Malarone (Atovaquone-Proguanil) for Malaria Prevention
Malarone (atovaquone-proguanil) is the most commonly prescribed malaria pill for short trips: one tablet a day, starting 1–2 days before you enter a malaria area and continuing for 7 days after you leave. It is well tolerated and works in every region, including places where older drugs no longer do. Prescription only, with generic versions available.
Also known as: Malarone
Availability
Prescription only
Start
1–2 days before entering the malaria area
Course
Daily during travel, then 7 days after leaving
Typical cost
Generic roughly $3–$6 per tablet; brand costs more
Who needs it
- Travellers to areas with malaria transmission, including much of sub-Saharan Africa (Kenya, Tanzania, Ghana, Nigeria, Uganda), the Amazon basin, and rural parts of South and Southeast Asia
- Short trips of up to a few weeks, where the short 7-day post-travel course is a real advantage
- Travellers going to regions with resistance to chloroquine or mefloquine, such as the Thailand–Myanmar and Thailand–Cambodia border areas
- Anyone who wants a daily option without doxycycline's sun sensitivity or mefloquine's neuropsychiatric warnings
How it works
The two ingredients attack the malaria parasite at different stages. Atovaquone blocks the parasite's energy production in the mitochondria; proguanil blocks its ability to copy DNA. Together they kill parasites in the liver before they reach the blood, which is why the course after travel is only 7 days instead of the 4 weeks needed with doxycycline or mefloquine.
How it's taken
The standard CDC summary. Your pharmacist confirms the schedule for your itinerary and health history.
- 1Adults: one adult-strength tablet (250 mg atovaquone / 100 mg proguanil) once a day, at the same time each day, with food or a milky drink to improve absorption and reduce stomach upset
- 2Start 1–2 days before entering the malaria area, take it every day you are there, and continue for 7 days after you leave
- 3Children are dosed by body weight with pediatric tablets; your pharmacist calculates this
- 4If you vomit within an hour of a dose, take another. Missing doses lowers protection, so set a daily reminder
- 5Pills are only part of the plan: use repellent, sleep under a net or in screened rooms, and cover up at dusk and dawn
Side effects and who should not take it
Common side effects
- Stomach pain, nausea, vomiting or diarrhea, usually mild and reduced by taking it with food
- Headache, and occasionally mouth ulcers or dizziness
- Rarely, a rash or raised liver enzymes
Talk to the pharmacist first if
- Severe kidney disease (creatinine clearance below 30 mL/min)
- Pregnancy and breastfeeding an infant under 5 kg, where data are limited; other drugs are usually preferred
- Children weighing less than 5 kg
- People taking rifampin, rifabutin, metoclopramide or tetracycline, which can lower atovaquone levels; a medication review is needed
Alternatives
Doxycycline
Daily, inexpensive, and also protects against some other infections, but must be continued for 4 weeks after travel and causes sun sensitivity and stomach upset in some people.
Mefloquine
Weekly dosing suits long trips, but it carries a boxed warning for neuropsychiatric side effects and does not work in parts of Southeast Asia.
Tafenoquine (Arakoda)
Weekly, with a short course after travel, but requires a blood test for G6PD deficiency before the first dose.
Chloroquine
Weekly, but useful only in the few remaining areas without chloroquine resistance, such as parts of Central America and the Caribbean.
How to get it in California
Voyax Health consultations are available to California residents.
Build your trip on Voyax Health. The health brief shows malaria risk for each stop, including cases like Thailand where risk is limited to border provinces and many visitors do not need pills at all.
A licensed pharmacist reviews your itinerary, health history and other medications, and where malaria prophylaxis is warranted a prescription is issued and routed to your California pharmacy. Generic atovaquone-proguanil is widely available.
Allow a few days: you need the first dose 1–2 days before you enter the malaria area, and pharmacies sometimes need to order the full course.
