Mefloquine

Aka: Mefloquine, Lariam

1. Indications
   1. Prophylaxis or Treatment of Malaria
   2. Preferred agent in Chloroquine resistance areas
2. 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
3. Pharmacokinetics
   1. Half-life: 33 days
   2. Steady state reached
      1. Weekly dose: 7 weeks
      2. Loading dose: 4 days
4. 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
5. Directions
   1. Take with food and full glass of water
6. Dosing: Prophylaxis
   1. Protocol
      1. Start dosing 1 week before exposure
      2. Complete dosing 4 weeks after exposure
   2. Adult
      1. Mefloquine 228 mg base (250mg salt) PO once weekly
   3. Child
      1. Weight <15 kg
         1. Dose: 4.6 mg/kg base (5 mg/kg salt) PO once weekly
      2. Weight 15-19 kg
         1. Mefloquine 1/4 tablet PO once per week
      3. Weight: 20-30 kg
         1. Mefloquine 1/2 tablet PO once per week
      4. Weight: 31-45 kg
         1. Mefloquine 3/4 tablet PO once per week
      5. Weight: >45 kg
         1. Mefloquine 1 tablet PO once per week
7. Dosing: Treatment
   1. Adult: 1250 mg for 1 dose
   2. Child: 15 mg/kg for 1 dose
8. 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]