I'm heading down to Ecuador for a few weeks and am planning to spend some time in the jungle environs. In the past I've used Chlorquinine, however this time my doctor prescribed Larium. Other than Greg99's "unfortunate dream involving Ethel Merman and this correspondent singing in the chorus from Oklahoma!" experience, has anyone got an opinion or experience on Larium (or Ethel Merman).

Cheers.

I took this for a trip to India and experienced no ill effects.

I frequently visit high malaria areas, (including a NYE on the Flotel Orellana which is where I suspect you are going?) and medics here have consistently told me that Larium is now the go. The old Chloriquin treatment is apparently something those cunning mozzies have grown resistant to. But DO take something.

To be honest I've been to the Amazon in Peru, Brazil and Ecuador and where we were was terribly disappointing. More different birds outside my office as I type this at sunset than I saw in a week there in Ecuador.

And DO take if time allows the "Devil's Nose" train ride down the Avenue Of The Volcanoes from Quito to the coast. The world's steepest and scariest!

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~ Glen ~

While there are lots of areas with chlorquinine restsant amlaria, ther is much controversy about the use of Larium. While I do not have first hand knowledge and I klnow hat many have used hte drug without any ill effects, a very close friend of mine had very serious side effewcts from the drug and has been on disability for almost a year.
If you would like more info- email me. Apparently the Americans and the British prescribe this drug diffeently- Th British being more cautious. Dont know about Canada though.

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As I've noted previously, it happens that folks do get malaria and can happen to anyone in many places including the US!

I've personally been to many infested areas many times and have never taken it.

Yet my esteemed ID colleages say I/you probably should!

My personal view is 50/50 - either way, and it's your classic benefit risk anaylsis situation.

FWIW, I recommend that you follow your own doctors advice!

Have a great trip!

I took Larium for a trip to Guinea in West Africa in 1999 and had no ill effects at all, except for the price they charged here for the pills.

I started on Lariam (250mg) last Friday for a trip to SAfrica next week. Dropped my second tab yesterday, but haven't seen Ethel around here... though Broadway showtunes have been running through my head more than is usually the case, which is never. Could be the new production of Cabaret I saw the other night, though. Lariam has a very sweet aftertaste. Definitely does not go with a '83 Sonoma Cabernet.

In the past I have used Chlorquinine, but having moved cities and doctors, this was what was prescribed. Seems more expensive than my past drugs for this preventative treatment too.

Took Lariam for 7 weeks in March-April for trip to Indonesia. Last time (2 years ago) I had no side-effects at all. This time I felt woozy and extremely tired off-and-on during the entire course of dosing. Also some nausea. No dreams. Feeling better this week due to finishing the course. The alternative (acquiring malaria) is too horrible to take a chance. Think positively and maybe you'll be side-effects-free.

I was on Lariam for two months last summer, and the only adverse effect was a little bit of wooziness. No psychotic dreams. It's really irritating that you are forced to keep taking it for 4 weeks after you're out of the malaria zone...but I guess those parasites are tenacious little bugs and you've got to show no mercy...

Unlike the others here, I have had very bad experiences with Larium (unable to sleep the night of ingestion, horrible dreams for the next three nights, and some nausea). These symptoms prompted me to abandon the stuff four weeks into my 10 week assignment. Incidentally, I don't think I got bitten more than once or twice during my stay there (India). I will say that I felt like an idiot for spending $200+ because generic versions for were available (and easy to find) there for less than 25 cents per dose. Furthermore, I believe that quality differences between Larium and the mainstay Indian knock-offs are minimal, if any.

Another anti-malarial drug is Doxycyclene -- its taken daily, so for longer trips it would be less convenient than Larium, but it has far fewer side-effects. The only really big one is that you'll get nausea if you take it on an empty stomach (we took it in the morning and literally got sick while walking to breakfast -- you have to eat within minutes of taking the pill).

I've taken both and definitely found doxy to be more to my liking than Larium. I definitely had more vivid dreams on Larium, but I'm glad nothing really nasty...

Noah -- To start with, I recommend looking at www.tripprep.com Secondly, since you're in Toronto, you've got an excellent department of travel medicine at Toronto General Hospital. That group is lead by Dr. Jay Keystone, one of leaders of the travel medicine speciality. Here's his info: Keystone, Jay S., MD FRCPC MSc (CTM)
Centre for Travel and Tropical Medicine
Toronto General Hospital, 200 Elizabeth Street, EN g-208, Toronto, Ontario M5G 2C4
Canada, Telephone: (pre-travel appointments): ++1-416-340-3000,(post-travel): ++1-416-340-3675; Fax: ++1-416-595-5826.

Some general info: Mefloquine is the CDC recommended anti-malaria for Ecudaor, although as others have stated doxy can be used. No need to worry about Malaria in the Galapagos or the Andes highlands, but pretty much present anywhere else at altitudes <1500m. Depending on your past medical history one may not be indicated for you. The best protection from exposure is to not get bitten in the first place... dusk to dawn is the time for the bites. Again, you should use Permethrin impregnated bug netting, and an insect repeallant high in DEET - say 20% or higher. Those herbal repellants have been studied and do not work.

Boil it, cook it, peel it, or forget it. Sure you know to watch the food, and water. Not all pumps and filters are good-- check to see the smallest filtratable material.. some just don't go low enough.

Other recommendations: Hep A -- highly recommend it, Hep B -- depends on "risky" behavior, might be better for SE Asia , make sure your tetnus is up to day - within the last 10 years. Just know proof of Yellow Fever vacination is required if previsouly traveling or transiting (except airport) an endemic area within the last 6 days.

If you need more detailed info, feel free to contact me.