Important Facts What are the contraindications?
• Mefloquine (Lariam®) is an anti-malarial drug effectively
Contraindications for mefloquine include those with a known
used to prevent malaria. It is FDA-approved for use in
hypersensitivity or allergy to mefloquine or related
regions where local strains of malaria have developed a
compounds (other quinoline methanol derivatives such as
resistance to other anti-malarial agents such as chloroquine.
quinine, quinidine); current or past depressive disorder,
• Mefloquine is prescribed to over 350,000 Americans each
general anxiety disorder, psychosis, schizophrenia, or other
year and has a relatively safe and efficacious record of
significant psychiatric illness; a cardiac conduction
abnormality or dysrythmia, liver disease, or history of
• Provide service members a medication guide detailing
possible side effects of this medication before taking
Providers should not prescribe mefloquine for patients
• Advise service members to avoid using alcohol while taking
taking medications that alter cardiac conduction (especially
mefloquine because the more serious side effects occur
beta-blockers such as propranolol, atenolol, and metoprolol),
among those who consume alcohol while taking the
anticonvulsant medications, drugs related to mefloquine
(e.g. chloroquine, quinine, quinidine, and halofantrine),
• While rare, suicides have been reported, but not proved
aurothioglucose,ampicillin, ampicil in/sulbactam, or the
scientifically, as a result of taking mefloquine. Remain alert
to talk or signs of suicide and evaluate as necessary.
• Advise female service members not to use mefloquine if
Some occupational groups (e.g., aviators) may be restricted
they are pregnant and not to become pregnant for three
from taking prophylactic mefloquine because of certain side
effects described later. No anti-malarial medication provides
100% effective prevention. Therefore, critical prevention
When should mefloquine be prescribed?
efforts include properly wearing the uniform and use of
Mefloquine should be prescribed for patients traveling to regions
in which malaria is present and the parasite is resistant to
chloroquine. Alternatives to prophylactic mefloquine include
What are the common side effects?
doxycycline and Malarone® (atovaquone with proguanil), but
For most patients, mefloquine is well tolerated and offers the
these require daily dosing instead of mefloquine’s weekly dosing.
best protection in regions with chloroquine-resistant malaria.
Side effects occur in 3 to 25 per cent of patients, rates
For adults, the usual oral dosing regimen is 250 mg each week
similar to chloroquine. Most side effects do not necessitate
beginning at least one week before travel, continuing weekly
altering the type of prophylactic drug. Potential side effects
during travel, and for 4 weeks after leaving an endemic area,
that can impair reaction time and thinking include sensory
generally with an additional antimalarial prophylaxis medication.
and motor neuropathies, encephalopathy, convulsions,
Doses should be taken on the same day of each week.
psychosis, nightmares, dizziness, and confusion.
Mefloquine should be taken with food and at least 8 oz. (240 ml)
of water to enhance bioavailability and to minimize side effects,
Side effects can include insomnia, unusual dreams,
particularly an upset stomach or vomiting. Steady state drug
lightheadedness, headache, vertigo, visual disturbances,
levels are reached after seven to eight weeks of consistent
ringing in the ear, rash, irritability, and gastrointestinal
weekly dosing. Thus, side effects are more likely to occur within
symptoms, such as nausea, vomiting, and diarrhea.
Vomiting is the most common side effect, affecting 3 percent
of users. Other complaints affect less than 1 percent of
The elimination half-life is relatively long, lasting from 13 to 24
users. If any of these effects occur, individuals should seek
medical advice about the safety of operating heavy
Your Suggestions
equipment or carrying a weapon while remaining on the
How can I report adverse drug events potentially
medication. If these effects persist or significantly impair
related to mefloquine?
functioning, consideration should be given to stopping the drug
Health care providers are encouraged to document and
report known or suspected patient adverse drug events.
What about neuropsychiatric side effects?
