Malarone and Spotting: Possible Side Effects & When to See a Doctor

Question
I have been taking Malarone to prevent Malaria while travelling for the past 40 days and have had spotting almost everyday and it has continued even though I have not taken Malarone for three days now.  I am on Alesse birth control and have not had spotting before, and I have taken this pill for numerous years.  I am wondering if taking the Malarone has possibly caused this side effect? Should I wait until my next cycle to see if it stops or go to the doctor to get it checked out.

Answer
As far as I can tell, spotting on the pill is not a known side effect of Malarone.  However, I think it's possible that that's what's happening in your case.  Some drugs are known to decrease the effectiveness of birth control pills due to their action on liver enzymes and consequent metabolism of the pill.  On the other hand, stress can sometimes cause spotting on the pill, so if that seems possible, that may be the cause.  If you haven't felt stressed, it may be wise to either double up on your pills or use a back up method of birth control while you're on the Malarone.