Diving and Antimalarials

A friend asked me if I had heard about any contraindications regarding diving and antimalarials like Larium. I had not heard of any but will check further with DAN. She said that a hotel in SA said there was some type of contraindication.

I did Google it and there are clearly side effects of these meds, but I cannot find specific contraindications to diving. In the absence of side-effects is it OK to dive with these meds. What do the guys who dive in SA, Mozambique etc take?

A friend asked me if I had heard about any contraindications regarding diving and antimalarials like Larium. I had not heard of any but will check further with DAN. She said that a hotel in SA said there was some type of contraindication.

I did Google it and there are clearly side effects of these meds, but I cannot find specific contraindications to diving. In the absence of side-effects is it OK to dive with these meds. What do the guys who dive in SA, Mozambique etc take?

Hi,

I used Lariam in Tanzania. Those side effects are real, so I swore I will never ever use it again... use gin-tonic against malaria... (I was not a diver that time..)

Since I was there only for a month, my experience is not overwhelming... But I am also interested in what can one use against malaria...

Jules

I would avoid larium, but instead use malarone. There are virtually no side effects to malarone that could impact your diving.

Malarone was my preferred antimalarial for Moz. Larium has funky effects on me sleepwise and some of the side effects mimic DCS type I. I have wild enough dreams on my own and Larium kept me restless that I stopped taking it. Nowadays I don't bother taking antimalarials but keep treatment dosage around (Malarone). I just use Lavender/Citronella (own mix) or Repel Lemon/Eucalyptus oil. I burn the lavender/citronella oil in the room just before dusk and turn off all the lights. I use the Repel spray on my bare skin and clothes. Keeps the mossies away, plus the girls come to borrow the oils

Gin tonic, boosting vitamin B supplements (short term only) are all preferred 'non-toxic' choices that haven't been really scientifically proven. So obviously, ymmv. The oils have been shown to be effective but not as effective as DEET. DEET, treated nets and prophylactics are the WHO recommended preventative measures.

Cor, stop posting and go to PhotoKina and report on the cameras!

Last Thursday I went in to my appointment for vaccinations for my upcoming trip to South Africa. My visit will include Johannesberg, and Cape Town (not at risk), as well as Zambia and Botswanna. The area's in those two countries I will be visiting are listed for risk by the CDC. My travel clinic does not advice the use of mefloquine (Larium) because of the potential of nightmares and side-effects. Larium is typically prescribed for those who will be in risk ares for long periods of time as you take it once weekly versus daily. Diver's Alert Network also advises against use of Larium for divers and pilots. Malarone was prescribed for us which we will take shortly before entering the risk areas and for a week afterward. A family member of mine who is also on the trip has taken Larium in the past without any of the side-effects but has no plans for its use on this trip, he will be taking Malarone. We will also be taking along a 3M company product called Ultrathon which is a DEET lotion that is quite effective. We will be on private reserves so night game viewing will be on our list of activities. 30%+ DEET ingredient is suggested as effective. There's a liquid called "Jungle Juice" in my area that I've used for many treks into the forest, it contains 99% DEET but not advisable for under any clothing and could be very damaging (all DEET can be) to camera equipment. I don't know if this helps, but thought I'd share.

Thanks folks; this confirms what I have read elsewhere.

Malarone as suggested. It is quite expensive if you're in a malaria-zone for longer periods of time, but the only one besides Lariam that is reccomended for Africa. I have personal experience of really bad side effects from Lariam and would never take it again.

/christian

For medical information on all travel related health issues see www.cdc.com and all will be revealed

For medical information on all travel related health issues see www.cdc.com and all will be revealed

Yes, do check with the CDC. Drug resistance mozzies vary by area. I have used Lariam; not likely to use it again per previously noted side affects. IMHO, most USA doctors are not up to speed on malaria, malaria prevention and hyperbolic interactions. I suggest finding a diving doc who travels to malaria infested area.

Next time I travel to a place with malaria, I think I will use mozzie deterents (but not DEET) and take the required anti-malarial drug (not Lariam) at the end of the dive trip.

I think its always helpful to remember you can die from malaria. Take it seriously. On the otherhand, your risks can vary. A liveaboard, is less risky then a jungle treck for example. BY FAR injurys, diarrhea, and ear issues are the most common conditions you should prepare for. Dont just do what so and so says, check sites like cdc, dan etc

You should definitely get information from the experts and not rely on what people say on an internet forum.

The CDC website is where I always go for figuring out which anti-malarials are effective in the area I'm going.

You should also follow the specified dosing instructions - you might not be properly covered if you only take these medicines after finishing your dive trip (ie, a week or more after infected mosquitos have bitten you).

Richard.

You should definitely get information from the experts and not rely on what people say on an internet forum.

 

The CDC website is where I always go for figuring out which anti-malarials are effective in the area I'm going.

 

You should also follow the specified dosing instructions - you might not be properly covered if you only take these medicines after finishing your dive trip (ie, a week or more after infected mosquitos have bitten you).

 

Richard.

