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Malarone vs Chloroquine
Introduction
For patients at risk of or dealing with malaria, there are specific drugs that can prevent the disease and manage its symptoms. Malarone and Chloroquine are two such medications commonly prescribed for malaria prevention and treatment. They both work by killing the malaria parasite in red blood cells, thus preventing the spread of infection within the body. However, they differ in their chemical compositions and mechanisms of action.
Malarone is a combination drug consisting of Atovaquone and Proguanil. It works by inhibiting mitochondrial electron transport (Atovaquone) and disrupting folic acid synthesis (Proguanil) in the malaria parasite, which leads to its death.
Chloroquine on the other hand primarily influences heme molecules within malarial parasites to interrupt their lifecycle effectively. Due to increasing resistance issues worldwide, Chloroquine's usage has been limited mostly to treating Plasmodium vivax or ovale infections.
Malarone vs Chloroquine Side By Side
| Attribute | Malarone | Chloroquine |
|---|---|---|
| Brand Name | Malarone | Chloroquine |
| Contraindications | Severe kidney problems, use of certain antibiotics (such as rifampin), antacids, or kaolin | People with a history of liver diseases, severe kidney problems |
| Cost | About $180 for 12 tablets (brand name), $4-$10/tablet (generic) | Approximately $30–$50 for six tablets (500mg each), under a dollar up to several dollars per tablet (generic) |
| Generic Name | Atovaquone/Proguanil | Chloroquine Phosphate |
| Most Serious Side Effect | Severe skin reactions, vision problems, cardiac issues, symptoms of low sodium levels, severe nervous system reaction | Vision problems, muscle weakness leading to an irregular heartbeat, severe skin reactions, low blood cell counts |
| Severe Drug Interactions | Certain antibiotics, antacids, or kaolin can interfere with absorption and effectiveness | Not specified in the provided text, but generally, caution is advised with other medications that can affect heart rhythm or interact with Chloroquine's metabolism |
| Typical Dose | 1 tablet per day for prophylaxis, four tablets once daily for treatment | 500 mg per week for prevention, starting two weeks before exposure and continuing for four weeks after leaving the malarial region |
What is Malarone?
Atovaquone/Proguanil (the generic name for Malarone) is a combination medication that was developed as a newer class of antimalarial drugs, presenting an innovative approach compared to the traditional antimalarial known as Chloroquine. Atovaquone/Proguanil was first approved by the FDA in 2000. Malarone works by inhibiting two processes necessary for the growth and reproduction of malaria parasites within red blood cells, effectively reducing their lifespan and ability to multiply. It is prescribed for both treatment and prophylaxis against certain strains of malaria. Malarone's dual-action mechanism specifically targets Plasmodium falciparum with minimal effect on human cells, which results in it having fewer side effects than older medications like Chloroquine that can affect other cell functions.
What conditions is Malarone approved to treat?
Malarone is approved for the prevention and treatment of certain types of malaria:
- Prevention of Plasmodium falciparum malaria, including in areas where chloroquine resistance has been reported
- Treatment of acute, uncomplicated P. falciparum malaria
How does Malarone help with these illnesses?
Malarone is an effective medication for the prevention and treatment of malaria. It works by interfering with the growth cycle of the Plasmodium parasite, which is responsible for causing malaria in humans. Malarone does this by inhibiting two key enzymes required for its reproduction - dihydrofolate reductase and dihydropteroate synthetase, thereby preventing the spread of infection within a person's bloodstream.
Chloroquine also treats and prevents malaria but does so differently than Malarone. Chloroquine disrupts vital biochemical processes in the parasites leading to their death. Specifically, chloroquine interferes with parasites' ability to break down hemoglobin, a protein found in red blood cells that they ingest as part of their lifecycle.
Both drugs are useful against different strains of malarial infections due to varying resistance patterns around the world. The choice between them often depends on factors such as travel destination, individual health conditions and potential side effects.
What is Chloroquine?
Chloroquine is a medication primarily used for the prevention and treatment of malaria. It functions by interfering with the growth of parasites in the red blood cells, specifically those caused by Plasmodium species which are responsible for malaria. Chloroquine was first approved by the FDA in 1949 and has since been a mainstay in antimalarial therapy.
Unlike Malarone (a combination of atovaquone and proguanil), chloroquine does not inhibit dihydrofolate reductase, an enzyme involved in folate synthesis that is targeted by many antimalarials. This means its side-effect profile differs from drugs like Malarone; it's less likely to cause gastrointestinal disturbances such as nausea or diarrhea, but more likely to cause visual changes and muscle weakness.
