Lariam

Mefloquine may induce psychiatric symptoms such as anxiety disorders, paranoia, depression, hallucinations and psychosis. Psychiatric symptoms such as insomnia, abnormal dreams/nightmares, acute anxiety, depression, restlessness or confusion have to be regarded as prodromal for a more serious event. Cases of suicide, suicidal thoughts and attempted suicide have been reported. Patients using mefloquine should be informed that if these reactions or changes to their mental state occur, they should stop taking mefloquine and seek medical advice immediately so that mefloquine can be replaced by alternative malaria prevention medication. Concomitant administration of mefloquine and drugs known to lower the epileptogenic threshold (antidepressants such as tricyclic or selective serotonin reuptake inhibitors (SSRIs); bupropion; antipsychotics; tramadol; chloroquine or some antibiotics) may increase the risk of convulsions. Vaccinations with oral attenuated live bacteria (e.g. typhoid) should be completed at least 3 days before the first dose of mefloquine.

For malaria prophylaxis the stated dose of mefloquine should be given once weekly, always on the same day. The tablets should be swallowed whole preferably after a meal with plenty of liquid. Tablet may be crushed and mixed with food such as jam or honey just before administration. Adults and children over 45kg in weight- 1 x 250mg tablet once a week. No specific adaptation of the usual adult dosage is required for elderly patients. In order to ensure, before arrival in endemic area, that mefloquine administration is well tolerated, patients who have never taken mefloquine before should start chemoprophylaxis 3 weeks prior to departure (10 days for patients who have taken mefloquine before). Treatment should be continued for 4 weeks after leaving a malarious area

Any drug may produce unwanted or unexpected adverse reactions. Detection and recording of these is of vital importance. Patients should be actively encouraged to report any suspected adverse reaction, particularly to black triangle medicines. All side effect information is taken from relevant product SPCs. In chemoprophylaxis, the safety profile of mefloquine is characterised by a predominance of neuropsychiatric adverse reactions. Adverse reactions may also occur after discontinuation of the drug In a small number of patients it has been reported that neuropsychiatric reactions (e.g. depression, dizziness or vertigo and loss of balance) may persist for months or longer, even after discontinuation of the drug. The most common adverse reactions to mefloquine chemoprophylaxis are nausea, vomiting and dizziness. Nausea and vomiting are generally mild and may decrease with prolonged use, in spite of increasing plasma drug levels. Very Common:

• Abnormal Dreams
• Insomnia

Common:

• Depression
• Anxiety
• Dizziness
• Headache
• Visual impairment
• Vertigo
• Nausea
• Diarrhoea
• Abdominal pain
• Vomiting
• Pruritis

Uncommon, rare and not known side effects are listed in the PIL and the patient should be advised to read the leaflet prior to taking medication. If neuropsychiatric reactions or changes to the mental state occur during mefloquine chemoprophylaxis, the patient should be advised to stop taking mefloquine and seek medical advice immediately so that mefloquine can be replaced by alternative malaria prevention medication. Abnormal dreams and insomnia are very common with mefloquine, therefore their significance should be considered in the overall evaluation of patients reporting reactions or changes to their mental state with mefloquine Healthcare professionals are asked to report any suspected adverse reactions via the Medicines and Healthcare products Regulatory Agency (MHRA), Yellow Card Scheme at https://yellowcard.mhra.gov.uk or search for MHRA Yellow Card in the Google Play or Apple App Store.