Pharm

Mefloquine

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Mefloquine, Lariam

  • Indications
  1. Prophylaxis or Treatment of Malaria
  2. Preferred prophylaxis agent in Chloroquine resistance areas
  3. Less commonly used for Malaria treatment
  • Contraindications
  1. History of Epilepsy (Seizure Disorder)
  2. History of psychiatric disorder
  3. Concomitant Beta Blocker use
  4. First Trimester Pregnancy
    1. May be used in second or third trimester pregnancy
  5. Children under age 3 months
  • Pharmacokinetics
  1. Half-Life: 33 days
  2. Steady state reached
    1. Weekly dose: 7 weeks
    2. Loading dose: 4 days
  • Adverse Effects
  1. Vestibular toxicity
    1. Risk of longterm Vertigo and Tinnitus
  2. Arrhythmia in patients with cardiac conduction defect
    1. QT Prolongation
    2. Bradycardia
  3. Neuropsychological effects (uncommon 1:200 to 1:500, but is a FDA black box warning)
    1. Insomnia
    2. Nightmares
    3. Anxiety
    4. Irritability
    5. Major Depression
      1. Possible increased Suicidality
    6. Psychosis (paranoia, Hallucinations) or Seizures (rare)
      1. Prophylaxis Incidence: <1:10,000
      2. Treatment Incidence: 1:100 to 1:1500
  4. Pregnancy
    1. No significant adverse fetal affects in studies
  • Directions
  1. Take with food and full glass of water
  1. Protocol
    1. Start dosing 1 week before exposure
    2. Complete dosing 4 weeks after exposure
  2. Adult
    1. Mefloquine 250 mg salt (228 mg base) orally once weekly
  3. Child
    1. Weight <9 kg
      1. Dose: 5 mg/kg salt (4.6 mg/kg base) orally once weekly
    2. Weight 9 to 19 kg
      1. Mefloquine 1/4 of adult tablet orally once per week
    3. Weight: 20 to 30 kg
      1. Mefloquine 1/2 of adult tablet orally once per week
    4. Weight: 31 to 45 kg
      1. Mefloquine 3/4 of adult tablet orally once per week
    5. Weight: >45 kg
      1. Mefloquine 1 adult tablet (250 mg) orally once per week
  1. Adult: 750 mg salt (684 mg base) for first dose, then second dose of 500 mg salt (456 mg base) in 6 to 12 hours
  2. Child: 15 mg/kg salt (13.7 mg/kg base) for first dose, then second dose of 10 mg/kg salt (9.1 mg/kg base) in 6 to 12 hours
  • References
  1. (2013) Presc Lett 20(9)
  2. Boudreau (1993) Trop Med Parasitol 44(3):257-65 [PubMed]
  3. Vanhauwere (1998) Am J Trop Med Hyg 58:17-21 [PubMed]
  4. Weimeke (1991) Am J Trop Med Hyg 45:86-9 [PubMed]
  5. Shahbodaghi (2022) Am Fam Physician 106(3): 270-8 [PubMed]