Mefloquine Lariam Larium

Lariam

Active Substance - Mefloquine

Indication - Therapy and prophylaxis of malaria.
For current advice on geographical resistance patterns and appropriate chemoprophylaxis, current guidelines or the Malaria Reference Laboratory should be consulted, details of which can be found in the British National Formulary (BNF).

Psychiatric Side Effects

This medicine may cause some serious side effects. Therefore, it is usually used only to prevent the symptoms of malaria or to treat serious malaria infections in areas where it is known that other medicines may not work. 

At the doses given for acute malaria, adverse reactions to Lariam may not be distinguishable from symptoms of the disease itself. The overall incidence of adverse events reported during mefloquine prophylaxis is comparable to that reported for other chemoprophylactic regimens. However, the profile of mefloquine adverse events is predominantly characterised by neuropsychological adverse events. Because of the long half-life of mefloquine, adverse reactions to Lariam may occur or persist for more than several weeks after the last dose.

Patients should be advised to obtain medical advice before the next weekly dose of Lariam, if any concerning or neuropsychiatric symptoms develop. Discontinuation of Lariam should be considered, particularly if neuropsychiatric reactions occur. The need for alternative antimalarial therapy or prophylaxis can then be evaluated.

Check with a doctor or seek emergency help immediately if any of the following side effects occur:
Aggressions; agitation; anxiety; confusion; 
dizziness; cough or hoarseness; depression;
fainting; hallucinations (seeing, hearing, or feeling things that are not there);
irritability; lightheadedness; lower back or side pain; nervousness;
mood or mental changes, mental depression; nightmares; restlessness;
psychosis; paranoia; unusual tiredness or weakness; panic attacks;
blurred or loss of vision; convulsions; disturbed color perception;
dizziness; double vision; halos around lights; night blindness; overbright appearance of lights; sudden loss of consciousness; tunnel vision.

Other side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. However,

check with a doctor if any of the following side effects continue or are bothersome:
Chills; continuing ringing or buzzing or other unexplained noise in ears or hearing loss; emotional problems; loss of balance; nausea; abnormal dreams; loss of appetite; trouble in sleeping
There have been reports of suicidal ideation and suicide linked to Lariam.

Lariam Action USA
Lariam/mefloquine Support Group USA is a good resource for information

Lariam Action explain why there is no Lariam Action group in the UK -

schroll down the page on this link  to find out why

Read more about this situation in the UK

On the above web site is a page explaining action taken in the UK against the manufacturer Roche.

Since the mid-1990s there has been public concern in the UK about the possible side effects of the drug. A self-help support group, Lariam Action, was set up in 1995, but is now disbanded.

After television publicity on the BBC consumer programme ‘Watchdog’ on 6th November 1995, and subsequent press reports, nearly 1000 people contacted the Bristol-based solicitors Lawrence Tucketts thinking they had a case against Roche. Some of them were actively involved in Lariam Action.

The Lariam Legacy - A Whistledown production for BBC Radio 4. April 2015

Producer: Deborah Dudgeon
"An investigation into why the Ministry of Defence continues to use a drug that has been shown to cause psychosis, hallucinations, paranoia and confusion.
Lariam, also known by its generic name Mefloquine, is a highly effective anti-malarial drug, but in some people it can cause unpleasant neuropsychiatric reactions, problems with balance and vision, tinnitus and seizures. The drug manufacturer warns that, "Lariam may cause serious mental problems in some people". It also reports a link between Lariam and suicide.
In 2013, the US Food and Drug Administration applied the most serious kind of warning to the drug label, adding that the neurologic side effects may "persist or become permanent". US Special Forces soon banned the drug and launched an investigation into potential cases that may have been previously overlooked or misdiagnosed.
The wider US Army has "drastically reduced" its use of mefloquine, prescribing it only to soldiers who cannot tolerate the alternative anti-malarial drugs - as is also the case in Australia.
So why does the MOD continue to issue it to approximately 2,500 British Service Personnel each year? And is enough being done to ensure its safe use by British Armed Forces? We hear claims from ex-soldiers who felt compelled to use the drug and unable to report the side effects.
 

The Journal of the American Academy of Psychiatry and Law published
Psychiatric Side Effects of Mefloquine: Applications to Forensic Psychiatry

Their Conclusions

After 40 years of experimental and licensed use where the intoxicating properties of mefloquine were poorly appreciated, the drug now appears to have significant forensic importance. As public and professional awareness and understanding grows of the drug's significant psychotropic and neurotoxic potential, the prior use of mefloquine is nearly certain to get increasing attention within criminal, civil, and military courts. In cases involving suicide, homicide, and other acts of violence or criminal conduct associated with mefloquine exposure, or in cases where a litigant alleges that exposure to mefloquine caused harm, the forensic psychiatrist may be called on to provide expert testimony at trial. In all cases, the relationship between the drug's administration and the symptoms in question must be carefully evaluated and the temporal relationship adequately established,¹⁹⁸ to assign causation confidently. The pathophysiological insights presented in this review will aid the forensic psychiatrist in conducting an evaluation and in securing appropriate consultation in support of this goal.

As evidence is increasingly clear that use of mefloquine is associated with a risk of long-term injury and harm, as well as death of self or others, so long as the drug remains licensed for use, physicians who continue to prescribe it must exercise caution to minimize potential liability. Such care includes implementing careful screening for contraindications and ensuring consideration of alternative medications. The insights of the present review also emphasize the critical importance of thoroughly documenting patient education should mefloquine be prescribed, including informing patients of those prodromal symptoms that should compel them to discontinue the medication immediately and seek medical assistance.⁹⁶ However, as mefloquine intoxication that adversely affects decision-making may occur after only a single 250-mg tablet,⁴⁰ and as the onset of psychosis may take place suddenly and even without prodromal symptoms, such education may minimize, but will clearly not eliminate,⁹⁶ the risk of acute harm and subsequent neurotoxicity associated with the drug.

Our evolving experience with mefloquine raises questions about the potential for lasting behavioral effects from other antimalarial medications, including those presently under development,¹⁹⁹ as well as from those long assumed to be benign. Our experience with mefloquine reemphasizes that many decades may pass before the dangers of a drug are widely appreciated.^10,186 In the particular case of mefloquine, the reasons for this delay, including those related to the unusual circumstances of its development and initial testing²⁰⁰ and its frequent use among individuals with limited personal autonomy and within highly regimented organizations, would clearly benefit from further exploration

Government Select Committee Inquiry from 2015 and concluded

Lariam should be 'drug of last resort' for troops

BBC broadcast programmes about Lariam

Call for Army to stop using malaria drug mefloquine

My Lariam dreams

13 September 2016

The Defence Committee publishes the Government Response to the Committee's Fourth Report of Session 2015–16, "An acceptable risk? The use of Lariam for military personnel" in its Third Special Report of Session 2016–17 (HC 648).

Reporting Adverse Drug Reactions (ADRs)
If you have suffered psychiatric adverse reactions please report them. There may be side effects not mentioned on the data sheets. You can request a list of drugs used pre surgery and during surgery. You should be given patient information for all drugs prescribed as you are discharged from hospital.

Please report Adverse Drug Reactions (ADRs) to:

UK Yellow Card Reporting for Patient and Health Professional reports of Adverse Drug Reactions

USA and worldwide to the Food and Drug Administration for Patients and Healthcare Professionals

Universal free, independent drug safety website - Rxisk

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