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Mefloquine (Larium)
⚠️ Mefloquine (Lariam®) is an antimalarial drug used for prophylaxis and treatment. It must be prescribed with caution as it can trigger serious neuropsychiatric side effects. Avoid in patients with a history of psychiatric disorders or seizures.
📖 About
- Used in both prophylaxis and treatment of malaria (especially chloroquine-resistant P. falciparum).
- 🔗 Always check BNF for the latest prescribing advice.
- Convenient weekly dosing makes it attractive for travellers, but tolerability limits use.
🧬 Mode of Action
- Exact mechanism not fully known.
- Interferes with parasite haem polymerisation, leading to accumulation of toxic haem and parasite death.
- Structurally related to quinine and acts on intra-erythrocytic stages of the parasite.
💊 Indication & Dose
- Treatment: Mild–moderate acute malaria due to mefloquine-susceptible P. falciparum or P. vivax. US CDC regimen: 1250 mg PO once OR 750 mg orally, then 500 mg 6–12 hrs later.
- Prophylaxis: 250 mg orally once weekly, starting 1 week before travel, continued during exposure and for 4 weeks after leaving endemic area.
🔄 Interactions
- Many important interactions – especially with anticonvulsants, antidepressants, and other antimalarials (BNF reference essential).
- Concurrent use with halofantrine may cause cardiotoxicity (QT prolongation).
⚠️ Cautions
- Use only when alternatives are unsuitable if there is a risk of psychiatric illness.
- Patients should be informed of potential side effects before starting.
- Consider baseline ECG in those with cardiac disease.
🚫 Contraindications
- History of psychiatric disorders (depression, anxiety, psychosis).
- History of seizures or epilepsy.
- Severe hepatic impairment.
💥 Side Effects
- Neuropsychiatric: Anxiety, depression, nightmares, insomnia, psychosis (can persist after drug stopped).
- Neurological: Dizziness, balance disorders, headache, visual disturbances.
- GI: Nausea, diarrhoea, vomiting, abdominal discomfort.
- Other: Skin rashes, pruritus, alopecia.
📚 References
🔄 Revision Notes
- Reinforce: psychiatric contraindications are absolute.
- Not first-line for prophylaxis in UK travellers; alternatives include doxycycline or atovaquone-proguanil.
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