The manufacturer of mefloquine has issued a letter to prescribers reminding them of the risk of serious neuropsychiatric reactions associated with the antimalarial.
Mefloquine (Lariam) should now be started at least 10 days before entering the endemic area, to ensure it is well tolerated. If neuropsychiatric reactions occur, it should be discontinued immediately and substituted with an alternative.
The letter also reminds prescribers that the drug must not be used for chemoprophylaxis in patients with a psychiatric disorder or a history of such disorders.
The most common neuropsychiatric reactions to mefloquine include abnormal dreams, insomnia, anxiety and depression. Hallucinations, psychosis and suicide/suicidal ideation have also been reported.
Mefloquine’s half life is between two and four weeks and these reactions may be delayed or persist for up to several months after discontinuing treatment.