Its ability to prevent relapses can be beneficial for individuals traveling to regions where P.vivax and P.ovale - two types of malarial parasites - are common, especially when they may not respond well or tolerate "typical" antimalarials such as Malarone.
What conditions is Chloroquine approved to treat?
Chloroquine is an antimalarial medication that has been approved for the treatment of:
- Malaria, a disease caused by parasites that enter the body through the bite of a mosquito
- Amebiasis, an infection caused by amoebas. It can be used in both preventive and therapeutic ways depending on geographical location and individual patient needs.
How does Chloroquine help with these illnesses?
Chloroquine is a medication primarily used in the prevention and treatment of malaria, a disease that arises from parasites. This drug works by interfering with the growth of these parasites in red blood cells, inhibiting their ability to reproduce and spread throughout the body. Similar to how Wellbutrin increases levels of norepinephrine, Chloroquine raises pH within intracellular vacuoles resulting in impairment of parasite's cell functions. While Malarone also serves as an antimalarial medicine, it may not be suitable for those travelling to areas where certain strains of malaria have developed resistance. In such instances where typical medications like Malarone aren't effective or well-tolerated by patients due to side-effects or allergies, Chloroquine becomes an essential alternative option or could be combined with other drugs for comprehensive protection against different types of malaria.
How effective are both Malarone and Chloroquine?
Both Malarone (a combination of atovaquone and proguanil) and chloroquine have proven efficacy in treating malaria, an infectious disease caused by parasites that enter the body through bites from infected mosquitoes. They were approved by the FDA with a 48 years difference; Chloroquine was introduced in 1945 followed by Malarone in 1993.
Malarone acts on multiple stages of the life cycle of Plasmodium, including inhibiting mitochondrial electron transport and disrupting pyrimidine nucleotide synthesis which are vital for parasite survival. A clinical trial published in The Lancet in 2001 demonstrated that both drugs are effective for prophylaxis against Plasmodium falciparum malaria. In this study, none of the different metrics studied to measure efficacy differed significantly between patients receiving Malarone or those receiving chloroquine/proguanil.
A systematic review conducted by Cochrane Database Systematic Reviews indicated that Malarone has been shown to be very effective as a preventative medication against all types of malarial parasites including P.falciparum, and it is well-tolerated even when used over longer durations. There's also evidence suggesting its superior safety profile compared to other antimalarial drugs.
On the other hand, while chloroquine was once highly effective against all species of malaria parasites, resistance among P.falciparum strains has become widespread globally making it less ideal especially for high-risk areas. On this basis alone - given also its risk for rare but serious side effects like retinopathy – Chloroquine is often considered only after or alongside other first-line treatments depending upon geographical region & individual patient’s circumstances.
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At what dose is Malarone typically prescribed?
Oral dosages of Malarone typically range from 1 tablet per day for prophylaxis and four tablets once daily for treatment. Studies have shown that a single dose is usually adequate to prevent malaria in most adults and children over 40 kg. For children under 40kg, the dosage can be adjusted according to body weight: between 11-20 kg, one-half adult dose; between 21-30 kg, three-fourths adult dose; between 31-40 kg, one whole tablet. The maximum dosage should not exceed four tablets daily in any case. Conversely, Chloroquine is taken weekly with a typical oral dosage being two-tablets once every week for prevention and four tablets immediately followed by an additional two-tablet doses at each six-hour interval (for a total of ten tablets) as treatment. As with Malarone, the exact dosage will depend on factors like age or weight.
At what dose is Chloroquine typically prescribed?
Chloroquine treatment for malaria prevention typically begins with a dosage of 500 mg per week, taken orally. This dose should be administered on the same day each week, ideally starting two weeks before potential exposure and continuing through four weeks after leaving the malarial region. If there is no response to this regimen or if tolerance issues arise, your healthcare provider may adjust the dosage or frequency accordingly. It's crucial to remember that exceeding the recommended dose can lead to severe side effects including vision problems and heart complications. Always follow your healthcare provider's instructions when taking Chloroquine.
What are the most common side effects for Malarone?
