Malarone vs doxycycline: choosing malaria tablets

Medically reviewed by Muhammad A Jalil, Superintendent Pharmacist (GPhC Reg No: 2236161)

Published 2026-08-22 · Clinically reviewed 2026-08-22 · Updated 2026-08-23

Atovaquone-proguanil (Malarone) and doxycycline compared for malaria prevention — schedules, side effects, costs and how UK travellers choose between them.

For most destinations where malaria tablets are advised, atovaquone-proguanil (best known by the brand name Malarone) and doxycycline are both effective choices — the real differences are the schedule around your trip, the side-effect profiles, and cost. Atovaquone-proguanil is the shortest course and the gentlest on most stomachs but costs more; doxycycline is inexpensive and well proven but must be continued for four weeks after you return and makes sunburn more likely. Which one suits you depends on the trip you are actually taking.

Start with your destination, not the tablet

Malaria risk is specific: it varies by country, region within a country, season and even altitude. UK travel medicine works from the TravelHealthPro (NaTHNaC) destination guidance, which states whether prevention tablets are advised for your itinerary and which ones are effective there — resistance patterns rule some options out in some regions. Popular examples make the point: most of Thailand's tourist coast needs no tablets at all, while much of sub-Saharan Africa calls for them year-round — two beach holidays, opposite answers. Any responsible prescriber, including our clinicians, checks your exact itinerary against that guidance first. Tablets are also only half the defence: bite avoidance — repellent with 50% DEET, covering up at dusk, treated nets — matters everywhere, because no tablet is 100% protective.

How each one works

Atovaquone-proguanil combines two medicines that attack the malaria parasite at different stages, including the early liver stage. That liver-stage activity is why it can be stopped just seven days after leaving a malaria area, the shortest tail of any commonly used option.

Doxycycline is a tetracycline antibiotic that kills the parasite once it emerges into the bloodstream. Because it only works at the blood stage, it must be continued for four full weeks after leaving the risk area to cover parasites still maturing in the liver.

Schedules compared

Atovaquone-proguanil: start 1–2 days before entering the malaria area, take one tablet daily with food at the same time each day, continue for 7 days after leaving. A two-week trip means roughly 24 tablets.
Doxycycline: start 1–2 days before entering the area, take 100 mg daily with plenty of water (not lying down straight afterwards), continue for 4 weeks after leaving. The same two-week trip means around 44 tablets.

That four-week tail is where doxycycline courses most often fail — finishing feels pointless once you are home. If you know you are unlikely to keep taking tablets a month after the holiday ends, that alone is a good reason to choose the shorter course.

Side effects and who should avoid each

Atovaquone-proguanil is generally the best tolerated: headache and mild stomach upset are the common complaints, and taking it with food or a milky drink helps absorption and comfort. It is not suitable in pregnancy, while breastfeeding, or with significant kidney impairment.

Doxycycline's signature issue is photosensitivity — skin burns faster in strong sun, which is worth taking seriously on precisely the sunny trips where malaria tablets are needed. High-SPF sunscreen and covering up manage it, but fair-skinned beach travellers often prefer the alternative. It can also irritate the food pipe if taken without enough water, and can cause thrush. It is unsuitable in pregnancy and for children under 12.

Neither tablet suits everyone; mefloquine (weekly dosing) remains an option for some itineraries and is one reason a short clinical review beats picking a tablet off a list.

Cost, in plain terms

Malaria prevention is a private prescription in the UK, so price differences are real: doxycycline is one of the least expensive medicines in the pharmacy, while atovaquone-proguanil costs more per tablet — though generic versions have narrowed the gap considerably since Malarone's patent ended. For a long trip the difference multiplies; for a ten-day break it is usually modest enough that convenience and tolerability decide.

Once you know your itinerary, you can check your eligibility for malaria prevention online — tell us where you are going and when, and a UK clinician will confirm which tablets are advised for those regions and prescribe the one that fits you.

Frequently asked questions

Which is more effective at preventing malaria?

Where both are recommended for a destination, effectiveness is comparable and very high when taken correctly — trial estimates for both sit above 90%. Missed doses are the biggest real-world difference, which tends to favour the shorter atovaquone-proguanil course.

Can I take these tablets if I'm on other medicines?

Both have interactions worth checking: doxycycline binds to indigestion remedies, iron and calcium (space them by two to three hours), and atovaquone-proguanil interacts with some blood thinners and epilepsy medicines. List everything you take in the consultation and the clinician will screen it.

What if I forget a dose while I'm away?

Take it as soon as you remember, then continue as normal — and be extra careful with bite prevention. Missing several doses of either tablet meaningfully weakens protection; if that happens, treat any fever within a year of the trip, especially the first three months, as possible malaria and seek urgent care, telling the clinician where you travelled.

Do children need different malaria tablets?

Often, yes. Paediatric dosing of atovaquone-proguanil is weight-based and available; doxycycline is not used under 12. Family trips are best planned in one consultation so everyone's option matches the same itinerary.