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|Lariam

MEFLOQUINE (Systemic)

Some commonly used brand names are:

In the U.S.—

• Lariam

In Canada—

• Lariam

Category

• Antimalarial

Description

Mefloquine (ME-floe-kwin) belongs to a group of medicines called antimalarials. It is used to prevent or treat malaria, a red blood cell infection transmitted by the bite of a mosquito.

Malaria transmission occurs in large areas of Central and South America, Hispaniola, sub-Saharan Africa, the Indian subcontinent, Southeast Asia, the Middle East, and Oceania. Country-specific information on malaria can be obtained from the Centers for Disease Control and Prevention (CDC), or from the CDC"s web site at http://www.cdc.gov/travel .

This medicine may cause some serious side effects. Therefore, it is usually used only to prevent the symptoms of malaria or to treat serious malaria infections in areas where it is known that other medicines may not work.

Mefloquine is available only with your doctor"s prescription, in the following dosage form:

• Oral
• Tablets (U.S. and Canada)

Before Using This Medicine

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For mefloquine, the following should be considered:

Allergies—Tell your doctor if you have ever had any unusual or allergic reaction to mefloquine, quinidine (e.g., Quinidex), quinine, or any related medicines. Also tell your health care professional if you are allergic to any other substances, such as foods, preservatives, or dyes.

Pregnancy—It is best if pregnant women can avoid traveling to areas where there is a chance of getting malaria. However, if travel is necessary, mefloquine may be used for women traveling to areas where the parasite is resistant to chloroquine. Pregnant women are advised to report to their doctor any side effects following the use of mefloquine.

Breast-feeding—Mefloquine passes into the breast milk in small amounts. However, the amount in breast milk is not enough to prevent the infant from getting malaria. Mefloquine could cause unwanted effects in the breast-fed baby. It may be necessary for you to take another medicine or to stop breast-feeding while taking mefloquine. Be sure you have discussed the risks and benefits of the medicine with your doctor.

Children—Children should avoid traveling to areas where there is a chance of getting malaria, unless they can take effective antimalarial medicines such as mefloquine. Studies on this medicine have not been done in infants below the age of 6 months old.

Older adults—Many medicines have not been studied specifically in older people. Therefore, it may not be known whether they work exactly the same way they do in younger adults or if they cause different side effects or problems in older people. There is no specific information comparing use of mefloquine in the elderly with use in other age groups. However, elderly people may be more sensitive to the adverse effects of mefloquine which may require caution.

Other medicines—Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking mefloquine, it is especially important that your health care professional know if you are taking any of the following:

• Anticonvulsants (carbamazepine [e.g., Tegretol, Carbatrol], phenobarbital [e.g., Luminal], phenytoin [e.g., Dilantin], valproic acid [e.g., Depakote])—Effects of the anticonvulsant (medicine to stop or reduce effects of seizures) not work as well. Your doctor may need to change your dose of anticonvulsant medicine.

• Chloroquine (e.g., Aralen)—Use of chloroquine with mefloquine may increase the chance of convulsions (seizures).

• Halofantrine (e.g., Halfan)—Use of halofantrine together with mefloquine may cause serious heart problems.
• Quinidine (e.g., Quinidex) or
• Quinine—Use of these medicines together with mefloquine may result in slow heartbeat and other heart problems; also, an increased chance of convulsions (seizures) may occur when quinine is taken together with mefloquine.

Other medical problems—The presence of other medical problems may affect the use of mefloquine. Make sure you tell your doctor if you have any other medical problems, especially:

• Allergy to mefloquine or similar medicines such as quinine and quinidine or
• Psychiatric conditions such as
  • Active depression or recent history of depression or
  • Generalized anxiety disorder or
  • Psychosis or
  • Schizophrenia or
  • Other major psychiatric disorders or
• Convulsions, history of—Mefloquine should not be taken if you have any of these conditions.

• Depression previous history of—Mefloquine should be used with caution.

• Epilepsy or
• Seizure disorder—Mefloquine may make these conditions worse.

• Heart conditions or
• Liver problems—Mefloquine should be used with caution.

Proper Use of This Medicine

Mefloquine is best taken with a full glass (8 ounces) of water and with food, unless otherwise directed by your doctor.

Mefloquine may be crushed and put in water, milk, or juice to make it easier to take.

For patients taking mefloquine to prevent the symptoms of malaria :

• Your doctor will want you to start taking this medicine one week before you travel to an area where there is a chance of getting malaria.
• Also, you should keep taking this medicine while you are in the area where malaria is present and for 4 weeks after you leave the area . No medicine will protect you completely from malaria. However, to protect you as completely as possible, it is important that you keep taking this medicine for the full time your doctor ordered . Also, if fever or “flu-like” symptoms develop during your travels or within 2 to 3 months after you leave the area, check with your doctor immediately .
• This medicine works best when you take it on a regular schedule. For example, if you are to take it once a week, it is best to take it on the same day each week. Do not miss any doses . If you have any questions about this, check with your health care professional.

For patients taking mefloquine to treat malaria :

• To help clear up your infection completely, take this medicine exactly as directed by your doctor .

