The Panama Canal Zone, the cities of Panamá, Santiago, and Colón, and the central highlands above 800 m / 2,624 ft are risk free.
Note: Risk is present in all provinces east of the Canal, including the indigenous regions of Guna Yala (also the San Blas Islands) and Embéra. Take any of the antimalarial medications listed below for these areas.
Risk is also present in Ngöbe-Buglé Comarca, west of the Panama Canal Zone. Take atovaquone-proguanil, doxycycline, or mefloquine hydrochloride if going to these areas (see below).
Take meticulous anti-mosquito bite measures in the provinces of Bocas del Toro, Chiriquí, Colón, Darién, Panamá Oeste, and Veraguas.
Risk is present throughout the country, excluding urban areas, and excluding the areas specified:
High risk months for Malaria are: January to December
Incidence of Plasmodium falciparum Malaria: 1%
Areas with drug resistant Malaria: Refer to text on geographical distribution of malaria in Panama (above) for a description of chloroquine resistant areas east of the Canal.
All malaria infections are serious illnesses and must be treated as a medical emergency. In offering guidance on the choice of antimalarial drugs, the main concern is to provide protection against Plasmodium falciparum malaria, the most dangerous and often fatal form of the illness.
Regardless of the medication which has been taken, it is of utmost importance for travellers and their physician to consider fever and flu-like symptoms appearing 7 days up to several months after leaving a malarious area as a malaria breakthrough. Early diagnosis is essential for successful treatment.
In addition to the suggested antimalarial medication, use a mosquito bed net and effective repellents to avoid the bite of the nocturnal Anopheles mosquito.
TAKE IN WEEKLY DOSES OF 500 mg (300 mg base).
START 1 WEEK BEFORE ENTERING MALARIOUS AREA, CONTINUE WEEKLY DURING YOUR STAY AND CONTINUE FOR 4 WEEKS AFTER LEAVING. TAKE IT AFTER A MEAL TO AVOID STOMACH UPSETS.
Note: The bitter taste makes the drug unpalatable. Minor stomach upsets, itching skin, nausea and diarrhea may occur. It may also cause blurred vision and a transitory headache.
TAKE IN WEEKLY DOSES OF 400 mg (310 mg base).
START 1 WEEK BEFORE ENTERING MALARIOUS AREA, CONTINUE WEEKLY DURING YOUR STAY AND CONTINUE FOR 4 WEEKS AFTER LEAVING.
Note: An alternative to chloroquine that may be better tolerated.
Brand names: Malarone, Malanil and others; generics available.
TAKE 1 TABLET DAILY (ATOVAQUONE 250 mg + PROGUANIL 100 mg).
START 1-2 DAYS BEFORE ENTERING THE MALARIOUS AREA, CONTINUE DAILY DURING YOUR STAY AND CONTINUE FOR 7 DAYS AFTER LEAVING.
Note: Take at the same time every day with food or milk.
Brand names: Vibramycin and others; generics available.
TAKE 1 TABLET DAILY (100 mg).
START 1 DAY BEFORE ENTERING MALARIOUS AREA, CONTINUE DAILY DURING YOUR STAY AND CONTINUE FOR 4 WEEKS AFTER LEAVING.
Note: When taking this drug, avoid exposure to direct sunlight and use sunscreen with protection against long range ultraviolet radiation (UVA) to minimize risk of photosensitive reaction. Take with large amounts of water to prevent esophageal and stomach irritation.
Brand names: Lariam, Mephaquin, Mefliam and others; generics available.
TAKE 1 TABLET OF 250 mg (228 mg base) ONCE A WEEK.
START 1-2 WEEKS BEFORE ENTERING THE MALARIOUS AREA, CONTINUE WEEKLY DURING YOUR STAY AND CONTINUE FOR 4 WEEKS AFTER LEAVING.
Note: Side effects include nausea and headache, including neurological side effects such as dizziness, ringing of the ears, and loss of balance. Psychiatric side effects include anxiety, depression, mistrustfulness, and hallucinations. Neurological side effects can occur any time during use and can last for long periods of time or become permanent even after the drug is stopped. Seek medical advice if any neurological or psychiatric side effects occur.