Find information on thousands of medical conditions and prescription drugs.

Lariam

Mefloquine is an orally administered antimalarial drug used as a prophylaxis against and treatment for malaria. It also goes by the trade name LariamTM (manufactured by Roche Pharmaceuticals) and chemical name mefloquine hydrochloride (forumulated with HCl). Mefloquine was developed in the 1970s at the Walter Reed Army Institute of Research in the U.S. as a chemical synthetic similar to quinine. more...

Home
Diseases
Medicines
A
B
C
D
E
F
G
H
I
J
K
L
Labetalol
Lacrisert
Lactitol
Lactuca virosa
Lactulose
Lamictal
Lamisil
Lamivudine
Lamotrigine
Lanophyllin
Lansoprazole
Lantus
Lariam
Larotid
Lasix
Latanoprost
Lescol
Letrozole
Leucine
Leucovorin
Leukeran
Levaquin
Levetiracetam
Levitra
Levocabastine
Levocetirizine
Levodopa
Levofloxacin
Levomenol
Levomepromazine
Levonorgestrel
Levonorgestrel
Levophed
Levora
Levothyroxine sodium
Levoxyl
Levulan
Lexapro
Lexiva
Librium
Lidocaine
Lidopen
Linezolid
Liothyronine
Liothyronine Sodium
Lipidil
Lipitor
Lisinopril
Lithane
Lithobid
Lithonate
Lithostat
Lithotabs
Livostin
Lodine
Loestrin
Lomotil
Loperamide
Lopressor
Loracarbef
Loratadine
Loratadine
Lorazepam
Lortab
Losartan
Lotensin
Lotrel
Lotronex
Lotusate
Lovastatin
Lovenox
Loxapine
LSD
Ludiomil
Lufenuron
Lupron
Lutropin alfa
Luvox
Luxiq
Theophylline
M
N
O
P
Q
R
S
T
U
V
W
X
Y
Z

Side-effects

Like many other drugs, mefloquine has adverse side-effects. It is known to cause severe depression, anxiety, paranoia, nightmares, insomnia, vestibular (balance) damage and central nervous system problems. For a complete list of adverse physical and psychological effects — including suicidal ideation — see the most recent product information. In 2002 the word "suicide" was added to the official product label, though proof of causation has not been established. Since 2003, the FDA has required that patients be screened before mefloquine is prescribed. Anyone taking antidepressants or with a history of psychiatric illness should not take mefloquine. The latest Consumer Medication Guide to Lariam has more complete information.

In the 1990s there were reports in the media that the drug may have played a role in the Somalia Affair, the misbehaviour of Canadian peacekeeping troops on duty in Somalia. There has been similar controversy since three murder-suicides involving Special Forces soldiers at Fort Bragg, N.C., in the summer of 2002. To date more than 19 cases of vestibular damage following the use of mefloquine have been diagnosed by military physicians. The same damage has been diagnosed among business travelers and tourists.

Neurological activity

In 2004, researchers found that mefloquine in adult mice blocks connexins called Cx36 and Cx50. Cx36 is found in the brain and Cx50 is located in the eye lens. Connexins in the brain are believed to play a role in movement, vision and memory.

Chirality and its implications

Mefloquine is a chiral molecule. It contains two asymmetric carbons, which means there are a total of four different enantiomers of the molecule. Mefloquine is currently manufactured and sold as a racemate of the (+/-) R*,S* enantiomers by Hoffman-LaRoche, a Swiss pharmaceutical company. According to some research, the (+) enantiomer is more effective in treating malaria, and the (-) enantiomer specifically binds to adenosine receptors in the central nervous system, which may explain some of its psychotropic effects. Some believe that it is irresponsible for a pharmaceutical company to sell mefloquine as a racemic mixture. It is not known whether mefloquine goes through stereoisomeric switching in vivo.

Advice to travelers

Mefloquine is one of the antimalarial drugs which the August 2005 issue of the CDC Travel Health Yellow Sheet advises travelers in areas with malaria risk — Africa, South America, the Indian subcontinent, Asia, and the South Pacific — to take.

There are virulent strains of malaria that are resistant to one or more anti-malarial drugs; for example, there are mefloquine-resistant strains in Thailand. Travelers are advised to compare current recommendations before selecting an antimalarial drug as the occurrence of drug-resistant strains changes.