Frequently asked questions
Can I get malaria pills online?▼
In California, yes, through a licensed telehealth or pharmacist review such as Voyax Health. Malaria prophylaxis is prescription-only, so a clinician reviews your itinerary and health history first, then the prescription goes to a pharmacy for pickup. Voyax does not ship medication; your pharmacy dispenses it.
How long before travel do I need to start Malarone?▼
Only 1–2 days before you enter the malaria area, which makes it the best option for last-minute trips. Continue daily while there and for 7 days after you leave.
Malarone or doxycycline: which is better?▼
Both work well in nearly all regions. Malarone has fewer side effects and a 7-day post-travel course but costs more per tablet. Doxycycline is cheaper but requires 4 weeks after travel and can cause sunburn easily. For trips under about three weeks, the total cost is often similar once you count the extra weeks of doxycycline.
Do I need malaria pills for Thailand?▼
Usually not. Bangkok, Chiang Mai, Phuket and the main islands have no malaria risk. Prophylaxis is advised only for rural forested areas along the borders with Myanmar, Cambodia and Malaysia, where atovaquone-proguanil or doxycycline are used because of mefloquine resistance.
Destinations where this matters
Country guides where this vaccine or medication is commonly part of the plan.
TanzaniaHigh riskTanzania carries a CDC Level 2 travel health notice. Malaria risk exists in all areas of Tanzania below 1,800 meters (5,900 feet) elevation. Key travel vaccines: COVID-19, Hepatitis A, Hepatitis B.
GhanaHigh riskGhana carries a CDC Level 2 travel health notice. Malaria risk exists throughout Ghana. Key travel vaccines: COVID-19, Hepatitis A, Hepatitis B.
NigeriaHigh riskNigeria carries a CDC Level 2 travel health notice. Malaria risk exists throughout Nigeria year-round. Key travel vaccines: COVID-19, Hepatitis A, Hepatitis B. Yellow fever vaccination is recommended for all travelers 9 months and older. It's required for entry if coming from countries with yellow fever risk, including airport transits.
UgandaHigh riskUganda carries a CDC Level 2 travel health notice. Malaria risk exists throughout Uganda year-round. Key travel vaccines: COVID-19, Hepatitis A, Hepatitis B.
ThailandModerate riskThailand carries a CDC Level 1 travel health notice. Malaria risk exists primarily in border provinces with Burma, Cambodia, and Malaysia. Key travel vaccines: COVID-19, Hepatitis A, Hepatitis B.
IndiaHigh riskIndia carries a CDC Level 1 travel health notice. Malaria is present throughout India below 2,000m elevation, including major cities. Key travel vaccines: COVID-19, Hepatitis A, Hepatitis B.
PeruModerate riskPeru carries a CDC Level 1 travel health notice. Malaria risk exists in areas below 2,500m elevation east of the Andes. Key travel vaccines: COVID-19, Hepatitis A, Hepatitis B.
Related disease guides
Mosquito-borne parasitic infection
Malaria is a serious, sometimes fatal disease spread by night-biting Anopheles mosquitoes. There's no vaccine for travelers, but prophylactic medication plus bite prevention are highly effective. Symptoms (fever, chills, flu-like illness) can appear weeks to months after travel.
Dengue FeverMosquito-borne viral infection
Dengue is a viral infection spread by day-biting Aedes mosquitoes, common in tropical and subtropical cities. There's no specific treatment and no prophylactic drug, so bite prevention is the main defense. Most cases resolve in about a week, but severe dengue is a medical emergency.
Get it prescribed for your trip
Enter your destinations and dates. Your free health brief shows whether malaria is a risk on your route; a licensed pharmacist then reviews your plan for $39.99 per traveller and sends prescriptions to your pharmacy.
Start my free health briefConsultations are available to California residents. Vaccines and medications are paid at your pharmacy.
Sources: CDC Yellow Book — Malaria · CDC — Choosing a Drug to Prevent Malaria. Last updated 2026-09-28. This page is informational and not a substitute for advice from a pharmacist or travel-medicine provider.