Malaria tablet shortage: what to do if you were expecting mefloquine

What happened

On 9 September 2026, the National Travel Health Network and Centre, NaTHNaC, updated its notice on a shortage of mefloquine. Mefloquine, often known by the brand name Lariam, is one of the antimalarial tablets used to prevent malaria in travellers. The 250mg tablets are currently out of stock in the UK, and the expected delivery has moved to somewhere between October and December 2026. NaTHNaC has asked clinics and pharmacies still holding stock to prioritise it carefully. Remaining supplies should go to travellers with imminent travel for whom mefloquine is the first-choice option. That includes pregnant travellers going to high-risk malaria regions such as sub-Saharan Africa, where the alternatives are more limited. Everyone who can safely take a different antimalarial should be prescribed one instead, so that the remaining mefloquine goes to the people who have no good substitute. Unlicensed mefloquine tablets can be sourced through specialist importers, and NaTHNaC names Alium, Chemys, Genetech, Smartway and Target Healthcare. Because unlicensed imports have not been through central regulatory assessment, prescribing them has to follow local governance and quality-check procedures, which takes time. This is not a new problem. Antimalarial supply in the UK has been under strain for some time, and chloroquine products have had their own difficulties.

Why this matters

Malaria is not a small risk. It killed an estimated 597,000 people worldwide in 2023, most of them children in sub-Saharan Africa. In the UK we usually see between 1,500 and 2,000 imported cases a year, in people who picked it up abroad. Almost all of those UK cases are preventable. The great majority happen in travellers who took no antimalarial tablets at all, or did not finish the course. Falciparum malaria, the most dangerous type, can go from first symptoms to life-threatening within a day or two. So a shortage of one antimalarial matters mainly because of what people do in response to it. The dangerous reaction is to shrug and travel without anything. The reassuring part is that mefloquine is one option among several. For most destinations there are alternatives, principally atovaquone with proguanil, often known as Malarone or its generic versions, and doxycycline. Which one suits you depends on your destination, your medical history, whether you are pregnant, what other medicines you take, and how long you are going for. That is a clinical decision, and it is exactly why the advice below is to get in front of someone qualified, early.

What the evidence actually says

Two things are worth separating: the supply problem, and mefloquine itself. On supply, this is a manufacturing and distribution issue, not a safety recall. Nothing has been found wrong with the medicine. The 250mg tablets are simply not available, and the expected resupply window has already slipped once, from a July to September estimate to October to December. Treat any date as provisional. On the medicine, mefloquine has a genuinely complicated history. It is effective, and it has the practical advantage of weekly rather than daily dosing, which suits long trips. It is also one of the few options considered suitable in pregnancy for high-risk areas, which is precisely why NaTHNaC is asking for remaining stock to be reserved for that group. But mefloquine has been associated with neuropsychiatric side effects, including anxiety, depression, vivid dreams and, rarely, more serious effects. UK product information carries warnings about this, and it should not be used by people with a history of certain psychiatric conditions or seizures. This is well established and it is why prescribers assess suitability rather than handing it out routinely. On the alternatives, the evidence is good. Atovaquone with proguanil and doxycycline are both highly effective when taken correctly. Correctly is the operative word: each has its own schedule for when to start before travel and how long to continue after leaving the risk area, and stopping early is a common and serious mistake.

Qurexa perspective

Medicine shortages are a large part of what we deal with day to day, and there is one practical lesson we would pass on above all others. Time is the resource that runs out first. When a medicine is short, the people who cope best are the ones who found out early, because that is when there are still options: a different antimalarial, a different pharmacy, an unlicensed import arranged properly through the right channels. The people who struggle are the ones who discover the problem a week before flying. At that point some antimalarials cannot even be started in time, because several need to be begun days or weeks before you arrive. So if you have travel booked to a malaria area in the next few months, this is a today job, not a nearer-the-time job. Ring your travel clinic or pharmacy now, tell them where you are going and when, and let them work out what is actually available. Qurexa supports people across Lincolnshire with prescription delivery and staying on track with their medicines, and the pattern is the same whether it is an antimalarial or a long-term prescription: early is easy, late is hard.

Practical advice

If you are travelling to a malaria risk area, here is the order to do things in. Book a travel health appointment four to six weeks before you go, and earlier for a long or complicated trip. Many pharmacies and GP practices offer travel health services, and travel clinics can prescribe privately. Check your destination on TravelHealthPro, the NaTHNaC website. It gives country-by-country malaria risk and the recommended options, and it is the same source UK clinicians use. If you were expecting mefloquine, say so at the start of the appointment, so the alternatives can be discussed straight away rather than after a wasted prescription attempt. Do not buy antimalarials from unregulated websites. Falsified antimalarials are a real and documented problem, and a fake tablet offers no protection at all against a disease that can kill. Remember that tablets are only half of it. No antimalarial is 100% effective. Insect repellent containing DEET, covering up at dusk and dawn when the mosquitoes that carry malaria bite, and sleeping under a treated net all matter. Finish the course. Most antimalarials must be continued for a set period after you leave the risk area, and stopping on the flight home is one of the most common causes of imported malaria. And if you develop a fever within a year of returning from a malaria area, seek medical help urgently and say where you have been. Malaria is treatable when caught early and dangerous when it is not.

What to know

Mefloquine (Lariam) 250mg tablets are out of stock in the UK, with resupply now expected between October and December 2026. NaTHNaC has asked that remaining stock be reserved for travellers with imminent travel for whom mefloquine is first choice, including pregnant travellers heading to high-risk regions such as sub-Saharan Africa. Everyone else should be given an alternative such as atovaquone with proguanil or doxycycline. Unlicensed imports are possible through named specialist importers but require local governance checks. This is a supply problem, not a safety recall. Book a travel health appointment four to six weeks before travel, check TravelHealthPro for your destination, never buy antimalarials from unregulated websites, use repellent and nets as well as tablets, and finish the full course after you get home. Sources: NaTHNaC / TravelHealthPro, 'Mefloquine shortage', 9 September 2026, https://travelhealthpro.org.uk/news/mefloquine-shortage ; NaTHNaC, 'Vaccines and medicines: availability, supply, shortages and use of unlicensed medicines', https://travelhealthpro.org.uk/factsheet/67/vaccines-and-medicines-availability-supply-shortages-and-use-of-unlicensed-medicines ; NaTHNaC malaria news topics, https://travelhealthpro.org.uk/news-topic/23/malaria This article is for general information and does not replace advice from a doctor, pharmacist or other qualified healthcare professional. Never travel to a malaria risk area without seeking proper travel health advice first.