Important information about medical and legal issues of particular concern to U.S. Military veterans.
(Information on this page is deemed reliable but not guaranteed, and should not be regarded or construed as actual medical or legal advice.)
Lariam (manufactured by Roche Pharmaceuticals) or Mefloquine is an orally administered anti-malarial drug used as a prophylaxis against and treatment for malaria. Lariam is prescribed to some U.S. military personnel operating in areas that may contain malaria. It goes by the chemical name mefloquine hydrochloride (formulated with HCl). Mefloquine was developed in the 1970s at the Walter Reed Army Institute of Research in the U.S. as a chemical synthetic similar to quinine. Lariam has been linked to serious psychiatric side effects, including suicide.
How is Mefloquine used?
Mefloquine is one of a few medicines recommended by the CDC to prevent malaria, especially in areas where malaria has become resistant to other medications. It offers the advantage of being taken once a week rather than once a day. You should begin taking the medicine at least one week before deployment or as instructed by your health care provider. Continue taking it once a week during deployment, and take it for 4 weeks more after leaving a malaria area. It is easier to remember and more effective if you take the medicine on the same day of each week. Avoid drinking alcohol while taking Mefloquine, since its use may interfere with the medication’s effectiveness and could strengthen the medication’s serious side effects.
Mefloquine must be entered in your health record like other medications you may be taking.
What information should I receive about Mefloquine?
The FDA developed a Medication Guide for Mefloquine in 2003 in collaboration with its manufacturer. This Medication Guide provides information on the risks of malaria, the risks and benefits of taking Mefloquine to prevent malaria, and the rare but potentially serious side effects including mental side effects associated with this medicine. The Medication Guide must be given to everyone who is given Mefloquine. Make sure that you receive a copy and read the Medication Guide from your health care provider before you begin taking the medication. The Medication Guide is also available at: http://www.fda.gov/medwatch/SAFETY/2003/LariamMedGuide.pdf
What are common side effects?
Most people do not experience side effects from taking Mefloquine. Side effects occur at rates similar to other malaria medicines. These side effects can include being unable to sleep, unusual dreams, lightheadedness, headache, dizziness, visual disturbances, ringing in the ears, rash, irritability, and gastrointestinal symptoms, such as nausea, vomiting, and diarrhea. Vomiting and nausea are often the most troubling side effects. Vomiting can often be controlled by taking Mefloquine with a meal and at least 8 ounces (a cup) of water. If you have these side effects, see your health care provider as soon as possible.
What about behavioral side effects?
Potential behavioral side effects may include anxiety, paranoia (suspicion of everyone), depression, agitation, restlessness, mood changes, panic attacks, forgetfulness, hallucinations (seeing or hearing things that are not there), aggression, and psychotic behavior (delusions or decreased “reality testing”). Unusual side effects that can impair reaction time and thinking include nerve problems, confusion and disorientation, convulsions, psychosis, nightmares, dizziness, and loss of balance.
Rare instances of suicide in patients taking Mefloquine have been reported but no studies have proven that Mefloquine use results in suicide, suicidal ideas, suicide attempts, or any other violent behavior. Even so, if you have any thoughts of suicide, consult a health care professional.
Normal reactions to deployments and combat stress may be similar to both the common and behavioral side effects of Mefloquine. However, if you have any of these changes in behavior, go for a medical evaluation immediately. Delay could put you or others at risk.
Who should not take Mefloquine?
You should not take Mefloquine if you have clinical depression or had clinical depression recently, have had recent mental illness, have had seizures, or are allergic to Mefloquine or related medications such as quinine or quinidine. If you have had these conditions, go to a health provider to determine if you should use a different anti-malaria medication.
What should I avoid while taking Mefloquine?
Avoid using alcohol while taking Mefloquine. Also avoid other anti-malaria medicines such as halofantrine, quinine, quinidine, or chloroquine with Mefloquine because of the potential for seizures, heart problems, or death. Do not take Mefloquine if you are pregnant.
Can Mefloquine be used during pregnancy or breastfeeding?
Malaria is a serious illness that is dangerous to both the mother and unborn baby. If you are a woman of childbearing age, you must use reliable birth control while taking Mefloquine and for up to three months after the last dose so you do not get pregnant. If you are pregnant, discuss all your medications, including Mefloquine, with your health care provider prior to use. Your health care provider can determine if you need to take Mefloquine or a different medication to prevent malaria.
What should I tell my health care provider?
Tell your health care provider if you:
- Have experienced depression, mental illness, or seizures.
- Are allergic to Mefloquine or related medications.
- Have heart disease.
- Are pregnant or are breast-feeding.
- Have liver problems.
- Are taking other medications, including non-prescription medications and dietary or herbal supplements.
Discuss with your provider alcohol consumption habits since that may interfere with Mefloquine’s effectiveness.
If you spent six months or less in a malarial area, you should not donate blood for one year after leaving that area. If you spent more than six months in a malarial area or had malaria, you should not donate blood for three years after leaving the area or after successful treatment of malaria.
How else can I prevent malaria?
No medicine is 100 percent effective. Therefore, you should carry out other prevention efforts including:
- Eliminating mosquito-breeding sites by emptying water collected in outdoor containers or debris.
- Remaining in well-screened areas, particularly at dawn, dusk, and early evening when mosquitoes are most active.
- Using mosquito bed nets.
- Wearing loose clothing that covers most of the body.
- Soaking or spraying bed nets and tents with permethrin.
- Wearing permethrin treated clothing with DEET insect repellents on exposed skin.
- Applying insect repellent that contains DEET (N,N- diethylmetatoluamide) to any exposed skin when traveling in areas with biting insects
- Mefloquine is recommended by the Centers for Disease Control and Prevention (CDC) to prevent malaria, especially where malaria has become resistant to other medications.
- Your health care provider must give you a Medication Guide detailing possible side effects of this medication from the Food and Drug Administration (FDA) before giving you Mefloquine. Read this guide before taking Mefloquine; it contains important information.
- Avoid using alcohol while taking Mefloquine because it can interfere with the medicine’s effectiveness and strengthen the medication’s side effects.
- Rare instances of suicide have been reported among those taking Mefloquine but not proven to be a result of taking the medication. Consult a health care provider about any thoughts of suicide.
- Do not use Mefloquine if you are pregnant. There may be risks if you become pregnant within three months after taking your last dose