mefloquine

Last reviewed 01/2018

This drug is used as a prophylaxis against falciparum malaria in areas where there is chloroquine resistance.

Mefloquine has been used in Europe and the United States of America for approximately 10 years.

The summary of product characteristics should be consulted before prescribing this drug.

Roche have stated that (1):

• Lariam (mefloquine) may induce potentially serious neuropsychiatric disorders
  
  
• the most common neuropsychiatric reactions to mefloquine include abnormal dreams, insomnia, anxiety, and depression. Additionally hallucinations, psychosis, suicide, suicidal thoughts and self-endangering behaviour have been reported
  
  
• do not use mefloquine for malaria chemoprophylaxis in patients with any active or a history of psychiatric disturbances
  
  
• due to the long half-life of mefloquine, adverse reactions may occur and persist up to several months after discontinuation of the drug
  
  
• healthcare professionals should react promptly to signs of neuropsychiatric reactions with mefloquine chemoprophylaxis. Mefloquine should be discontinued immediately and replaced by alternative malaria prophylaxis medication
  
  
• advise patient that if they experience a neuropsychiatric reaction such as suicidal thoughts; self-endangering behaviour; severe anxiety; feelings of restlessness, confusion, or mistrust towards others; visual/auditory hallucinations; depression; or changes to their mental state during mefloquine chemoprophylaxis, they should stop taking mefloquine immediately and seek urgent medical advice

Reference:

• Roche (October 2013). Direct Helathcare Professional Communication on Larium (mefloquine) for malaria chemoprophylaxisis and the risk of neuropsychiatric adverse reactions