Read more at Wikipedia.org


[List your site here Free!]


Mefloquine for preventing malaria in nonimmune adult travelers - Cochrane For Clinicians: Putting Evidence Into Practice
From American Family Physician, 2/1/04 by William E. Cayley, Jr.

The Cochrane Abstract below is a summary of a review from the Cochrane Library. It is accompanied by an interpretation that will help clinicians put evidence into practice. William E. Cayley, Jr., M.D., presents a clinical scenario and question based on the Cochrane Abstract, along with the evidence-based answer and a full critique of the abstract.

This clinical content conforms to AAFP criteria for evidence-based continuing medical education (EB CME). EB CME is clinical content presented with practice recommendations supported by evidence that has been systematically reviewed by an AAFP-approved source. The practice recommendations in this activity are available online at http://www.cochrane.org/ cochrane/revabstr/AB000138.htm.

Clinical Scenario

A 54-year-old woman preparing for a mission trip to Mexico asks what she should do to prevent malaria.

Clinical Question

Should we prescribe mefloquine for the prevention of malaria in nonimmune adult travelers?

Evidence-Based Answer

Mefloquine prevents malaria in military personnel, but its effectiveness in a heterogeneous population of civilian travelers is poorly studied. Evidence of side effects is based on spontaneous reports and may underestimate their frequency.

Practice Pointers

Residents of countries with endemic malaria have some protection from severe disease because of partial immunity. Although mefloquine is commonly recommended for preventing malaria in the 70 million nonimmune civilian travelers visiting such areas annually, (2) reports of adverse effects have led to public concern. (3) The U.S. Food and Drug Administration recently issued a Safety Alert indicating potential side effects ranging from depression to psychosis and suicidal ideation. (4)

This review sought documentation of the efficacy, tolerability, and safety of mefloquine in civilian travelers, but the authors found only field trials in military populations and tolerability trials in nonexposed civilians. One study found that mefloquine and doxycycline were equally effective (one case of malaria prevented for every two people treated), but the study did not include enough patients to detect a clinically meaningful difference between the medications. Four trials found more withdrawals from mefloquine than placebo (of every 30 patients given mefloquine, one stopped treatment), but six trials found no difference between mefloquine and other medications in the rates of withdrawal from therapy. The only side effects consistently specific to mefloquine in the controlled trials were insomnia and fatigue, but the review found 516 additional published case reports of adverse effects.

Although the reviewed studies suggest that mefloquine may be just as safe and effective as other malaria prevention medications, it is unclear if the efficacy information derived from military populations can be generalized to the civilian traveling population. Because 63 percent of the 516 adverse-event case reports were from business or tourist travelers, it is possible that civilian populations may have more difficulties with mefloquine and lower tolerance for its adverse effects, and may be less likely to continue therapy than persons in a more structured military setting. (5)

Since this review was published, one study in nonimmune civilian travelers found that atovaquone plus proguanil is just as effective as mefloquine, with fewer neuropsychiatric side effects and fewer withdrawals from prophylaxis. (6) Another study comparing four prophylactic regimens in civilian travelers found that overall tolerability was the same among mefloquine, doxycycline, chloroquine plus proguanil, and atovaquone plus proguanil. (7) Patients taking mefloquine had higher rates of severe neuropsychiatric side effects, and patients taking chloroquine plus proguanil had higher rates of adverse skin reactions. (7) A third study has shown that nearly one third of malaria cases in returning travelers is late-onset illness, most often caused by Plasmodium vivax and Plasmodium ovale, which have a liver phase that is not susceptible to mefloquine. (8)

Although mefloquine is the most commonly recommended agent for malaria prophylaxis, no study has adequately assessed its safety and efficacy in the general civilian population. Although mefloquine prevents malaria, doxycycline may work just as well, and atovaquone plus proguanil may work better with fewer side effects. Selection of an antimalarial agent should be guided by the patient's health status and travel plans.

Research is needed to clarify the most appropriate regimen for prevention and terminal prophylaxis against liver-stage P. ovale and P. vivax. Recommendations from the Centers for Disease Control and Prevention are available online at http://www.cdc.gov/travel.

REFERENCES

(1.) Croft AM, Garner P. Mefloquine for preventing malaria in non-immune adult travellers. Cochrane Database Syst Rev 2000: CD000138.

