Travel Medicine · Tool

When to start and stop your malaria pills

Last updated:
Clinically reviewed by Ashley Cranage, APRN, FNP-C ·
By Bidwell Cranage, APRN, FNP-C, Member, International Society of Travel Medicine

Malaria prevention starts before entry into the risk area and continues afterward. Doxycycline continues for 28 days after leaving; atovaquone-proguanil continues for 7 days. This planner assumes a 2-day lead-in and one adult tablet per day to estimate dates and quantities for discussion with your clinician. It does not choose a medicine, issue a prescription or handle switching drugs or missed doses.

The rules behind it

MedicationStartStopDaily dose
Doxycycline (malaria)1 to 2 days before entering the area4 weeks (28 days) after you leave100 mg once a day
Atovaquone-proguanil / Malarone (malaria)1 to 2 days before entering the area7 days after you leaveOne adult tablet (250/100 mg) once a day with food
Acetazolamide / Diamox (altitude)The day before you ascendIndividualized to ascent, target sleeping altitude and acclimatization; do not automatically stop after two days125 mg twice a day

Doxycycline and atovaquone-proguanil have different after-exposure courses, so compare the full quantities. This planner uses two days before entry; a clinician may prescribe a different supported lead-in. Acetazolamide timing needs the nightly ascent profile, so this tool deliberately does not calculate its stop date or tablet count.

This is general timing, not a prescription. Your exact start and stop depend on your itinerary, layovers, and health, which your clinician confirms. We prescribe doxycycline or Malarone (not mefloquine, primaquine, or tafenoquine, which need extra screening), and pills never replace mosquito-bite avoidance. See how we decide.

FAQ

When should I start taking malaria pills?

Doxycycline and atovaquone-proguanil (Malarone) are both started 1 to 2 days before you enter the malaria area, then taken once a day while you are there. Mefloquine, which we do not prescribe online, has to be started about 2 weeks before travel instead.

How long do I take Malarone after I leave the malaria area?

Atovaquone-proguanil (Malarone) is continued for 7 days after you leave the malaria area. That short tail is why many short-trip and last-minute travelers choose it over doxycycline.

How long do I take doxycycline after travel?

Doxycycline is continued for 4 weeks (28 days) after you leave the malaria area. Stopping early is a common mistake that can leave you unprotected, so plan to fill enough tablets for the full course.

When do I start altitude medicine (acetazolamide/Diamox)?

Acetazolamide prevention commonly starts the day before ascent. How long to continue depends on the ascent rate and time at the target sleeping altitude. Continued ascent or rapid ascent may require a longer course. Confirm the stop date with your prescriber; two travel dates alone are not enough.

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Related

Source details

CDC Yellow Book: malaria · Wilderness Medical Society 2024 altitude guidance

Earlier review by Bidwell Cranage, APRN, FNP-C, AANP board-certified Family Nurse Practitioner and Member, International Society of Travel Medicine.
Sources: CDC Yellow Book: malaria; WMS altitude guidance (2024). The calculator is general guidance; confirm timing with your clinician for your exact itinerary.