Malarone vs Doxycycline vs Mefloquine: Which Malaria Pill Should You Take?

Short answer: in most malaria areas, all three work well — so the right choice comes down to side effects, trip length, cost and your own health. As a rough guide:

• Malarone (atovaquone-proguanil) — the one with the fewest side effects and the shortest post-trip course. Great for short trips and last-minute travel. Usually the most expensive.
• Doxycycline — cheap, daily, and starts at the last minute, but makes you burn easily in the sun and has to be continued for 4 weeks after you get home.
• Mefloquine (Lariam) — one tablet a week and the option most suited to pregnancy, but it needs a 2-week head start and isn't suitable for anyone with a history of depression, anxiety or seizures.

This guide is the head-to-head comparison. For the full background — how malaria works, chloroquine and tafenoquine, and which drug suits which region — see our complete antimalarials guide.

Side by side

Based on CDC Yellow Book guidance. Pricing varies by country, pharmacy and insurance.

Side effects: what people actually notice

Malarone is the best tolerated of the three. CDC describes side effects as rare, with stomach pain, nausea, vomiting and headache the most common. Taking it with food or a milky drink helps. If you vomit within an hour of a dose, the product leaflet says to take another.

Doxycycline's big one is sun sensitivity — an exaggerated sunburn reaction. On a beach holiday, a boat trip or a high-altitude trek, that's a real consideration; you'll need high-factor sunscreen, cover-up clothing and shade. It can also cause nausea, increases the chance of vaginal thrush, and can irritate the throat badly if taken just before lying down. CDC advises taking it with plenty of fluid, at least an hour before bed, and staying upright for 30 minutes afterwards.

Mefloquine is the one with the reputation. The most common effects are vivid or abnormal dreams, trouble sleeping, anxiety, dizziness, headache and stomach upset. Less commonly, it can cause serious neuropsychiatric reactions — including depression, panic attacks, paranoia, hallucinations and, rarely, psychosis or seizures. It carries an FDA boxed warning that these effects can persist after you stop taking it. CDC advises against mefloquine for anyone with current or past depression, generalised anxiety disorder, psychosis, other major psychiatric conditions, seizures, or certain heart rhythm problems.

That said, many people take mefloquine without trouble, and its 2-week head start exists partly so that side effects show up before you travel.

Can you drink alcohol on malaria pills?

• Malarone: the product leaflet doesn't carry a specific alcohol warning. Normal sensible drinking is generally considered fine — but heavy drinking and hangovers make it harder to keep tablets down and remember doses.
• Doxycycline: the NHS says it's best not to drink alcohol, because it can stop the medicine working properly.
• Mefloquine: the Lariam product information says it's best to avoid alcohol during treatment — alcohol can also make dizziness and mood effects harder to judge.

If drinking is part of the trip — a wedding, a festival, a party island — that's worth mentioning to your clinician when choosing.

Sun, beaches and outdoor trips

If your trip is mostly beaches, boats, snow, or long days outdoors at high altitude, doxycycline's sun sensitivity is the main argument against it. Malarone or mefloquine avoid that problem.

On the other hand, doxycycline has a bonus for campers, hikers and freshwater swimmers: CDC notes it also gives some protection against rickettsial infections (such as tick-borne fevers) and leptospirosis.

Diving

The Divers Alert Network warns that mefloquine's side effects can mimic symptoms of decompression illness — dizziness, confusion and coordination problems are exactly what divers and dive medics watch for. For that reason, many divers and dive physicians prefer an alternative. DAN also notes there's no clinical data on diving while taking any antimalarial, so talk it through with your doctor and dive operator. If you choose doxycycline for a dive trip, remember the sun sensitivity on deck.

Children

• Malarone comes in a paediatric tablet and can be used from 5 kg, dosed by weight.
• Doxycycline isn't used under age 8 because of effects on teeth and bones.
• Mefloquine can be used at any age, dosed by weight, and some families find a once-weekly tablet (crushed into food) easier than a daily one.

Children's doses are always weight-based — your clinic will calculate them. More on travelling with children in our family travel vaccine guide.

Pregnancy and breastfeeding

This is where the choice narrows sharply. CDC recommends mefloquine as the option that can be used in all trimesters and during breastfeeding. Malarone isn't recommended in pregnancy (or when breastfeeding a baby under 5 kg), and doxycycline isn't used in pregnancy. CDC's broader advice is that pregnant women should avoid travel to malaria areas if possible, because malaria is more dangerous in pregnancy.

