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Travel Medicine (Expert Forum)
Halofantrine for malaria therapy and sudden cardiac arrest
Answered by
Philip Parks, MD - Occupational Safety, Occupational Health, Travel Medicine, Environmental Health
Lifespan Occupational Health Services
Providence - RI
Questions in the Travel Medicine forum are answered by Dr. Philip D Parks, affiliated with Harvard School of Public Health. Topics covered include disease prevention, finding a doctor abroad, food and water safety, illness and injury abroad, mosquito and tick protection, resources for travelers, traveling with children or pets, traveling with special needs, vaccinations and immunizations.
Halofantrine for malaria therapy and sudden cardiac arrest
by kibarisho, Dec 06, 2007 08:33AM
Recently read (CDC website) about instances of SCA and death in people with hypertrophic cardiomyopathies some days after being given halofantrine for treatment of malaria. I've lived in the tropics (East and Central Africa) for 20+ years and will be travelling to West Africa at Christmas for a two week work trip. I plan to take doxycycline for malaria prophylaxis and carry Coartem (purchased from a reputable pharmacy in Nairobi Kenya) for emergency treatment. I've used malarone in the past but cannot afford it with current insurance. I have a mild IDC.
I want to ensure that even if very ill with suspected malaria, I am not given halofantrine. How can a traveller find out if a particular medication is used in a foreign environment? Make sure he/she doesn't take a drug with dangerous side effects? Medic alert bracelets are in English, and cannot cover everything. Internet may not be available in the Sahara or Somalia.
I want to ensure that even if very ill with suspected malaria, I am not given halofantrine. How can a traveller find out if a particular medication is used in a foreign environment? Make sure he/she doesn't take a drug with dangerous side effects? Medic alert bracelets are in English, and cannot cover everything. Internet may not be available in the Sahara or Somalia.
Doctor's Answer
by Philip Parks, MD, Dec 11, 2007 10:01PM
, Dec 11, 2007 10:01PM
To: kibarisho
Hello,
I congratulate you for being so proactive regarding you upcoming trip to West Africa.
Unfortunately, and you know from residing in Africa in the past, there is no way of knowing with absolute certainty which anti-malarials will be used in a given hospital or care facility.
I would recommend that you wear a medical alert bracelet in English and possibly in the language of the primary destination that you are traveling to that is endemic with malaria.
Based on your history of "mild" idiopathic dilated cardiomyopathy (no history of bradycardia or atrial fibrillation, right?), I would recommend that you discuss your planned use of Coartem with your personal physician or health care provider.
From: http://www.malariaandhealth.com/professional/prescribing_coartem.htm
Coartem® is contraindicated in those with hypersensitivity to the active substances or any of the excipients; in cases of severe malaria and in the first trimester of pregnancy. During the second and third trimester, treatment should only be considered if the expected benefit to the mother outweighs the risk to the foetus. Coartem® is also contraindicated in patients with a history of symptomatic cardiac arrhythmias, clinical relevant bradycardia or severe heart disease. Also in patients with a family history of congential prolongation of the QTc interval or sudden death, disturbances of electrolyte balance, e.g. hypokalaemia or hypomagnesaemia. Drugs that are known to be metabolised by cytochrome enzyme CYP2D6 or drugs that are known to prolong the QTc interval should not be used concomitantly with Coartem®.
* ~ Dr. Parks
This answer is not intended as and does not substitute for medical advice. The information presented in this posting is for patients’ education only. As always, I encourage you to see your personal physician for further evaluation of your individual case.
I congratulate you for being so proactive regarding you upcoming trip to West Africa.
Unfortunately, and you know from residing in Africa in the past, there is no way of knowing with absolute certainty which anti-malarials will be used in a given hospital or care facility.
I would recommend that you wear a medical alert bracelet in English and possibly in the language of the primary destination that you are traveling to that is endemic with malaria.
Based on your history of "mild" idiopathic dilated cardiomyopathy (no history of bradycardia or atrial fibrillation, right?), I would recommend that you discuss your planned use of Coartem with your personal physician or health care provider.
From: http://www.malariaandhealth.com/professional/prescribing_coartem.htm
Coartem® is contraindicated in those with hypersensitivity to the active substances or any of the excipients; in cases of severe malaria and in the first trimester of pregnancy. During the second and third trimester, treatment should only be considered if the expected benefit to the mother outweighs the risk to the foetus. Coartem® is also contraindicated in patients with a history of symptomatic cardiac arrhythmias, clinical relevant bradycardia or severe heart disease. Also in patients with a family history of congential prolongation of the QTc interval or sudden death, disturbances of electrolyte balance, e.g. hypokalaemia or hypomagnesaemia. Drugs that are known to be metabolised by cytochrome enzyme CYP2D6 or drugs that are known to prolong the QTc interval should not be used concomitantly with Coartem®.
* ~ Dr. Parks
This answer is not intended as and does not substitute for medical advice. The information presented in this posting is for patients’ education only. As always, I encourage you to see your personal physician for further evaluation of your individual case.
You are welcome.
Have an enjoyable and safe trip.
Stay well !
~ Dr. Parks
This answer is not intended as and does not substitute for medical advice. The information presented in this posting is for patients’ education only. As always, I encourage you to see your personal physician for further evaluation of your individual case.