Which antimalarial drugs can I advise for a traveller who has epilepsy?
A.Both chloroquine and mefloquine are unsuitable for those with epilepsy. For areas with a high risk of chloroquine resistant Plasmodium falciparum, doxycycline or atovaquone / proguanil can be used. However for children under the age of 12 the only suitable antimalarials under these circumstances will be atovaquone / proguanil (Malarone?) (bearing in mind the length of travel). Proguanil alone can be given for malarious areas without chloroquine resistance. Phenytoin, carbamazepine and barbiturates reduce the half life of doxycycline; in theory the dose should be increased for those taking these drugs. However, there is no evidence that this is necessary, and a dose adjustment is not recommended.