Cost

Cost often decides it on long trips. CDC lists Malarone as often more expensive, especially for long trips, while doxycycline is generally the cheapest option. On a two-week safari the difference may be modest; on a four-month backpacking trip, it can be substantial. Generic atovaquone-proguanil is usually much cheaper than branded Malarone — ask your pharmacist.

Remember the tail end too: doxycycline and mefloquine both continue for 4 weeks after you leave the malaria area, Malarone for just 7 days.

Where mefloquine doesn't work

Mefloquine resistance has been confirmed in parts of Southeast Asia — along Thailand's borders with Myanmar and Cambodia, western Cambodia, eastern Myanmar near China, along the Myanmar–Laos border, and southern Vietnam. In those areas, CDC recommends Malarone, doxycycline or tafenoquine instead. Elsewhere, all three drugs in this comparison are effective options in chloroquine-resistant areas, which covers most of the world's malaria regions.

Which one suits which trip?

These are typical patterns, not prescriptions — your clinician will factor in your health, medications and exact itinerary.

• 10-day safari in Kenya or Tanzania, booked last-minute: Malarone is the usual favourite — starts 1–2 days before, few side effects, only 7 days afterwards. See our safari health guide.
• Four months backpacking on a budget: doxycycline keeps costs down — if you can manage the sun sensitivity. Mefloquine is the weekly alternative for those without contraindications.
• Pregnant traveller who can't avoid a trip to a malaria area: mefloquine is generally the option, after a careful discussion.
• Dive trip: Malarone or doxycycline, usually — mefloquine's side effects can be confused with decompression illness.
• Anyone with a history of depression, anxiety or seizures: not mefloquine.
• Already taking doxycycline for acne: CDC notes this can double as malaria prevention — check the dose with your clinician.

If you miss a dose or need to switch

Missed a daily dose (Malarone or doxycycline)? CDC advises taking it as soon as you remember and carrying on daily from the new time. Don't double up the next day.

Missed a weekly mefloquine dose? Take it as soon as possible. If you're only 1–2 days late, go back to your usual day; if you're later than that, make the new day your weekly day.

Side effects forcing a switch? CDC doesn't recommend switching from a daily drug to weekly mefloquine mid-trip, because mefloquine takes time to build up. Switching between Malarone and doxycycline is possible, but the length of the post-trip course changes — follow your clinician's instructions.

Whichever you choose

• No antimalarial is 100% effective. Avoiding mosquito bites — especially from dusk to dawn — is still essential. See DEET, picaridin and what actually works.
• Finish the course. Stopping as soon as you get home can leave you unprotected against parasites you picked up in the last days of your trip.
• Fever after a malaria-area trip is an emergency — even weeks or months later. Get tested the same day and tell the doctor where you've been.

Short on time before your trip? See last-minute travel vaccines. Check whether your destination needs malaria prevention on the interactive vaccine map.

Frequently asked questions

Which malaria pill has the fewest side effects?

Malarone (atovaquone-proguanil) is generally the best tolerated. CDC describes its side effects as rare, mostly mild stomach upset and headache.

Is Malarone or doxycycline better?

Both work in most malaria areas. Malarone has fewer side effects and only needs to continue for 7 days after you leave, but costs more. Doxycycline is cheap but causes sun sensitivity and must continue for 4 weeks after you leave.

Can you drink alcohol on Malarone?

The Malarone leaflet doesn't carry a specific alcohol warning, so moderate drinking is generally considered fine. The NHS advises avoiding alcohol with doxycycline, and Lariam's product information advises avoiding it with mefloquine.

Why do I have to take doxycycline for 4 weeks after I get home?

Doxycycline and mefloquine act on the parasite once it's in the bloodstream, which can be weeks after an infected bite. Malarone also acts at the earlier liver stage, which is why its post-trip course is just 7 days.

Is mefloquine still prescribed?

Yes. It's less commonly first choice because of its neuropsychiatric side effects, but it remains useful for long trips (weekly dosing) and in pregnancy, for travellers without contraindications.

Can I take malaria tablets with the oral typhoid vaccine?

It depends on the drug. The oral typhoid vaccine shouldn't be taken close to antibiotics such as doxycycline, and CDC advises a gap before starting Malarone. Mefloquine can be taken alongside it. See our typhoid and hepatitis A guide.

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Sources: CDC Yellow Book – Malaria · CDC Yellow Book – Typhoid and Paratyphoid Fever · NHS – Doxycycline · Malarone Consumer Medicine Information (Australia) · Lariam (mefloquine) Product Monograph – Health Canada · Divers Alert Network – Malaria and mosquito bite prevention for divers

This article is for informational purposes only and does not constitute medical advice. The right antimalarial depends on your destination, health, medications and trip — always consult a qualified travel health professional or GP before travel.