Clare Daly (Dublin North, United Left)
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534. To ask the Minister for Defence further to Parliamentary Question No. 23 of 18 June 2014, the reason he said Doxycycline has to be taken in the absence of dairy products when a glance at the IBM website safety information states that if your stomach is upset Doxycycline can be taken with milk or cereal; and the way he can have confidence in the current Defence Force anti-malaria policy when despite many experts they say they consulted they have committed such a fundamental error. [31087/14]

Simon Coveney (Cork South Central, Fine Gael)
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TheHealth Products Regulatory Authority (HPRA) formerly The Irish Medicines Board (IMB) is the statutory authority with responsibility for the quality, safety and efficacy of medicines in Ireland. The Defence Forces Medical Corps is advised that the three anti-malarial medications licensed by the IMB – Lariam (mefloquine), Malarone and Doxycycline – can all have significant side effects and protocols are in place to control the risk of side effects in individuals. As stated in previous PQ’s Doxycycline should be taken in the absence of dairy products. It has a daily dosage regime. While it can cause minor but troublesome, mainly gastrointestinal side effects, it can also produce sun-sensitivity skin rashes (akin to severe sun burn) in some individuals. Another possible side effect is heartburn. Calcium ions interfere with the absorption of the active ingredient into the blood stream from the bowel. The less calcium ions the greater the absorption and more effective the result. Milk products are rich in calcium. The compromise in respect of the possible side effect of heartburn is to take a little milk that lines the oesophagus/stomach and makes the medication more tolerable (albeit at the price of decreased absorption and efficacy).

The choice of chemoprophylaxis is dependent on a number of factors including the type of malaria in the destination, resistance to particular drugs, the profile of the traveller (contra-indications, underlying health conditions, purpose of travel), the duration of travel and adherence issues. The choice of medication is a medical decision made by Medical Officers in the Defence Forces on the basis of best international practice having regard to the specific circumstances of the mission and the individual member of the Defence Forces.