E-DRUG: Mefloquine as malaria chemoprophylaxis (feedback)
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Greetings E-Druggers,
First of all my deepest thanks for your prompt responses to my earlier
request for info on Maloprim, especially from Mrs Lee Baker, Dr Richard
Laing and Mr Andy Gray. You have greatly influenced our abandon of Maloprim
as suitable malaria chemoprophylaxis in our protocol with the detailed
information you sent. Thank you once again :-)!
Now to my new question: is there any contraindication to using mefloquine in delicate job situations, here I am thinking of piloting a ship or working in the ship engine rooms where psychotic side effects may endanger hundreds of volunteers?
Most sources of information suggest that psychotic side effects
of mefloquine should appear within three weeks of starting, but it can
appear later according to ADR reports. If so, does it justify avoiding
mefloquine as malaria chemoprophylaxis in such job situations (a
clarification, we have no hesitation with its use in malaria treatment).
Were there similar problems with its use in the army, for example? I imagine
handling weaponry would be a sensitive job situation. Since mefloquine is
available as generics at low cost and is one of the first chemoprophylaxis
(if not the only) recommended for malaria in west Africa, I would welcome
any comments on this.
[moderator: mefloquine was developed for the Vietnam war by the Walter Reed institute, but the war was lost before the drug was ready...
Iraq has no malaria as far as I know. Maybe Afghanistan?
More serious: I know that Lufthansa pilots are not allowed to use mefloquine for malaria prophylaxis.
Difficult to recommend what to do for a ship captain. WB]
E-DRUG: Mefloquine as malaria chemoprophylaxis (2)
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Dear E-druggers,
Now to my new question: is there any contraindication to using
mefloquine in delicate job situations, here I am thinking of piloting a
ship or working in the ship engine rooms where psychotic side effects
may endanger hundreds of volunteers?
The South African guidelines stated that "Mefloquine can cause dizziness,
disturbed sense of balance and neuropsychiatric reactions during and up to
three weeks after its use. Caution must therefore be exercised when driving
and operating machines while taking this drug29. The WHO recommends that
piloting of aircraft and deepsea diving should be avoided while taking
mefloquine1.Although the latest studies do not seem to show significant
effects of mefloquine on fine motor co-ordination, it seems prudent to
exercise caution when used in persons operating machines, driving, deep-sea
diving or flying28. (The drug may cause sleep disturbances which, in the
long term, may affect co-ordination)".
The references cited are:
1. WHO International Travel and Health 2002. Geneva.
28. WHO International Travel and Health booklet. 2001
29. Lariam. package insert. 1997. Roche.
Were there similar problems with its use in the army, for example? I
imagine handling weaponry would be a sensitive job situation.
To add to Wilbert's comment - my recollection is that the first relatively
large-scale deployment of mefloquine by the US Army was in Somalia. It may
be worthwhile contacting the team at Walter Reed to see what current US
military recommendations are regarding its use.
Mefloquine as malaria chemoprophylaxis (3)
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Mefloquine is known to be neurotoxic, a fact which may explain the
documented increased odds of panic attacks and psychosis. An increased
incidence of neuropsychiatric side effects was convincingly demonstrated in
a placebo controlled study. These adverse events occurred in the phase
before departure, discounting the effects of travel.
Many military organizations give their troops mefloquine. I am not sure this
is always sensible. The high profile murder investigation in the US military
is examining whether mefloquine may have played a causative role.
It would seem unwise to give mefloquine to those working with dangerous
machinery, as in a vessel's engine room. Aviation pilots are precluded from
using mefloquine for prophylaxis, and it would seem to be a good idea for
ship's pilots.
Dr Stephen Toovey MBBCh, CTM, FACTM, FFTM
Aviation medical examiner
Johannesburg South Africa, Basel Switzerland
Phones:+27-82-466-6322;+41-61-421-7872
SMS:+27-82-466-6322
Fax:+41-61-421-7063
Postal address: Burggartenstrasse 32, CH-4103 Bottmingen, Switzerland
toovey@travelclinic.co.za