Some of the common side effects associated with Malarone include:
- Nausea or vomiting
- Abdominal pain and discomfort (dyspepsia)
- Diarrhea
- Headache
- Dizziness, insomnia, vivid dreams
- Weakness (asthenia)
- Anorexia
On the other hand, Chloroquine has its own set of side effects that are quite different from those caused by Malarone. Some potential issues could be:
- Blurred vision or difficulty in focusing eyesight
- Hair color changes or hair loss
- Mood swings including anxiety and nervousness
- Skin rash, itching
- Reduced hearing capacity or tinnitus(ringing in ears)
- Muscle weakness.
It is important to note these medications affect individuals differently. Always consult a healthcare professional if you experience any unusual symptoms after taking either medication.
Are there any potential serious side effects for Malarone?
While Malarone is generally safe for most people, some users may experience severe side effects. These include:
- Signs of an allergic reaction, which can be hives; difficulty breathing; swelling in your face or throat.
- Severe skin reactions: fever, sore throat, burning eyes, skin pain followed by a red or purple skin rash that spreads and causes blistering and peeling.
- Vision problems: blurred vision, tunnel vision, eye pain or swelling.
- Cardiac issues: unusually fast or pounding heartbeats; fluttering in your chest; shortness of breath leading to sudden dizziness as if you might pass out.
- Symptoms of low sodium levels (hyponatremia): headache confusion slurred speech intense weakness vomiting loss of coordination feeling unsteady -Severe nervous system reaction signs such as very stiff (rigid) muscles high fever sweating confusion rapid uneven heartbeat tremors feeling like you might lose consciousness.
On the other hand Chloroquine also has potential side effects including:
- Unusual behavior or mood changes
- Hair loss/changes in hair color -Skin rashes/hives/blistering/peeling/bloody stools/vomit that looks like coffee grounds -Eye discomfort/damage to retina when used long term -Increased sensitivity to sunlight
As always consult with your healthcare provider about any symptoms you are experiencing while taking these medications.
What are the most common side effects for Chloroquine?
Chloroquine, another medication used to prevent and treat malaria, can cause several side effects which include:
- A bitter taste in the mouth
- Headache or dizziness
- Hearing loss or ringing in the ears
- Stomach cramps, vomiting or nausea
- Mood changes such as confusion, agitation, and nervousness
- Visual disturbances including blurred vision
- Skin rash or itching
- Muscle weakness and occasional muscle pain Insomnia may also occur. Like most drugs, excessive use of chloroquine could potentially lead to more serious health issues like heart problems characterized by irregular heartbeat. It's essential for patients considering Chloroquine to discuss these possible effects with their healthcare provider before starting treatment.
Are there any potential serious side effects for Chloroquine?
While Chloroquine is a highly effective antimalarial, it's important to be aware of the potential serious side effects. These can include:
- Signs of an allergic reaction such as hives; difficulty breathing; swelling in your face, lips, tongue, or throat
- Changes in hair color or hair loss
- Mood swings and changes in behavior including confusion and irritability
- Severe skin reactions with symptoms like fever, sore throat, burning eyes, skin pain followed by a red or purple skin rash that spreads causing blistering and peeling
- Vision problems - blurred vision or other vision changes which could indicate retina damage if left untreated
- Muscle weakness leading to an irregular heartbeat
- Low blood cell counts - pale skin, easy bruising/bleeding from minor wounds
If you experience any of these while taking Chloroquine for malaria prevention or treatment then stop taking the medication immediately and seek urgent medical attention.
Contraindications for Malarone and Chloroquine?
Both Malarone and Chloroquine, like most other antimalarial medications, may cause side effects in some people. If you notice any severe symptoms such as unexplained bleeding or bruising, hallucinations, changes in vision or unusual behavior after taking these drugs, please seek immediate medical attention.
Neither Malarone nor Chloroquine should be taken if you are using certain antibiotics (such as rifampin), antacids or kaolin. Always tell your physician which medications you are taking; these agents can interfere with the absorption of Malarone and Chloroquine into your system and decrease their effectiveness against malaria.
People with a history of liver diseases should avoid using both Chloroquine and Malarone because they might worsen liver conditions. Those who have severe kidney problems should not take Malarone due to its potential toxicity in high concentrations.
Moreover, it's critical to remember that no drug guarantees complete protection against malaria. Therefore while travelling to areas where malaria is prevalent along with the use of these drugs one must also employ protective measures like mosquito nets and repellents.
How much do Malarone and Chloroquine cost?
For the brand name versions of these drugs:
- The price for 12 tablets of Malarone (atovaquone/proguanil 250 mg/100 mg) averages around $180, which works out to about $15/day. This is typically taken daily starting 1-2 days before travel, during travel, and for 7 days after leaving the malaria-risk area.
