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Lancet (London, England) Jun 1993
Topics: Dreams; Humans; Male; Mefloquine; Sensation Disorders
PubMed: 8099690
DOI: 10.1016/0140-6736(93)90751-2 -
BMJ (Clinical Research Ed.) Nov 1997To evaluate the research evidence on the efficacy and tolerability of mefloquine chemoprophylaxis. (Review)
Review
OBJECTIVE
To evaluate the research evidence on the efficacy and tolerability of mefloquine chemoprophylaxis.
SEARCH STRATEGY
Any potentially relevant trial from the Cochrane Infectious Disease Group's register of controlled trials; systematic searches of Medline, Embase, Lilacs and Science Citation Index; scanning citations; and consulting drug companies and key investigators. We considered studies in all languages.
INCLUSION CRITERIA
Trials carried out in non-immune adult travellers, and in non-travelling volunteers, where an attempt had been made to conduct a randomised comparison of mefloquine against placebo or against alternative standard prophylaxis.
RESULTS
37 potentially eligible trials of mefloquine prophylaxis were identified, and 10 met the inclusion criteria. These 10 trials comprised a total of 2750 non-immune adult participants randomised to mefloquine or to a control. One placebo controlled trial examined malaria incidence directly and showed mefloquine to be highly effective in preventing malaria in an area of drug resistance. However, four placebo controlled trials showed that mefloquine was not well tolerated, and withdrawals were consistently higher in mefloquine treatment arms than in placebo arms (odds ratio 3.49 (95% confidence interval 1.42 to 8.56)). Five field trials compared mefloquine with other chemoprophylaxis. Mefloquine was no worse tolerated than other chemoprophylaxis, although there was possibly a trend towards higher withdrawals in mefloquine arms (odds ratio 1.33 (0.75 to 2.36)).
CONCLUSION
One trial showed mefloquine to be effective in preventing malaria, but withdrawal rates, presumably from side effects, were high across most studies. This is likely to impair mefloquine's effectiveness in general travellers, and it may therefore not be useful for routine prophylaxis. Mefloquine may be useful in specific situations such as for groups travelling to regions with a high risk of chloroquine resistant malaria and only limited access to effective medical care.
Topics: Adult; Antimalarials; Humans; Malaria; Mefloquine; Randomized Controlled Trials as Topic; Travel; Treatment Outcome; Treatment Refusal
PubMed: 9418088
DOI: 10.1136/bmj.315.7120.1412 -
Biology of Reproduction Sep 2012Obstetric use of the antimalarial drug mefloquine has historically been discouraged during the first trimester and immediately before conception owing to concerns of... (Review)
Review
Obstetric use of the antimalarial drug mefloquine has historically been discouraged during the first trimester and immediately before conception owing to concerns of potential fetal harm. With the rise of resistance to the antimalarial drug sulfadoxine-pyrimethamine (SP), mefloquine is now being considered as a replacement for SP for universal antenatal administration to women from malaria-endemic regions. Recent recommendations have also suggested that mefloquine may be used cautiously among pregnant travelers who cannot otherwise avoid visiting these areas. Mefloquine has been demonstrated to cause blockade of gap junction protein alpha 1 (GJA1) gap junction intercellular communication (GJIC), and recent evidence suggests that GJA1 GJIC is critical to successful embryonic implantation and early placental development. During routine use, mefloquine accumulates in organ and peripheral tissue, crosses the blood-placental barrier, and may plausibly accumulate in developing decidua and trophoblast at concentrations sufficient to interfere with GJA1 GJIC and, thus, cause deleterious effects on fetal outcomes. This conclusion is supported by epidemiological evidence that demonstrates use of the drug during early development is associated with an increased risk of miscarriage and stillbirth. Confirmatory studies are pending, but the available experimental and epidemiological evidence support renewed adherence, where feasible, to existing mefloquine package insert guidance that women avoid the drug during the periconceptional period.
Topics: Abortion, Spontaneous; Animals; Antimalarials; Female; Gap Junctions; Humans; Malaria, Falciparum; Mefloquine; Pregnancy; Pregnancy Complications, Parasitic; Risk Factors
PubMed: 22837476
DOI: 10.1095/biolreprod.112.099614 -
Drug and Therapeutics Bulletin Mar 1998In the UK, mefloquine (Lariam-Roche) has been marketed since 1990 for both malaria prophylaxis and for acute treatment of falciparum malaria. In 1991, we concluded that... (Review)
Review
In the UK, mefloquine (Lariam-Roche) has been marketed since 1990 for both malaria prophylaxis and for acute treatment of falciparum malaria. In 1991, we concluded that prophylaxis with mefloquine was appropriate for those travelling to areas where strains of Plasmodium falciparum resistant to chloroquine and proguanil are common. Since then, UK recommendations have changed several times. Recently, mefloquine's use as a prophylactic has been questioned because of reports of neuropsychiatric unwanted effects. This article discusses the place of f2p4oquine in malaria prophylaxis in light of these concerns.
Topics: Antimalarials; Central Nervous System Diseases; Drug Administration Schedule; Humans; Malaria, Falciparum; Mefloquine
PubMed: 9684417
DOI: 10.1136/dtb.1998.36320 -
American Family Physician Feb 2004
Review
Topics: Adult; Antimalarials; Humans; Malaria; Mefloquine; Military Personnel; Randomized Controlled Trials as Topic; Travel
PubMed: 14971832
DOI: No ID Found -
Malaria Journal Dec 2010Malaria chemoprophylaxis prevents the occurrence of the symptoms of malaria. Travellers to high-risk Plasmodium falciparum endemic areas need an effective... (Review)
Review
BACKGROUND
Malaria chemoprophylaxis prevents the occurrence of the symptoms of malaria. Travellers to high-risk Plasmodium falciparum endemic areas need an effective chemoprophylaxis.
