[e-drug] Mefloquine as malaria chemoprophylaxis (2)

[" Andy Gray " <andy@gray.za.net>]

E-DRUG: Mefloquine as malaria chemoprophylaxis (2)
---------------------------------------------

Dear E-druggers,

> Now to my new question: is there any contraindication to using
> mefloquine in delicate job situations, here I am thinking of piloting a
> ship or working in the ship engine rooms where psychotic side effects
> may endanger hundreds of volunteers? 

The South African guidelines stated that "Mefloquine can cause dizziness, 
disturbed sense of balance and neuropsychiatric reactions during and up to 
three weeks after its use. Caution must therefore be exercised when driving 
and operating machines while taking this drug29. The WHO recommends that 
piloting of aircraft and deepsea diving should be avoided while taking 
mefloquine1.Although the latest studies do not seem to show significant 
effects of mefloquine on fine motor co-ordination, it seems prudent to 
exercise caution when used in persons operating machines, driving, deep-sea 
diving or flying28. (The drug may cause sleep disturbances which, in the 
long term, may affect co-ordination)".

The references cited are:

1. WHO International Travel and Health 2002. Geneva.
28. WHO International Travel and Health booklet. 2001
29. Lariam. package insert. 1997. Roche.
 
> Were there similar problems with its use in the army, for example? I
> imagine handling weaponry would be a sensitive job situation. 

To add to Wilbert's comment - my recollection is that the first relatively 
large-scale deployment of mefloquine by the US Army was in Somalia. It may 
be worthwhile contacting the team at Walter Reed to see what current US 
military recommendations are regarding its use.

regards
Andy

~~~~~~~~~~~~~~~~~~~
Andy Gray MSc(Pharm) FPS
* Senior Lecturer
Dept of Therapeutics and Medicines Management
* Study Pharmacist
Centre for the AIDS Programme of Research 
in South Africa (CAPRISA)
Nelson R Mandela School of Medicine
University of KwaZulu-Natal
PBag 7 Congella 4013
South Africa
Tel: +27-31-2604334/4298 Fax: +27-31-2604338
email: graya1@ukzn.ac.za or andy@gray.za.net 

[These are the most current warnings for Lariam in the American data sheet:
WARNINGS 
In case of life-threatening, serious or overwhelming malaria infections due to P. falciparum , patients should be treated with an intravenous antimalarial drug. Following completion of intravenous treatment, Lariam may be given to complete the course of therapy. 

Data on the use of halofantrine subsequent to administration of Lariam suggest a significant, potentially fatal prolongation of the QTc interval of the ECG. Therefore, halofantrine must not be given simultaneously with or subsequent to Lariam. No data are available on the use of Lariam after halofantrine (see PRECAUTIONS : Drug Interactions ). 

Mefloquine may cause psychiatric symptoms in a number of patients, ranging from anxiety, paranoia, and depression to hallucinations and psychotic behavior. On occasions, these symptoms have been reported to continue long after mefloquine has been stopped. Rare cases of suicidal ideation and suicide have been reported though no relationship to drug administration has been confirmed. To minimize the chances of these adverse events, mefloquine should not be taken for prophylaxis in patients with active depression or with a recent history of depression, generalized anxiety disorder, psychosis, or schizophrenia or other major psychiatric disorders. Lariam should be used with caution in patients with a previous history of depression. 

During prophylactic use, if psychiatric symptoms such as acute anxiety, depression, restlessness or confusion occur, these may be considered prodromal to a more serious event. In these cases, the drug must be discontinued and an alternative medication should be substituted. 

Concomitant administration of Lariam and quinine or quinidine may produce electrocardiographic abnormalities. 

Concomitant administration of Lariam and quinine or chloroquine may increase the risk of convulsions. KM, Moderator]