Protect Yourself: How to Prevent Painful Side Effects from Doxycycline for Malaria Prophylaxis

Learn how to prevent serious side effects from doxycycline for malaria prophylaxis.

Taking doxycycline to prevent malaria virus is a common and inexpensive practice all over the world. Unfortunately, even with plenty of experience with travel medications and even prior use of doxycycline, I wasn’t educated enough and paid the price with the serious side effect of esophageal ulcers, which hurts like crazy!

It’s important to talk to your doctor before taking a trip to learn about the medications and vaccines you might need.

How To Reduce Doxycycline for Malaria Prophylaxis Side Effects

If you decide to take doxycycline for malaria prophylaxis, be sure to take the following precautions:

1. There are two different types of doxycycline. Ask for doxycycline monohydrate as it has less risk of stomach problems, acid reflux, and esophageal ulcers.

2. Take your pill every day at the same time, with either BREAKFAST or LUNCH, not dinner. I was cautious to take doxycycline with food as recommended by the pharmacist, but didn’t realize that it’s also important that you don’t lay down until ideally two hours after taking it.

Do Not Take Doxycycline with Dinner

I was taking doxycycline at dinner, then going to bed soon after, and this increases your risk of stomach and esophageal complications. I’ve never even had heart burn before, so I was not pre-disposed to this side effect. But it hit me hard.

3. Doxycycline can also cause sun sensitivity, so the best thing you can do it cover up and wear a hat, or if that’s not possible, apply sun screen often, especially after swimming or sweating. Serious sun burns not only hurt and looks ridiculous, but they also increase your risk of skin cancer.

4. Taking Doxycycline with antacids or multivitamins can reduce its effectiveness.

How to tell if you have esophageal ulcers:

If possible, go to a hospital or travel clinic. Basically, it feels like constant, severe heartburn. Like you’ve been skewered through your chest and right into your upper back. A sharp pain in your chest when you swallow. A constant burning or ache in your upper body, ribs, and chest. The feeling of something jagged being stuck at the bottom of your throat, just before your stomach.

How to treat esophageal ulcers:

1. Go to the clinic or hospital as soon as possible.

2. Stop taking doxycycline immediately

3. Practice mosquito safety, including full coverage clothing, tuck socks into shoes, stay inside when possible, bed mosquito netting. Get to a low malaria risk area if possible.

4. Drink plenty of water and try to eat soft, nutritious foods even though it may hurt. Banana is especially good for reducing heart burn.

5. Take antacids during or soon after meals

There are a few other side effects to doxycycline, such as vivid dreams. If you have serious side effects talk to your doctor.

Though taking doxycycline for malaria prophylaxis is usually the cheapest drug option, it has some setbacks: serious side effects, regions where malaria is doxycycline resistant, and the nuisance of needing to take the pills daily and four weeks after your trip.

Alternatives to Doxycycline for Malaria Prevention:

There are a few other alternatives to doxycycline you can consider with your doctor: the CDC covers them here

  • Malarone (atovaquone and proguanil): This drug can be expensive, and you still need to take daily. But much fewer side effects and you can stop taking the pills after only one week after exiting the malaria zone, rather than 4 weeks like Doxycycline.
  • Mefloquine: This one is wonderful because it’s a weekly pill. I first heard about this drug when I was travelling in Uganda and a doctor from the USA was talking about taking it as it’s more gentle on the stomach and a less harsh antibiotic. This one is also safe for taking during pregnancy. However, this drug takes a little planning, as you must start 2 weeks before departure.
  • Primaquine or Tafenoquine (ArakodaTM): You must be pre-screened for G6PD deficiency by your doctor before taking either of these drugs. These are daily pills. You only need to take this drug 1-3 days before entry and 7 days after departing the malaria zone.

If you have questions about my experience with malaria prevention drugs, please comment below and I’ll respond!

I write about a few locations that require doxycycline for malaria prophylaxis, including: Costa Rica and Tanzania.

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