MEFLOQUINE

Mefloquine is a medication used to prevent and cure malaria. It is able to kill the parasite causing malaria, but its mechanism of action remains unknown. However, this drug can cause significant side effects, primarily in the nervous system. It is for this reason that in Canada, mefloquine is not recommended as the primary treatment against malaria.

GENERAL INFORMATIONS

antimalarial medication
usual dose :
- take 1 dose 1 time per week.
- start the treatment 1 to 3 weeks before arrival, continue the treatment during your stay and for 4 weeks after leaving the area.

INDICATIONS

Official indications accepted in Canada :

malaria – treatment (adult and child)
malaria – prévention (adult and child)

DOSES – MALARIA

Adults

Mefloquine administered dose varies according to the patient’s immunization: if the patient is not immune to malaria, the total dose is 20-25 mg / kg, to a maximum of 1500 mg. If the patient is partially immunized against malaria, the total dose is 15 mg / kg, to a maximum of 1000 mg. It is possible to take the total dose once or dividing it into 2 or 3 doses administered at 6 to 8 hours apart.

For the prophylactic treatment against malaria, taking mefloquine 1-3 weeks before departure, continue treatment during the stay, and for 4 weeks after leaving the area. If treatment is started at least one week before departure, take 250 mg of mefloquine daily for 3 days, and follow the usual dosage thereafter.

Children

For children over 3 months and weighing more than 5 kg, the doses are the same as the adult’s one. Take mefloquine 1-3 weeks before departure, continue treatment during the stay, and for 4 weeks after leaving the area.

For children weighing less than 5 kg, the use of mefloquine is not recommended.

For the prophylactic treatment against malaria, the dose to be taken is 5 mg / kg 1 time per week, to a maximum dose of 250 mg / dose.

SIDE EFFECTS

The most common side effects are :

Tinnitus (1-10%)
headache (1-10%)
diarrhea (1-10%)
decreased appetite (1-10%)
abdominal pain (1-10%)
muscle pain (1-10%)
rash (1-10%)
dizziness (1-10%)
fatigue (1-10%)
fever (1-10%)
chills (1-10%)
nausea (1-10%)
vomiting (3%)

anxiety (0-1%)
panic attacks (0-1%)
confusion (0-1%)
depression (0-1%)
hallucinations (0-1%)
insomnia
paranoia (0-1%)
loss of balance (0-1%)
psychosis (0-1%)
visual disturbances (0-1%)
dizziness (0-1%)

PRECAUTIONS

Pregnancy

It seems that mefloquine has adverse effects on fetal development. When possible, mefloquine should be avoided. However, the benefits for the mother are significant in comparison with the risks for the fetus. So, if there’s no other possible treatment, mefloquine may be considered against malaria.

Breastfeeding

It is possible to take mefloquine during breastfeeding. Studies on this subject show no risk of adverse effects on the child.

Food

It is advisable to take this medication with food and with a large glass of water. Do not chew or crush the tablet because it tastes bad. However, for children who are not able to swallow the medication, it is possible to crush it and mix it with water, milk or other beverage.

Monitoring therapy

As mefloquine can have many major side effects, it is important to keep an eye on certain elements to ensure the welfare of the patient. Monitors the occurrence of dizziness, vertigo, loss of balance and other neurological signs. Also, it is important to perform an ophthalmic monitoring and liver function tests.

Contraindications:

The contraindications related to mefloquine are numerous. It is important to respect them in order to avoid further complications:

Contraindications :	Cautions :
arrhythmia convulsions (active or history) depressions (active or history) prolongation of the QT interval psychosis (active or history) schizophrenia (active or history) generalized anxiety disorder (active or history)	anxiety cardiovascular diseases

INTERACTIONS AND ALLERGIES

Interactions:	Allergies:
anisindione dicumarol halofantrine nicoumalone rifampin ritonavir warfarin ziprasidone	dihydroquinidine-barbiturate quinidine quinine

NOTICES AND WARNINGS

FDA – July 2013

Neurological side effects (dizziness, loss of balance, ringing in the ears) and psychiatric (anxiety, distrust, depression and hallucinations) have been associated with the use of mefloquine. Neurological side effects can occur at any time during the use, persist for months or years after stopping the treatment and can be permanent. Patients should monitor the occurrence of these side effects and contact their healthcare professional if any of these symptoms occur.