The FDA has the primary responsibility for assuring the
Rare instances of suicide in patients taking mefloquine have
safety and efficacy of all regulated drug products.
been reported but no studies have demonstrated a statistical
MedWatch, the FDA Safety Information and Adverse Event
association between mefloquine use and suicide, suicidal ideas,
Reporting Program, serves both health care professionals
suicide attempts, or any other violent behavior. Patients with a
and the public. MedWatch facilitates voluntary and
history of psychiatric il ness may be vulnerable to mefloquine-
confidential reporting of adverse events potentially related to
related psychiatric symptoms, and the package insert
various medications. Reporting can be done via the FDA
recommends against prescribing to patients with a history of
telephone (1-800-FDA-1088), fax (1-800-FDA-0178) or mail.
FDA MedWatch Form 3500 may also be completed online.
Often, potential neuropsychiatric side effects are the greatest
It is also appropriate to notify the local Medical Treatment
concern for patients. Side effects may include anxiety, paranoia,
Facility Pharmacy and Therapeutics Committee of adverse
depression, agitation, restlessness, mood changes, panic
events potentially due to prescribed or dispensed
attacks, forgetfulness, hallucinations, aggression, and psychotic
medications. This committee can review the event and
forward the report to the FDA (see AR 40-3, Chapter 11,
Studies indicate that these may occur in 1 in 2,000 to 1 in 13,000
people who receive prophylactic mefloquine. Neuropsychiatric
What medical tests are indicated?
side effects may occur more commonly among those who
Baseline liver function tests are ideal though potential y
consume alcohol while taking mefloquine, so patients should be
impractical before deployment and should be repeated if
careful y instructed to avoid alcoholic beverages.
clinical signs or symptoms suggest possible liver problems.
An EKG should be performed for signs or symptoms
Symptoms may continue long after mefloquine use has been
suggestive of a potential cardiac problem. Animal studies
stopped. If neuropsychiatric symptoms occur, mefloquine use
have suggested changes in vision may occur with long-term
should be discontinued in favor of other prophylactic medications
mefloquine administration. Therefore, baseline vision testing
is recommended and patients should be told to report vision
problems to their provider. Repeat vision testing and eye
What neuropsychiatric red flags should precipitate a
examinations should be performed if the patient reports
referral?
vision changes or if administration is prolonged (twelve
In the event a patient who is taking mefloquine experiences
suicidal ideation, depression, acute psychosis, or any of the other
above-mentioned neuropsychiatric symptoms, the clinician should initiate an urgent medical referral including psychiatric assessment by a specialist. Under some deployed conditions, a psychiatric consultation may not be possible. In this situation, medical consultation with careful patient observation may be substituted. Mefloquine should be discontinued and replaced with another appropriate anti-malarial medication.
Can mefloquine be used during pregnancy or breastfeeding? CDC has advised that mefloquine can be used during pregnancy and breastfeeding, but its use in the first trimester should be based on assessment of benefits versus risks. Pregnant women or those desiring to become pregnant while in malarial regions should be advised against travel to such locations. Women of childbearing age should use a reliable contraceptive during prophylaxis and for three months after the last dose to avoid conceiving. Consultation with a travel medicine or infectious disease expert is recommended for these patients. Where Do I Get More Information?
Air Force Institute for Operational Health DoD Deployment Health Support U.S. Army Center for Health Promotion and Preventive Medicine Directorate (DHSD) (USACHPPM) DoD Deployment Health Clinical Center Navy Environmental Health Center (NEHC) Food and Drug Administration Medication Guide
Bulletin of the Canadian Network for Human Health and the Environment Number 15 November 2009 Welcome to the fifteenth Bulletin of the Canadian Network for Human Health and the Environment! Visit us at If you have new information that would be useful to others on any aspect of human health and the environment, please forward it to us for inclusion in the next Bulle
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Mefloquine (Lariam®) 
equipment or carrying a weapon while remaining on the
How can I report adverse drug events potentially 
Can mefloquine be used during pregnancy or