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Information on Larium

A Resource for Service Members and Their Families

Introduction
Mefloquine is one of the best drugs for service men and women to take for protection from the disease malaria. The benefits of taking mefloquine, most importantly prevention of death from malaria, often outweigh the possibility of having both common and rare side effects from the drug. The following fact sheet was designed to inform readers about mefloquine and address concerns about the drug common among veterans, service members and their families.

What is Malaria?
Malaria is a serious and sometimes fatal disease caused by a parasite that is widespread in tropical and semitropical developing countries. Mosquitoes become infected with malaria and then spread malaria to humans by biting them. Malaria is not transmitted from person to person. You cannot get malaria from casual contact with people who are infected with malaria. When malaria infects an individual it enters his or her blood stream. Because the parasite that causes malaria gets into the blood stream, malaria can be transmitted through a blood transfusion, organ transplant, or by sharing needles or syringes contaminated with blood. Malaria may also be transmitted from a mother to her fetus before or during delivery. Patients with malaria typically get very sick with high fevers, shaking, chills, and flu-like illness. Malaria can be a fatal disease, but illness and death from malaria are largely preventable.

Malaria is Preventable!
Since malaria can cause severe illness and can even be deadly, the most effective way to deal with the disease is to prevent it. There are ways to prevent malaria without taking medication. These include use of mosquito netting and insect repellant to keep mosquitoes away from the body. Health care professional agree that medication offers the best prevention. Of the medications that are available, mefloquine is the usually best medication for service men and women, to take (for all instances other than a very short deployment) because it only has to be taken once a week and offers protection for the longest period of time. In many parts of the world, malaria is resistant to other anti-malarial drugs, as well. Lariam is the brand name for the drug mefloquine - they are the exact same medication. Both the generic drug (mefloquine) and the brand name drug (lariam) work the same way and have exactly the same impact on a person who takes it.

Why take Mefloquine?
Mefloquine is one of the few medications approved by the Food and Drug Administration (FDA) and recommended by the Center for Disease Control (CDC) to prevent malaria. Mefloquine works by killing the parasite that causes malaria . Because malaria is a disease that is widespread in many countries people who travel and visit these countries - including service members - are advised by health organizations, including the Center for Disease Control (CDC), to take mefloquine for protection from the disease. Health care providers agree that mefloquine is the best medication to take when people visit countries where malaria is present for a prolonged amount of time or where the malaria is resistant to other drugs. Because the medication can remain in the body for a while after it is taken, it does not have to be taken daily. It should however be taken for the entire time that a person remains in an infected area. While all medications can have possible side effects - the benefits of taking mefloquine are important to remember - it can prevent malaria and its serious consequences.

Only service men and women who are deployed to a high risk area for getting malaria are given the drug mefloquine to protect them from becoming infected. It is the most convenient medication to take for service men and women because it only has to be taken once a week. Mefloquine has been given to military personnel since it was approved by the FDA in 1997, including those serving in Operation Iraqi Freedom/Operation Enduring Freedom ( OIF/OEF).

How is Mefloquine Taken?
An individual should begin taking mefloquine at least one week before the time of deployment and continue to take it throughout the time they are deployed. It is important to take the medication for four weeks after leaving the high risk area to ensure protection against the disease.

Should Everybody Take Mefloquine?
Doctors who prescribe mefloquine to an individual must be given information about the individual's past medical history. People with certain medical conditions, such as depression or seizure disorders, should not take mefloquine. Also, people who have had an allergic reaction to mefloquine in the past should not take the drug. An individual's health care provider can decide whether or not the drug is right for him or her. It is required that all people that take mefloquine receive a copy of the medication guide created by the Food and Drug Administration (FDA) and the company that makes the drug. The guide discusses the risks and benefits of taking the drug to prevent malaria and the side effects. Military unit leaders are advised by the Department of Defense to make sure service members who plan to take mefloquine have been given a copy.