Hi Richard,

My question was not about the effectiveness of the antimalarials, but about combining them with diving.

Unfortunately there is no information that I can find on any medical website including the CDC, that specifically indicates that Lariam is contraindicated. (I am a physician). From reading everything I have found so far there is no actual medical contraindication to Larium and diving, but the point is that if you are susceptible to some of the side effects of Larium, then it could well impair your ability to dive safely. Like many things, there are many opinions on the 'best' form of malarial treatment and prevention. I have even come across the opinion of a highly respected South African physician that it may be easier to treat malaria when it occurs, rather than to have to deal with the side effects of the prevention medications. I actually have a nurse working for me at the present time who has long term cardiac effects from antimalarials. So everything is risk versus benefit.

I think I will use mozzie deterents (but not DEET) and take the required anti-malarial drug (not Lariam) at the end of the dive trip.

HI

Everyone has this thing against DEET, but boy is it preferable to malaria (speaking as someone who has had the disease). As Drew says "DEET, treated nets and prophylactics are the WHO recommended preventative measures"

Ultrathon was mentioned, it looks weak at only 30% DEET, but it is the US Armys choice of repellent. The main trick here is that it comes as a lotion, applied all over like sunblock, and lasts 12hours (delayed release microcapsule or some such tosh) and is water resistant. I used this for two weeks in Roatan (No-see-ums territory) and didn't get one bite. On the last day, I was sitting around waiting for the ride to the airport and hadn't put any on (I was going home after all) and in 2 hours got bitten to pieces - so my trial of one proves Ultrathons effectiveness beyond doubt.

Don't dive on Larium, about 30% of people experience sleep disturbance of one type or another, this makes your judgment under stress less than perfect. More worrying if you have an underlying borderline psychiatric disorder Larium can make it manifest (remember Obsession is a psychiatric disorder - with like dive gear etc), and underwater would be a really bad place to become clinically paranoid.

As everyone says speak to the CDC / local travel clinic about what is right for you. Take the medicine AS PRESCRIBED for the DURATION PRESCRIBED (before, during and after your trip)

Cheers

Hal

(P.S. I am a physician who used to live in Swaziland, and dive in MZB and SA)

Another chemoprophylactic not to take is Doxycycline due to the big side effect of sun sensitivity. So unless you are doing a lot of night dives, that'd be a big no no.

Since we are still talking about Southern Africa, you have assess the risks involved. Botswana, Mozambique and Malawi all have the strain of Malaria that is drug resistant to chloroquine, which is why it's a big killer in Malawi.

Still, since prophylactics are not 100% and bite prevention seems to be the better alternative, some people make the choice to not take prophylactics and concentrate on bite prevention (like myself). As Jeff says, cost/benefit of prophylaxis (especially long term consumption) makes bite prevention the more viable (and cheaper, thus more effective) prevention method. That's why programs like One Net One Life distribute treated nets to afflicted areas in Africa.

Hal, my dislike of DEET unfortunately comes from paranoid fear of no data on long term effects on humans and the very real toxic effects on marine life (much like permethrin). DEET is also a solvent so it'll kill plastics and the like. No good for cameras.

SoyBean and other not-so toxic alternatives have shown to be as effective as DEET, although for shorter periods.

Jeff, I believe Roche has amended their literature to account for diving now.

I agree with loftus, you have to get the best information you can, use reliable sources, and try to make an informed decision you feel comfortable with, weigh the risks and benefits. Such is medicine.

Like Drew, I dont take prophylactics anymore. I used to take Malarone (and if you take anything while diving id take that) except that I am susceptible to one of the minor side effects of Malarone, insomnia. (ive not heard of anyone else that has that as well). Since I usually go on liveaboards, the risk of infection is extremely small for me so I stopped taking it.

For Africa id probably use Malarone again, but id talk to our local tropical disease center first.

I am not a doctor, but I can say this: I would not recommend diving with the symptoms that I got from Lariam back in the mid 90's... anxiety and weirness! I have since used Malarone on several trips with none of the nasty side effects that Lariam gave me. I don't care how much I hear that side effects of Lariam are "rare" - it seems like every other person you speak to have had some unpleasant side effect from Lariam.

Jeff, I believe Roche has amended their literature to account for diving now.

I think you are right; I have read this through indirect reports, but for some reason I cannot get the actual Prescribing Information pdf from their site to download.

Edit:

OK finally can download the pdf - lines 169-173 specifically cautions the use of Larium durig 'deep-sea diving'

pi.pdf

I took Larium over a dive vacation and can vouch for a little wierdness. Nothing during diving or even during the day for that matter but you have some really vivid dreams/nightmares. I actually got up in the middle of the night and started sleep walking...until I tripped over my dive case. I laugh now, but it was pretty freaky when it happened.

Not sure how effective it is but I take brewers yeast, along with a deet preventative and that combo seems pretty effective.

I'm going to Malaysia in November. My Doc has prescribed Doxycycline Hyclate for anti-malaria. My internet search does not show any side effects that concern me. Has anyone used it, and what, if any side effects did you experience?