METHODS
A literature search to update the status of mefloquine as a malaria chemoprophylaxis.
RESULTS
Except for clearly defined regions with multi-drug resistance, mefloquine is effective against the blood stages of all human malaria species, including the recently recognized fifth species, Plasmodium knowlesi. New data were found in the literature on the tolerability of mefloquine and the use of this medication by groups at high risk of malaria.
DISCUSSION
Use of mefloquine for pregnant women in the second and third trimester is sanctioned by the WHO and some authorities (CDC) allow the use of mefloquine even in the first trimester. Inadvertent pregnancy while using mefloquine is not considered grounds for pregnancy termination. Mefloquine chemoprophylaxis is allowed during breast-feeding. Studies show that mefloquine is a good option for other high-risk groups, such as long-term travellers, VFR travellers and families with small children. Despite a negative media perception, large pharmaco-epidemiological studies have shown that serious adverse events are rare. A recent US evaluation of serious events (hospitalization data) found no association between mefloquine prescriptions and serious adverse events across a wide range of outcomes including mental disorders and diseases of the nervous system. As part of an in-depth analysis of mefloquine tolerability, a potential trend for increased propensity for neuropsychiatric adverse events in women was identified in a number of published clinical studies. This trend is corroborated by several cohort studies that identified female sex and low body weight as risk factors.
CONCLUSION
The choice of anti-malarial drug should be an evidence-based decision that considers the profile of the individual traveller and the risk of malaria. Mefloquine is an important, first-line anti-malarial drug but it is crucial for prescribers to screen medical histories and inform mefloquine users of potential adverse events. Careful prescribing and observance of contraindications are essential. For some indications, there is currently no replacement for mefloquine available or in the pipeline.
Topics: Antimalarials; Chemoprevention; Drug Resistance; Humans; Malaria; Mefloquine; Plasmodium; Travel
PubMed: 21143906
DOI: 10.1186/1475-2875-9-357 -
Malaria Journal Oct 2011Use of anti-malarial medication in children is hampered by a paucity of dosage, pharmacokinetic and tolerability data. (Review)
Review
BACKGROUND
Use of anti-malarial medication in children is hampered by a paucity of dosage, pharmacokinetic and tolerability data.
METHODS
Data on the use of mefloquine in children, particularly in young children weighing less than 20 kg, were reviewed using PubMed literature and reports on file.
RESULTS
Chemoprophylaxis data: Two studies with a total of 170 children were found. A simulated mefloquine plasma profile showed that doses to achieve protective chemoprophylaxis blood concentration of mefloquine of approximately 620 ng/mL (or 1.67 μmol/L) in children should be at least 5 mg/kg. This simulated plasma profile in children corresponds to that seen in adult travellers using a weekly prophylaxis dose of 250 mg. This reinforces current practice of using weight-based dosage for children. Clearance per body weight is higher in older children. For children who travel to malaria risk areas tablets can be broken and crushed as required. It is necessary to disguise the bitter taste of the drug. Treatment data: Mefloquine treatment (alone or in combination) data are available for more than 6000 children of all age and weight categories. The stereoselectivity and pharmacokinetic profile of mefloquine in children is similar to that observed in adults. There is higher clearance in older children (aged 5-12 years) compared to younger children (aged 6-24 months). Mefloquine treatment is well tolerated in infants (5-12 kg) but vomiting is a problem at high doses. This led to the use of a "split dose" regimen with 15 mg/kg initially, followed 12 hours later by 10 mg/kg. Mefloquine 125 mg has been used as intermittent preventive treatment (IPT) and was found to be efficacious in reducing episodes of malaria in a moderate-transmission setting but vomiting was a problem in 8% of children aged 2-11 months. Mefloquine is also used as a component of artemisinin combination therapy (ACT) in small children. The combination artesunate plus mefloquine is a WHO approved first-line treatment for uncomplicated malaria in Africa.
CONCLUSION
Currently available data provide a scientific basis for the use of mefloquine in small children in the chemoprophylaxis setting and as a part of treatment regimens for children living in endemic areas.
Topics: Adolescent; Africa; Antimalarials; Chemoprevention; Child; Child, Preschool; Drug Therapy; Humans; Infant; Malaria; Mefloquine
PubMed: 21981927
DOI: 10.1186/1475-2875-10-292 -
Australian Family Physician May 1996
Review
Topics: Antimalarials; Female; Humans; Male; Mefloquine; Neurotic Disorders; Sex Characteristics
PubMed: 8935556
DOI: No ID Found -
Journal of Travel Medicine 2006Mefloquine is indicated as oral treatment and as prophylaxis for malaria in areas where chloroquine-resistant malaria is present. Gastrointestinal and neuropsychiatric...
Mefloquine is indicated as oral treatment and as prophylaxis for malaria in areas where chloroquine-resistant malaria is present. Gastrointestinal and neuropsychiatric side effects of mefloquine are well known. More severe neuropsychiatric disorders such as psychosis, depression, hallucinations, and seizures are also reported in the literature. We are reporting a case of drug-induced pneumonia due to mefloquine. This diagnosis was confirmed 4 months after the adverse event, after restarting the same malaria prophylaxis, which could be considered as an unintentional provocation test. This is the third case report in the literature of acute lung injury caused by mefloquine.
Topics: Antimalarials; Female; Humans; Malaria; Mefloquine; Middle Aged; Pneumonia
PubMed: 16706949
DOI: 10.1111/j.1708-8305.2006.00037.x -
Lancet (London, England) Aug 1993
Topics: Chloroquine; Humans; Malaria, Falciparum; Mefloquine
PubMed: 8102683
DOI: 10.1016/0140-6736(93)91675-c