Children taking mefloquine to treat malaria may vomit after taking this medicine. Your child may vomit some of the dose of medicine. Contact your child"s doctor if vomiting occurs. The doctor may need for you to give your child more medicine.

Dosing—The dose of mefloquine will be different for different patients. Follow your doctor"s orders or the directions on the label . The following information includes only the average doses of mefloquine. If your dose is different, do not change it unless your doctor tells you to do so.

The number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on whether you are using mefloquine to prevent or to treat malaria .

• For oral dosage form (tablets):
  • For prevention of malaria:
    • Adults and children weighing over 45 kilograms (kg) (99 pounds)—250 milligrams (mg) (1 tablet) one week before traveling to an area where malaria occurs. Then 250 mg once a week on the same day of each week and preferably after your main meal while staying in the area and every week for four weeks after leaving the area.
    • Children—Dose is based on body weight and must be determined by your doctor.
      • Children weighing 5 to 9 kg (11 to 20 pounds): 5 mg per kg of body weight one week before traveling to an area where malaria occurs.
      • Children weighing 10 to 19 kg (21 to 43 pounds): 62.5 mg (1/4 tablet) one week before traveling to an area where malaria occurs. Then 62.5 mg once a week while staying in the area where malaria occurs and every week for four weeks after leaving the area.
      • Children weighing 20 to 30 kg (44 to 66 pounds): 125 mg (1/2 tablet) one week before traveling to an area where malaria occurs. Then 125 mg once a week while staying in the area and every week for four weeks after leaving the area.
      • Children weighing 31 to 45 kg (67 to 99 pounds): 187.5 mg (3/4 tablet) one week before traveling to an area where malaria occurs. Then 187.5 mg once a week while staying in the area and every week for four weeks after leaving the area.
  • For treatment of malaria:
    • Adults—1250 mg as a single dose, or 750 mg as one dose, then a 500 mg dose 8 hours later, or may be determined by your doctor based on body weight
    • Children—Dose is based on body weight and must be determined by your doctor. The usual dose is 20 to 25 mg per kg (9 to 11 mg per pound) of body weight as a single dose or two doses (divide the single dose by two) taken 6 to 8 hours apart. Taking two doses may decrease the occurrence of unwanted side effects.

Missed dose—If you miss a dose of this medicine, take it as soon as possible. This will help to keep you taking your medicine on a regular schedule. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses.

Storage—To store this medicine:

• Keep out of the reach of children.
• Store away from heat and direct light.
• Do not store in the bathroom, near the kitchen sink, or in other damp places. Heat or moisture may cause the medicine to break down.
• Do not keep outdated medicine or medicine no longer needed. Be sure that any discarded medicine is out of the reach of children.

Precautions While Using This Medicine

Mefloquine may cause vision problems. It may also cause some people to become dizzy or lightheaded or to have hallucinations (seeing, hearing, or feeling things that are not there). Make sure you know how you react to this medicine before you drive, use machines, or do anything else that could be dangerous if you are dizzy or are not alert or able to see well . This is especially important for people whose jobs require fine coordination. If these reactions are especially bothersome, check with your doctor.

Malaria is spread by the bite of certain kinds of infected female mosquitoes. If you are living in, or will be traveling to, an area where there is a chance of getting malaria, the following mosquito-control measures will help to prevent infection:

• If possible, sleep under mosquito netting, preferably netting coated or soaked with pyrethrum, to avoid being bitten by malaria-carrying mosquitoes.
• Remain in air-conditioned rooms to reduce contact with mosquitoes
• Wear long-sleeved shirts or blouses and long trousers to protect your arms and legs, especially from dusk through dawn when mosquitoes are out.
• Apply mosquito repellant, preferably one containing DEET, to uncovered areas of the skin from dusk through dawn when mosquitoes are out.
• Using a pyrethrum-containing flying insect spray to kill mosquitoes in living and sleeping quarters during evening and nighttime hours.

If you are taking quinidine (e.g., Quinidex) or quinine, talk to your doctor before you take mefloquine. While you are taking mefloquine, take mefloquine at least 12 hours after the last dose of quinidine or quinine . Taking mefloquine and either of these medicines at the same time may result in a greater chance of serious side effects.

If you are taking anticonvulsants (e.g., Tegetrol, Dilantin), halofantrine (e.g., Halfan), or typhoid vaccine, talk to your doctor before you take mefloquine. Taking mefloquine and any of these medicines at the same time may result in a greater chance of serious side effects.

For patients taking mefloquine to treat malaria :

• If your symptoms do not improve within a few days, or if they become worse, check with your doctor.

Side Effects of This Medicine

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor immediately if any of the following side effects occur:

Incidence not determined

Other side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. However, check with your doctor if any of the following side effects continue or are bothersome:

Rare

Mefloquine very rarely may cause partial loss of hair. After treatment with mefloquine has ended, normal hair growth should return.

Incidence not determined

Other side effects not listed above may also occur in some patients. If you notice any other effects, check with your doctor.

Revised: 12/02/2003

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