What are the Possible Side Effects of Mefloquine?
All medications have side effects so it is important to understand the benefits and risks of taking versus not taking any particular medication.

Common Side Effects: What is Known?
The most commonly reported side effect of the drug mefloquine is vomiting (3% of those taking the medication). Other common side effects are nausea, vomiting, loose stools or diarrhea, abdominal pain, dizziness or vertigo, loss of balance and neuropsychiatric events such as headache, somnolence (sleepiness), and sleep disorders (insomnia, abnormal dreams). Less commonly reported effects are disorders such as convulsions, agitation or restlessness, anxiety, depression, mood changes, panic attacks, forgetfulness, confusion hallucinations and aggression. The benefits of taking the drug mefloquine to prevent malaria outweigh the possibility of both common and less common side effects.

Other Questions?
Some service men and women and their families have raised concern about the possibility of a link to suicide and homicide. The reports connecting mefloquine with suicide and homicide are extremely rare. Importantly, a link between taking the drug and committing suicide or murder has not been proven. There are no rigorous scientific studies that link the drug with suicide or thoughts about killing oneself (suicidal ideation).

Mefloquine may cause psychiatric symptoms in a small number of patients. The FDA requires a warning regarding this on the label for the drug mefloquine. Patients with a history of psychiatric illness may be vulnerable to mefloquine-related psychiatric symptoms, or developing psychosis, as a result of taking the drug, and the package insert recommends against prescribing it to patients with a history of psychiatric problems including depression, generalized anxiety disorder, psychosis, schizophrenia or any other major psychiatric disorder.

Are there Long Term Health Effects from Mefloquine?
Mefloquine can stay in the body for up to four months after an individual stops taking it - this is one of the reasons why it is so effective in preventing against the disease malaria. Once the drug leaves the body, the possibility of having physical side effects is rare. People with psychiatric conditions who may have been given the drug might have worse side effects and feel symptoms continue to worsen after they stop taking the drug. Current research shows that instances of long term health effects from the drug mefloquine are extremely rare.

What Should Someone Who Experiences/Experienced Symptoms Do?
If you are currently taking mefloquine and you experience any of the symptoms discussed in this fact sheet you should report those symptoms to your primary care doctor right away. Depending on the type and extent of your symptoms, your doctor might switch your medication to another anti-malarial drug or offer advice on other preventative measures, to reduce your chances of becoming infected with malaria. It is important to consider the benefits and risks of the medication when making this decision. It is also important that your doctor properly documents your health concerns, including adverse reaction to medications.

Since the drug is completely out of the body in four months, it is unlikely that symptoms will last long term. If you have taken mefloquine in the past, have stopped taken the medication and are still concerned about side effects, you should report them to your primary care doctor. When you make an appointment to see your doctor, he or she will ask you many questions about your health. It's important to talk about your symptoms in relation to the time period that you took mefloquine and the amount that you took, which varies according to the amount of time one spends in a high risk malaria area. Your doctor may order additional testing to further assess and treat your reported symptoms. Symptoms should be cared for and treated on a case-by-case basis.

The Future...
Mefloquine is a very effective and usually the most convenient drug for the military to use to protect service men and women from malaria. The benefits of taking mefloquine usually outweigh the possibility of experiencing side effects as a result of taking the drug. Although some service men and women have expressed concern over the possibility of long term illness resulting from mefloquine, there is not any medical evidence that shows instances of long term health effects from the drug mefloquine. There are no scientific studies that link mefloquine use with suicide, suicidal ideation or homicide. A service member who took mefloquine in the past or who plans to take it in the future should address any concerns about the drug with their primary care doctor.

***The information contained in this sheet was obtained in part from the following sources. It was developed by a group of health care providers with special concern about deployment-related health concerns. For more information you can see the following websites:

REFERENCES

This document was developed by the War Related Illness and Injury Study Center (WRIISC)
VA-New Jersey Health Care System in East Orange, NJ
Last Updated December 16, 2004.