Arakoda (Tafenoquine) for Malaria Prevention: Dosing, Side Effects, and How to Get It

The short answer

Arakoda (tafenoquine) is an FDA-approved prescription pill that prevents malaria with once-weekly dosing while you travel, instead of the daily dosing that doxycycline and Malarone require. It works against all species of malaria, it stays in your body for a long time (a half-life of about 15 days), and that long half-life is what makes weekly dosing possible. There is one non-negotiable catch: before you can take it, you need a quantitative blood test to confirm you are not G6PD deficient, because tafenoquine can cause dangerous red blood cell breakdown in people who are. Arakoda is approved for adults 18 and older. It is not for pregnant women, people who are breastfeeding an infant who has not been tested for G6PD deficiency, or anyone with a history of psychotic illness.

If weekly dosing sounds easier to stick to than a daily pill, tafenoquine is worth asking about. Below is exactly how it works, the dosing schedule travelers get wrong most often, who should not take it, and how to get a prescription before you fly.

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What is tafenoquine (Arakoda)?

Tafenoquine is an antimalarial drug in the 8-aminoquinoline class, the same family as primaquine. The FDA approved it in 2018 under two different brand names for two different jobs:

• Arakoda (100 mg tablets) is approved for prevention of malaria in adults 18 and older, for any malarious area and against all Plasmodium species.
• Krintafel is approved for a different purpose: preventing relapse of Plasmodium vivax malaria in people who are already being treated for an active infection.

This article is about Arakoda, the version travelers use to keep from getting malaria in the first place.

What makes Arakoda stand out is its pharmacology. Tafenoquine has an unusually long half-life, roughly 15 days. Most malaria pills clear your system quickly, which is why doxycycline has to be taken every single day and why missing doses leaves gaps in protection. Tafenoquine lingers, so once you are loaded up, a single weekly dose keeps a protective level in your blood.

How well does it work?

According to the CDC, the major antimalarial options for travelers, atovaquone-proguanil (Malarone), doxycycline, and tafenoquine, are all considered equally effective at preventing malaria when taken correctly. The differences between them are not really about whether they work. They are about dosing schedule, side effects, cost, who can take them, and how forgiving each one is if you slip up.

Tafenoquine's pitch is adherence. A pill you take once a week is easier to remember than one you take every day, especially on a long trip where daily routines fall apart. For travelers who know they struggle to take daily medication, that can be the deciding factor.

The Arakoda dosing schedule

This is the part travelers get wrong, so read it carefully. Arakoda uses a three-part schedule: a loading dose before you go, a weekly maintenance dose while you are there, and one final dose after you get back.

1. Loading dose (before travel). Take 200 mg (two 100 mg tablets) once daily for 3 days before you leave for the malaria-endemic area.

2. Maintenance dose (during travel). Starting 7 days after your last loading dose, take 200 mg (two tablets) once a week while you are in the malaria area. Pick a consistent day of the week so it is easy to remember.

3. Final dose (after travel). Take one more 200 mg dose 7 days after your last maintenance dose, in the week after you leave the area.

Take each dose with food. Taking tafenoquine on a full stomach improves how much your body absorbs and can reduce stomach upset.

Compare that to the alternatives: doxycycline is a daily pill you start 1 to 2 days before travel and keep taking for a full 4 weeks after you leave. Malarone is a daily pill you start 1 to 2 days before and stop just 7 days after leaving. Tafenoquine sits in between on the back end (one dose in the week after you return) but wins on the front end and middle with weekly, not daily, dosing.

Because the loading dose starts 3 days before departure, tafenoquine is not a last-minute option. Plan to have it in hand at least several days before you fly.

The G6PD test you cannot skip

Here is the single most important safety point about tafenoquine. Like other 8-aminoquinolines, it can cause hemolysis, the destruction of red blood cells, in people who have glucose-6-phosphate dehydrogenase (G6PD) deficiency. G6PD deficiency is a common inherited enzyme condition, and in someone who has it, tafenoquine can trigger a serious and potentially life-threatening drop in red blood cells.

For that reason, the CDC and the FDA require a quantitative laboratory G6PD test before tafenoquine is prescribed. Tafenoquine is contraindicated in anyone who is G6PD deficient and in anyone whose G6PD status is unknown. This is not optional and it is not a test you can guess your way around. A quantitative blood test is the standard, not a quick fingerstick screen.

If you have never had a G6PD test, that needs to happen first. The long half-life that makes tafenoquine convenient is also why this matters so much: if you have an adverse reaction, the drug is in your system for weeks, and there is no quick way to clear it.