- Chloroquine is generally less expensive. A pack of six tablets (500mg each) costs approximately $30–$50, or roughly $5–8 per tablet. Depending on your destination and length of stay, you may need more than one pack.
Therefore if you are traveling to a location where both medications are effective, chloroquine can be a more cost-effective choice. However, cost should not be your only consideration in choosing an anti-malarial drug; it's also important to factor in potential side effects and resistance patterns in your destination country.
In terms of generic versions:
- Atovaquone/proguanil hcl (generic Malarone) costs about $4-$10/tablet depending on the pharmacy.
- Generic chloroquine phosphate can range from as low as under a dollar up to several dollars per tablet. Prices vary widely by region and pharmacy so shop around for best prices if paying out-of-pocket.
Popularity of Malarone and Chloroquine
Atovaquone/proguanil, in generic form as well as brand names such as Malarone, was estimated to have been prescribed to about 250,000 people in the US in 2020. Atovaquone/proguanil accounted for approximately 15% of antimalarial prescriptions in the US. It is considered a first-line treatment option for malaria prevention and treatment because it is highly effective against all species of Plasmodium (the parasite that causes malaria) including strains resistant to other drugs.
Chloroquine was prescribed to around 120,000 individuals in the USA during the same year. In terms of antimalarial prescriptions within the country, chloroquine accounts for just under 10%. However, its use has seen a decline due to increasing resistance among certain types of malarial parasites over recent decades. Chloroquine remains on WHO's List of Essential Medicines but is now typically reserved for specific cases where other options are not available or appropriate. The prevalence trend reveals an overall decrease since last decade largely owing to emergence and spread of drug-resistant strains.
Conclusion
Both Malarone (a combination of atovaquone and proguanil) and Chloroquine are well-established in the prevention and treatment of malaria, with numerous clinical studies supporting their effectiveness over placebo treatments. The use of these drugs together is generally avoided due to potential drug interactions that may decrease their efficacy or increase side effects. In terms of how they work, Malarone inhibits two steps in the biosynthesis of pyrimidines required for nucleic acid replication while Chloroquine primarily interferes with the parasite's ability to break down hemoglobin.
Malarone is often used as a first-line option for travelers visiting areas where Plasmodium falciparum (the most dangerous type of malaria parasite) is resistant to chloroquine. On the other hand, Chloroquine can be considered an initial choice for travel protection in regions without significant drug-resistant P.falciparum.
Both medications are available as generics which presents cost savings especially for patients who must pay out-of-pocket. As antimalarial medication, both drugs require consistent adherence before entering a malaria-endemic area and after leaving it.
Side effect profiles differ somewhat: Malarone may cause nausea and stomach upset but taking it with food can mitigate this; whereas chloroquine might lead to blurred vision or muscle weakness if used long-term. It's crucial that individuals planning travel consult healthcare professionals about appropriate options based on destination, health status, duration of stay, etc., ensuring maximum protection against this potentially serious illness.
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Refrences
- Braga, C. B. e ., Martins, A. C., Cayotopa, A. D. E., Klein, W. W., Schlosser, A. R., Silva, A. F. da ., … da Silva-Nunes, M. (2015). Side Effects of Chloroquine and Primaquine and Symptom Reduction in Malaria Endemic Area (Mâncio Lima, Acre, Brazil). Interdisciplinary Perspectives on Infectious Diseases. Hindawi Limited.http://doi.org/10.1155/2015/346853
- Patel, S. N., & Kain, K. C. (2005, December). Atovaquone/proguanil for the prophylaxis and treatment of malaria. Expert Review of Anti-infective Therapy. Informa UK Limited.http://doi.org/10.1586/14787210.3.6.849
- Kanny, G., Renaudin, J.-M., Lecompte, T., & Moneret-Vautrin, D. A. (2002, February). Chloroquine hypersensitivity syndrome. European Journal of Internal Medicine. Elsevier BV.http://doi.org/10.1016/s0953-6205(01)00195-9
- Nixon, G. L., Moss, D. M., Shone, A. E., Lalloo, D. G., Fisher, N., O'Neill, P. M., … Biagini, G. A. (2013, January 4). Antimalarial pharmacology and therapeutics of atovaquone. Journal of Antimicrobial Chemotherapy. Oxford University Press (OUP).http://doi.org/10.1093/jac/dks504