejournal.com]

The most recent story I heard was just last year, and the others are all withing the last 5 or 10 years. But I'm glad to know you've known a lot of people who didn't have a reaction at all. Thank you!

[wordsofastory.livejournal.com]

Thank you! I'm glad to hear that some people have taken the drugs without problems.

And that's a good tip!

[wordsofastory.livejournal.com]

I am really glad dengue fever is not an issue, and I've got vaccinations for typhoid and Hep A now. Also, super special anti-biotics, in case of general "bad water" -ness.

Oh, man, that clothing line looks awesome! I might get the handkerchief at least, since I need one. Thanks so much!

[wordsofastory.livejournal.com]

Thanks! Good to hear some other people's stories.

[graene.livejournal.com]

Too true, however drinking while nursing is generally considered irresponsible, as is being drunk at work, not to mention dehydration in a desert. With my concern, it is also much easier to get most friends to order me a tonic and lime than a Shirley Temple.

[lizmopuddy.livejournal.com]

MrPuddy goes kayaking in Africa most years, he always reacted very badly to anti-malarials until last year when a new one came out called Malarone, it is the first anti-malaraial that he, or any member of his party have not had a bad reaction to. In previous years members of their travelling party contracted malaria, so it's definitely not worth the risk to go without.

[lady-ganesh.livejournal.com]

I had a friend who had a bad reaction, refused to take them, and died. Please take them.

[lady-ganesh.livejournal.com]

Modern tonic water doesn't have enough quinine, sadly. You can get prescription quinine, though, or at least you could. My mom used to take it for leg cramps.

[a1onzo-alonzo7.livejournal.com]

Yeah!

[anton1o8881.livejournal.com]

That's good to know.