Who should not take Arakoda

Tafenoquine is a strong, effective drug, but it has a clear list of people who should choose something else:

• Anyone with G6PD deficiency or unknown G6PD status. As above, this is an absolute contraindication.
• Pregnant women. Tafenoquine is contraindicated in pregnancy because the fetus may be G6PD deficient even if the mother is not.
• Breastfeeding parents whose infant has G6PD deficiency or has not been tested. Because the drug passes into breast milk, the baby's G6PD status has to be known and normal.
• People under 18. Arakoda is only approved for adults.
• Anyone with a history of psychotic disorders or current psychotic symptoms. Tafenoquine has been associated with psychiatric effects, and people with this history should avoid it.

If any of these apply to you, doxycycline or Malarone is usually the better fit. Our guides on Malarone vs. doxycycline and how to get malaria pills online walk through those options.

Side effects to know about

In studies of tafenoquine used for prevention, the most common side effects were dizziness, nausea, vomiting, and headache. Some travelers also experienced elevated liver enzymes, trouble sleeping, depression, abnormal or vivid dreams, and anxiety.

A few practical notes:

• Take it with food to cut down on nausea and improve absorption.
• Watch for signs of hemolysis even after G6PD screening: unusual tiredness, shortness of breath, a fast heartbeat, or dark urine. These warrant prompt medical attention.
• Mental health changes matter. If you notice new or worsening mood symptoms, sleep disturbances, or unsettling dreams, mention them to a clinician. This is part of why a psychiatric history is a contraindication.

As with any antimalarial, no pill is 100 percent protective. Tafenoquine works best alongside mosquito-bite prevention: an EPA-registered repellent, permethrin-treated clothing, and a bed net in higher-risk settings. See our insect repellent guide for what actually works.

Tafenoquine vs. Malarone vs. doxycycline

Here is how the three main travel antimalarials stack up.

The short version: doxycycline is the budget option but demands daily dosing and a full month of pills after you get home. Malarone is well tolerated and only needs 7 days of post-travel dosing, but it is daily and pricey. Tafenoquine is the only weekly option and shortens the post-travel commitment to a single dose, but it requires that G6PD test and rules out several groups of people.

There is no single "best" malaria pill. The right one depends on your destination, your trip length, your health history, and how confident you are about sticking to a daily schedule.

Frequently asked questions

Is tafenoquine the same as Malarone? No. Malarone is atovaquone-proguanil, a daily pill. Tafenoquine (brand name Arakoda for prevention) is a different drug taken weekly during travel. Both prevent malaria and the CDC considers them equally effective when taken correctly, but they have different dosing, side effects, and requirements.

How often do you take Arakoda for malaria prevention? You take a 200 mg loading dose once daily for 3 days before travel, then 200 mg once a week during travel (starting 7 days after the last loading dose), then one final 200 mg dose 7 days after your last weekly dose.

Why do I need a G6PD test before taking tafenoquine? Tafenoquine can cause serious red blood cell destruction (hemolysis) in people with G6PD deficiency. A quantitative G6PD blood test is required before prescribing, and the drug is contraindicated if you are deficient or your status is unknown.

Can I take tafenoquine if I'm pregnant or breastfeeding? No, not in pregnancy. Tafenoquine is contraindicated because the fetus may be G6PD deficient. While breastfeeding, it should only be used if the infant has been tested and does not have G6PD deficiency.

Is tafenoquine better than doxycycline? Neither is universally "better." Tafenoquine is weekly and may be easier to stick to; doxycycline is daily, cheaper, but requires 4 weeks of dosing after you return and causes sun sensitivity. The best choice depends on your destination, trip length, budget, and health history.

What are the most common side effects of Arakoda? Dizziness, nausea, vomiting, and headache are the most common. Some people also report sleep disturbances, vivid dreams, anxiety, low mood, or elevated liver enzymes. Taking it with food helps with stomach upset.

How far in advance do I need to start tafenoquine? The loading dose begins 3 days before you leave, so plan to have the prescription, plus your G6PD result, in hand at least a week or two before your trip.

Does tafenoquine protect against all types of malaria? Arakoda is approved for prophylaxis against all Plasmodium species in any malarious area. No antimalarial is 100 percent protective, so pair it with mosquito-bite prevention.

Sources

• CDC Travelers' Health: Tafenoquine Approved for Malaria Prophylaxis and Treatment
• CDC MMWR: Guidance for Using Tafenoquine for Prevention and Antirelapse Therapy for Malaria — United States, 2019
• CDC Yellow Book: Malaria
• CDC: Choosing a Drug to Prevent Malaria
• Journal of Travel Medicine: Tafenoquine for travelers' malaria: evidence, rationale and recommendations
• NCBI Bookshelf: Tafenoquine and G6PD: a primer for clinicians

This article is for general educational purposes and is not a substitute for personalized medical advice. Talk to a licensed clinician about which malaria medication is right for you.