Mefloquine

Uses of Lariam
Malaria is caused by a parasite that is passed from one person to another by mosquito bites. Lariam interferes with the growth of the parasites in red blood cells. Lariam is effective in preventing malaria and is recommended in certain parts of the world. Recommendations for anti-malaria prevention in different countries can be found at the NHS Scotland Fit for Travel website.

No malaria prevention tablet is 100% effective – mosquito bite avoidance measures should also be taken.

Lariam can also be used to treat malaria. Treatment for malaria should only be administered under medical supervision and after a definite blood diagnosis of malaria. The recommended adult dosage for the treatment of P. falciparum malaria is up to 6 Lariam tablets over 24 hours depending on body weight.

Dr Fox supplies Lariam on prescription only for malaria prevention.

How to take Lariam tablets for malaria prevention
Adults over 45kg: Take one Lariam tablet on the same day each week, starting at least 10 days before entering malaria areas. If you have never taken Lariam before, it is often recommended to start earlier, 2-3 weeks before travel, in case of side effects and needing to swap to a different preventative medication. Continue weekly tablets whilst in the malaria region and for 4 weeks after leaving. The minimum course of treatment is 6 weeks.

Swallow tablets whole with plenty of water, preferably after a meal. Do not suck or chew the tablets.

Lariam should not be taken for longer than 12 months.

Cautions
Checks for suitability are carried out online as part of Dr Fox’s consultations. Alternatives to Lariam tablets for malaria prevention are available through Dr Fox.

Lariam can be taken by many people, although it is not suitable for everyone. Travel is often stressful and Lariam may exacerbate stress-related symptoms.

There is a very rare theoretical risk of abnormal heart rhythm if Lariam (mefloquine) is taken at the same time as some other medications – please check this list.

Who should not take Lariam?
Lariam should not be taken if any of the following apply:

• Allergy to mefloquine, quinidine, or quinine.
• You have – or have had in the past – any mental health problems including depression, anxiety, psychosis, suicidal thoughts or attempts, self-harming, or schizophrenia.
• A history of fits or seizures (Lariam may increase the risk of fits and also reduce the effectiveness of antiseizure medications).
• Severe liver problems.
• Previous Blackwater fever (a complication of malaria that affects the blood and kidneys).
• A known heart conduction condition, e.g. heart block, long QT syndrome.
• You are taking medication that slows the heart rate, or fluconazole, itraconazole, or ketoconazole tablets.
• A traumatic brain injury – an alternative antimalarial prophylaxis to Lariam should usually be considered.
• Scuba divers planning to dive during their trip should not take Lariam as it can lower the seizure threshold and also affect decompression symptoms.
• The UK Civil Aviation Authority advises against pilots using Lariam.

Halofantrine (to treat active malaria) should not be used within 15 weeks of taking Lariam as the combination may slow the heartbeat to a dangerous level.

Pregnancy and breastfeeding
Developing malaria at any stage during pregnancy can have very severe consequences including a higher risk of death of mother or baby. Therefore pregnant women are strongly advised not to travel to malarious areas if at all possible. If travel is unavoidable, malaria prevention medication should be used. The risk from malaria is much greater than any risk to the baby from taking antimalarial medication. Lariam can be taken in some circumstances. Dr Fox does not prescribe during pregnancy. A specialist in travel medicine should be consulted.

See also Best use of medicines in pregnancy – Mefloquine.

Breastfeeding whilst taking Lariam is not recommended.

Lariam for children
Lariam can be used in children and babies over 3 months or over 5kg. Dr Fox only prescribes for people 18 years and over. See more information about malaria tablets for children.

Driving and operating machinery
Occasionally Lariam can affect fine coordination or the ability to visually assess distance which may impact driving, piloting an aircraft, or operating machinery. Special care should be taken when doing any of these tasks.

Side effects of Lariam
Most people can take Lariam without significant side effects. The most common side effects of Lariam include:

• Depression and anxiety.
• Sleeping problems.
• Nausea (feeling sick).
• Vomiting.
• Dizziness.
• Headache.
• Problems with vision.
• Loss of balance (vertigo).
• Diarrhoea.
• Stomach ache (abdominal pain).
• Itching.

Other side effects are listed in the Lariam patient information leaflet supplied with the medicine.

In a few people, depression, dizziness, or vertigo may continue for several months after stopping Lariam.

When should you stop Lariam?

In very few people Lariam can cause serious psychiatric symptoms.

Stop taking Lariam immediately, consult a doctor, and use a different antimalarial, if you experience any of the following symptoms:

• Severe anxiety.
• Paranoia (feelings of mistrust towards others).
• Depression.
• Hallucinations (seeing or hearing things that are not there).
• Insomnia.
• Abnormal dreams/nightmares.
• Feeling restless.
• Confusion or other unusual behaviour.
• Suicidal thoughts.
• Self-harming.

Also, stop Lariam, swap to a different antimalarial, and consult a doctor, if any of these other problems develop:

• Changes to your vision.
• Burning sensation.
• Tingling.
• Numbness.
• Muscle weakness.
• Breathlessness.
• Dry cough.

Other measures to prevent malaria

In addition to taking recommended malaria tablets, malaria risk can also be reduced by avoiding mosquito bites.

Mosquitoes can bite at any time of day. Most bites by malaria mosquitoes occur in the evening and overnight between dusk and dawn. In contrast, dengue fever mosquitoes tend to bite during the day.

• Wear long-sleeved clothing and long trousers if you are out at dusk, dawn, and at night. Several companies sell insect-resistant travel clothing pre-treated with insecticide (permethrin).
• Use insect repellent containing DEET on exposed skin and under thin clothing, particularly around the ankles. The best strength DEET is 50% There is no added benefit to using higher concentrations. Other repellents containing picaridin 20% or lemon eucalyptus 30% are less effective than DEET and must be reapplied very frequently.
• Insect-repellent room sprays, mosquito coils, and heating insecticide-impregnated tablets all reduce the risk of bites and should be used to kill mosquitoes in bedrooms before going to bed.
• Where possible sleep in screened rooms and use a mosquito net, preferably one impregnated with insecticide (permethrin). Mosquitoes are deterred by air conditioning but not fans.

Ultrasound devices, mobile phone apps, garlic, Vitamin B, marmite, homeopathic products, tonic water, alcohol, tea tree oil, and citronella DO NOT prevent bites.

For further information see Travel Health Pro – Insect and tick bite avoidance and NHS – Malaria Prevention.