The absolute configuration of (؊)-mefloquine has been established as 11R,12S by X-ray crystallography of the hydrochloride salt, thus allowing comparison of the configuration of mefloquine's optical isomers to those of quinine and quinidine. (؊)-Mefloquine has the same stereochemistry as quinine, and (؉)-mefloquine has the same stereochemistry as quinidine. Since (؉)-mefloquine is more potent than (؊)-mefloquine in vitro against the D6 and W2 strains of Plasmodium falciparum and quinidine is more potent than quinine, a common stereochemical component for antimalarial activity is implicated. The crystal of (؊)-mefloquine hydrochloride contained four different conformations which mainly differ in a small rotation of the piperidine ring. These conformations are essentially the same as the crystalline conformations of racemic mefloquine methylsulfonate monohydrate, mefloquine hydrochloride, and mefloquine free base. Quinine and quinidine (Fig. 1), antimalarial agents isolated from the bark of the Cinchona tree, are diastereomers, but they mirror each other at carbons C-8 and C-9. In vitro quinidine is more potent than quinine against many strains of Plasmodium falciparum. Specifically, quinidine is 2.3 and 2.8 times more potent than quinine against the chloroquine-sensitive Sierra Leone D-6 clone and the chloroquine-resistant Indochina W-2 clone, respectively (15). Quinidine is 2.5 times more potent than quinine and cinchonine (the demethoxy analog of quinidine) is 2.8 times more potent than cinchonidine (the demethoxy analog of quinine) in vitro against Papua New Guinea FCQ-27/PNG P. falciparum (25). Similarly, quinidine was 2.2 and 3.2 times more potent than quinine against Cameroon chloroquine-resistant FCM 29 and Ivory Coast chloroquine-sensitive L-3 strains, respectively (1). Against clinical isolates from Liberia, quinidine was on average 3 times more potent than quinine (4). Clinical differences in the antimalarial activities of quinine and quinidine have also been reported. Compared to quinine, quinidine was twice as effective against induced McClendon P. falciparum infections (23) and more potent clinically against Thai P. falciparum (18,26).Mefloquine, a synthetic analog of quinine and quinidine, is marketed in racemic form under the trade name Lariam. Mefloquine is basically a structurally simpler form of quinine and quinidine. Mefloquine differs from the cinchona alkaloids in that it has a different substitution on the quinoline ring, a piperidine ring rather than the bicyclo quinuclidine ring, and no vinyl group (see Fig. 1). However, the C-8 and C-9 chiral centers of the cinchona alkaloids are preserved in the mefloquine molecule (numbered C-12 and C-11, respectively). Thus, one enantiomer of mefloquine will share the same stereochemistry as quinine and the other enantiomer of mefloquine will share the same stereochemistry as quinidine at the equivalent chiral centers.Since quinine and quinidine possess different antimalarial activities, the (ϩ) and (Ϫ) isomers of mefloquine were tested against P. falc...