If you are traveling to an area where malaria is prevalent, for example, sub-Saharan Africa, your healthcare provider will recommend taking medication for malaria prevention. One such medication used for the prevention of malaria is doxycycline. It belongs to a group of drugs called tetracycline antibiotics and is available with your doctor’s prescription.

Doxycycline can be used alone to prevent malaria or in combination with another medicine for malaria treatment. It is available as a generic drug and is also sold under different brands (common brand names include Vibramycin, Oracea, Doryx, Acticlate, and Monodox). Doxycycline is available as oral tablets, dispersible tablets, delayed-release tablets, capsules, oral suspension, and intravenous (into the vein) injections to be administered in the hospital setting.

Please continue reading to find out more about taking doxycycline antimalarial tablets. We will also list the pros and cons of malaria chemoprophylaxis (malaria prevention) with doxycycline.

How should you take doxycycline for malaria prevention?

The protocol for taking doxycycline to prevent malaria is as follows:

Take a single dose of doxycycline 100 mg, starting 1-2 days before traveling to a malaria-endemic country.
Continue taking doxycycline tablets daily (one-100 mg dose per day) while you are there, and continue for 28 days after you leave the malaria endemic area.
The CDC has placed no time limit on how long you can take doxycycline to prevent malaria. However, check with your healthcare provider if you plan to stay on a doxycycline regimen for malaria prevention for longer than 4 months.

Note: Doxycycline prophylactic doses in children depend on the child’s body weight. Your child’s healthcare provider will tell you the correct dose for your child. This should not exceed the adult dose of 100 mg/day. Doxycycline is not for children younger than 8 years old.

Keep in mind that the doxycycline dosing to treat malaria is different from the preventive dosing.

What to know when taking doxycycline?

Before starting treatment with doxycycline, tell your doctor if you are allergic to doxycycline, other tetracyclines, or any other medications or if you have a sulfite allergy.

Give your doctor a complete list of your medications, including prescription drugs, over-the-counter medications, dietary supplements, and herbal products. This will help avoid potential drug interactions.

Tell your doctor if you have medical conditions such as a yeast infection, systemic lupus erythematosus, intracranial hypertension (increased pressure inside the skull), asthma, kidney disease, liver disease, previous stomach surgery, or recent diarrhea.

Remember, doxycycline does not provide foolproof protection against malaria. In addition to taking doxycycline tablets, you should also take other precautions, such as using mosquito nets, screens, and insect repellent and wearing long-sleeved shirts and pants to cover your body, especially in the early evening (dusk) when mosquitoes that transmit malaria are most active.

What should you avoid when taking doxycycline?

Administration

Avoid taking doxycycline on an empty stomach. Also, avoid lying down for 1 hour after taking a doxycycline dose. Take the medicine in an upright position to prevent throat irritation. Always take doxycycline on a full stomach with a full glass of water. Avoid milk and other dairy products for 1-2 hours before and after a doxycycline dose.

Missed dose

Avoid missing doses of doxycycline, as this can lead to incomplete protection. In case of a missed dose, take the medicine as soon as you remember. However, if it is almost time for the next dose, skip the missed dose and go back to your regular dosing schedule. Do not take two doses together to make up for a missed dose.

Supplements

Avoid taking doxycycline with calcium supplements, antacids, or magnesium-containing laxatives. Take doxycycline at least 1-2 hours away from these products and 2-3 hours away from iron supplements or multivitamins containing iron.

Pregnancy and birth control

Avoid getting pregnant while on doxycycline. Tell your doctor immediately if you become pregnant while on doxycycline. Doxycycline can affect bone development and cause tooth discoloration, especially if a pregnant woman takes it during the last half (the last 4-5 months) of the pregnancy.

Doxycycline may pass into breast milk and interfere with the bone and tooth development of the infant. You should not take doxycycline while breastfeeding. Talk to your provider about other options.

Also, talk to your doctor about using a non-hormonal birth control such as condoms or a spermicide-containing diaphragm while on doxycycline. This medication can interfere with the effectiveness of hormonal contraceptives (birth control pills, patches, rings, and injections).

Sun exposure

Avoid unnecessary sun exposure while on doxycycline. This drug can increase the sensitivity of your skin to sunlight. Wear sunscreen, sunglasses, and protective clothing when outdoors. Tell your doctor without delay if you develop a sunburn while on doxycycline.

Children

Avoid giving doxycycline to children younger than 8 years old. This medicine can cause problems with bone growth and permanent teeth staining in young children. Your doctor may, however, prescribe doxycycline to a child younger than 8 years of age for inhalational anthrax or Rocky Mountain Spotted Fever.

What are the side effects of doxycycline?

According to the Centers for Disease Control and Prevention (CDC), common side effects of doxycycline include nausea, vomiting, diarrhea, and stomach pain. These side effects can be lessened by taking doxycycline with food. Doxycycline can increase sun sensitivity. This risk can be lowered by using a broad-spectrum, high-SPF sunscreen and wearing protective clothing.

Women who take doxycycline are at an increased risk of vaginal yeast infections. You can take an over-the-counter or prescription medication if you develop symptoms of a yeast infection.

Who should not take doxycycline?

The following individuals should not take doxycycline to prevent malaria:

Children under 8 years of age
Pregnant women
People with a history of hypersensitivity (allergic reaction) to doxycycline in the past

Is doxycycline effective against Plasmodium falciparum malaria?

Five different Plasmodium species cause malaria in humans, namely Plasmodium malariae, Plasmodium ovale, Plasmodium vivax, Plasmodium knowlesi, and Plasmodium falciparum. According to the World Health Organization (WHO), there were approximately 219 million cases of malaria in 90 countries.

Evidence suggests that when taken as directed, doxycycline is between 92% and 96% effective against Plasmodium falciparum and 98% effective against Plasmodium vivax.

Among these, Plasmodium falciparum malaria is the most common. Plasmodium falciparum is also the most dangerous because it causes severe malaria that can progress to serious illness, leading to death if not treated within 24 hours. Falciparum infections are responsible for more than 9 out of 10 deaths due to malaria worldwide.

In addition, over the past 50 years, Plasmodium falciparum has become multidrug-resistant, which makes this tropical medicine disease more challenging to treat.

What are the advantages and disadvantages of taking doxycycline for malaria prophylaxis?

You must pay attention and follow instructions regarding when you need to start doxycycline to prevent malaria and how long you need to continue taking it. Some of the pros and cons of doxycycline for malaria prophylaxis are listed below:

Pros of taking doxycycline for malaria prophylaxis:

Cons of taking doxycycline for malaria prophylaxis:

You need to take this malaria prophylaxis medication every day and continue taking it for 28 days after leaving an area where malaria transmission is common.
Doxycycline has a short half-life. This means missing even one dose can lead to a lack of protection against malaria.
It is not safe for children younger than 8 years of age and pregnant women.
Adverse events related to doxycycline use include gastrointestinal symptoms, sun sensitivity, and throat irritation.
It may not be the best choice for people who plan to get a lot of sun exposure or women prone to vaginal yeast infections.

References:

https://www.ncbi.nlm.nih.gov/books/NBK551639/#
https://www.cdc.gov/malaria/resources/pdf/fsp/drugs/doxycycline.pdf
https://medlineplus.gov/druginfo/meds/a682063.html
https://www.cdc.gov/malaria/travelers/drugs.html
https://pubmed.ncbi.nlm.nih.gov/28580606/

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