(2.) Lo Re V 3d, Gluckman SJ. Prevention of malaria in travelers. Am Fam Physician 2003;68:509-14.

(3.) Croft AM, Garner P, Squire SB. Malaria prevention for travelers. JAMA 1998;279:990.

(4.) U.S. Food and Drug Administration. 2002 safety alert-Lariam (mefloquine hydrochloride). Accessed November, 2003 at: http://www.fda.gov/medwatch/SAFETY/2002/lariam_deardoc.htm.

(5.) Croft A, Garner P. Mefloquine to prevent malaria: a systematic review of trials. BMJ 1997;315:1412-6.

(6.) Overbosch D, Schilthuis H, Bienzle U, Behrens RH, Kain KC, Clarke PD, et al. Malarone International Study Team. Atovaquone-proguanil versus mefloquine for malaria prophylaxis in nonimmune travelers: results from a randomized, double-blind study. Clin Infect Dis 2001;33:1015-21.

(7.) Schlagenhauf P, Tschopp A, Johnson R, Nothdurft HD, Beck B, Schwartz E, et al. Tolerability of malaria chemoprophylaxis in non-immune travellers to sub-Saharan Africa: multicentre, randomised, double blind, four arm study. BMJ 2003;327:1078.

(8.) Schwartz E, Parise M, Kozarsky P, Cetron M. Delayed onset of malaria-implications for chemoprophylaxis in travelers. N Engl J Med 2003;349:1510-6.

RELATED ARTICLE: Cochrane abstract.

Background. Mefloquine is commonly prescribed to prevent malaria in travelers and has replaced other drugs because Plasmodium falciparum is commonly resistant to them. However, mefloquine may be associated with harmful neuropsychiatric effects.

Objectives. To assess the effects of mefloquine in adult travelers compared with other regimens in relation to episodes of malaria, withdrawal from prophylaxis, and adverse events.

Search Strategy. The authors1 searched the Cochrane Infectious Diseases Group specialized trials register (September 2002), the Cochrane Central Register of Controlled Trials (the Cochrane Library, Issue 3, 2002), MEDLINE (1966 to September 2000), EMBASE (1980 to September 2002), LILACS (September 2002), Science Citation Index (1981 to September 2002), and bibliographies in retrieved papers and standard textbooks. They contacted pharmaceutical companies and researchers in the subject of malaria chemoprophylaxis.

Selection Criteria. Randomized trials comparing mefloquine with other standard prophylaxis or placebo in nonimmune adult travelers and nontraveling volunteers were selected. For adverse events, any published case reports were collected.

Data Collection and Analysis. The authors independently assessed trial quality and extracted data. Adverse events from observational studies were categorized by the study type. Study authors also were contacted.

Primary Results. Ten trials involving 2,750 nonimmune adult participants were included. Five were field trials, and of these, all involved primarily male soldiers. One trial comparing mefloquine with placebo showed that mefloquine prevented malaria episodes in an area of drug resistance (Peto odds ratio [OR], 0.04; 95 percent confidence interval [CI], 0.02 to 0.08). Withdrawals in the mefloquine group were consistently higher in four placebo controlled trials (OR, 3.56; 95 percent CI, 1.67 to 7.60). In five trials comparing mefloquine with other chemoprophylaxis, no difference in tolerability was detected. The authors found 516 published case reports of mefloquine adverse effects; 63 percent involved tourists and business travelers. Four fatalities were attributed to mefloquine.

Reviewers' Conclusions. Mefloquine prevents malaria but has adverse effects that limit its acceptability. There is evidence from nonrandomized studies that mefloquine has potentially harmful effects in tourists and business travelers, and its use needs to be carefully balanced against this potential risk. Trials of comparative effects of anti-malarial prophylaxis should include episodes of malaria and withdrawal from prophylaxis as outcomes.

William E. Cayley, Jr., M.D., is assistant professor at the University of Wisconsin Eau Claire Family Practice Residency Program.

Address correspondence to William E. Cayley, Jr., M.D., University of Wisconsin Eau Claire Family Practice Residency, 807 S. Farwell, Eau Claire, WI 54701 (e-mail: bcayley@yahoo.com). Reprints are not available from the author.

COPYRIGHT 2004 American Academy of Family Physicians
COPYRIGHT 2004 Gale Group

Return to Lariam
Home Contact Resources Exchange Links ebay