Can I take another antimalarial (in addition to hydroxychloroquine) while travelling to a country at risk of malaria?

The parasite causing malaria is increasingly resistant to antimalarials. It is necessary to know the classification of the country concerned with regard to resistance to antimalarials, and in particular to chloroquine.

This classification is international, established by the WHO, and divides countries into 3 risk zones, from 1 to 3:

Zone 1: no resistance to chloroquine

Zone 2: intermediate resistance

Zone 3: countries of high resistance

In case of travel to zone 1, the recommended treatment is chloroquine. If this treatment is already prescribed, it can be continued at the same dosage as in lupus and is a priori sufficient. If the treatment prescribed in lupus is hydroxychloroquine (the most common case), and you must take chloroquine, you must suspend your hydroxychloroquine treatment during this time and resume it when chloroquine is stopped (indeed, hydroxychloroquine is not as effective against malaria as chloroquine is but is more effective for lupus). In case of travel to zone 2 and zone 3 (zones that concern most countries in Africa and Asia), your treatment will not be sufficient to protect you against malaria and a specific treatment must be added. Available products are:

- Proguanil + chloroquine

- Atovaquone + proguanil

- Mefloquine

- Doxycycline

All of these are prescription drugs. The opinion of a doctor is mandatory to assess whether or not to prescribe these drugs without risk, depending on possible personal contraindications and taking other associated drugs. Mefloquine should rather be avoided due to interaction with hydroxychloroquine and potential neuropsychiatric adverse effects.

In case of combined treatment proguanil + chloroquine, it is possible to temporarily stop any hydroxychloroquine or chloroquine taken for lupus.

Taking doxycycline is possible, but presents a risk of phototoxicity (toxicity of the sun on the skin when taking this drug), hence the strengthening of protection against UV is needed.

A specialised consultation allows, depending on the places visited and the lifestyle adopted, to evaluate the real exposure to the parasite and the choice of prophylaxis (urban or rural stay, in dry or rainy season, business or tourism, ...).

In any case, be aware that the first preventive measure concerning malaria remains protection against mosquito bites: by applying repellents, by wearing long sleeves and pants in the evening and by using a mosquito net. This will, moreover, have the advantage of also protecting you against other infections that can be transmitted by mosquitoes (such as dengue, chikungunya or zika for example).


If you travel to a malaria zone 2 or 3, make sure you discuss with your doctor which anti-malarial is most suited for you and what to do with your Hydroxychloroquine treatment.

Also define clearly with your doctor when to resume hydroxychloroquine upon return

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