Mefloquine Dangers – Fact or Fancy?

Keystone, J. S.; Kain, K. C.

doi:10.1155/1995/819270

Cited by 4 publications

(3 citation statements)

References 5 publications

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“…Severe and life-threatening psychiatric symptoms from mefloquine, including suicidal ideation and suicide, may be preceded by often subtle prodromal symptoms including even mild disturbances in sleep and dreaming [ 215 ]. Although such symptoms have often previously been attributed to other causes and their critical significance overlooked even by influential authorities [ 216 – 218 ], both the European and US product labelling now explicitly direct the discontinuation of the drug at the onset of any psychiatric symptom [ 190 ]. Even the earliest approved US mefloquine product insert appeared to echo the conclusions of prospective studies of quinacrine conducted decades earlier [ 152 ] listing “anxiety, depression, restlessness or confusion” as potentially prodromal to a “more serious event” and requiring the drug’s discontinuation [ 190 ].…”

Section: Introductionmentioning

confidence: 99%

Psychiatric effects of malaria and anti-malarial drugs: historical and modern perspectives

Nevin

Croft

2016

Malar J

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The modern medical literature implicates malaria, and particularly the potentially fatal form of cerebral malaria, with a risk of neurocognitive impairment. Yet historically, even milder forms of malaria were associated in the literature with a broad range of psychiatric effects, including disorders of personality, mood, memory, attention, thought, and behaviour. In this article, the history of psychiatric effects attributed to malaria and post-malaria syndromes is reviewed, and insights from the historical practice of malariotherapy in contributing to understanding of these effects are considered. This review concludes with a discussion of the potentially confounding role of the adverse effects of anti-malarial drugs, particularly of the quinoline class, in the unique attribution of certain psychiatric effects to malaria, and of the need for a critical reevaluation of the literature in light of emerging evidence of the chronic nature of these adverse drug effects.

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Section: Introductionmentioning

confidence: 99%

Psychiatric effects of malaria and anti-malarial drugs: historical and modern perspectives

Nevin

Croft

2016

Malar J

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“…7 In contrast, influential Canadian authorities have previously claimed, in a figure that continues to be erroneously cited to the present day, 3 that psychosis and other severe adverse effects occur at a frequency of only 1 in 10 000 to 1 in 13 000. 9 Canadian pharmacists should ensure that their patients are properly counselled about the very common occurrence of psychiatric or neurologic symptoms with prophylactic use of mefloquine. Consistent with guidance in the updated Canadian product monograph, pharmacists should also counsel their patients that they should discontinue the drug at the onset of psychiatric or neurologic symptoms, and that they specifically must discontinue the drug at the onset of acute anxiety, depression, restlessness, or confusion, to reduce the risk of potentially permanent adverse effects.…”

Section: Implications Of Changes To the Mefloquine Product Monographmentioning

confidence: 99%

Implications of Changes to the Mefloquine Product Monograph

Nevin

2017

CJHP

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“…Although mefloquine use is not recommended during pregnancy, recent data indicate that mefloquine is safe and effective for antimalarial prophylaxis or treatment in the second half (more than 20 weeks' gestation) of pregnancy (37,39). Similarly, there is no convincing evidence of teratogenicity or other adverse events during the first half of pregnancy (39,40). It is recommended that mefloquine not be used with calcium channel blockers, digoxin or beta-blockers, although there is no convincing evidence of adverse interactions with these agents.…”

Section: Epidemiology and Treatment Of Drug-resistant Falciparum Malariamentioning

confidence: 99%

Chemotherapy of Drug‐Resistant Malaria

Kain¹

1995

Canadian Journal of Infectious Diseases and Medical Microbiolog

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KC KAIN. Chemotherapy of drug-resistant malaria. Can J Infect Dis 1996;7(1):25-33. OBJECTIVE:To review the impact of drug-resistant malaria on current management of plasmodial infections. DATA SOURCES: A MEDLINE search of the English-language medical literature from 1985 to 1995; bibliographies of selected papers; international malaria advisory experts. DATA SYNTHESIS: Combinations of artemisinin derivatives and mefloquine or atovaquone plus proguanil appear to be the most active drug regimens against multidrug-resistant falciparum malaria from Southeast Asia. The optimal therapy for chloroquine-resistant Plasmodium vivax is unknown, but recent data indicate that halofantrine or chloroquine plus high doses of primaquine are efficacious. CONCLUSIONS:The incidence of drug-resistant malaria continues to increase at a rate that exceeds new drug development. Ultimately the control of malaria will require more creative approaches than just the development of additional inhibitory drugs. These might include the identification of biochemical pathways unique to the parasite (such as drug efflux and heme polymerization), making it possible to design new classes of antimalarial agents that are selectively toxic to the parasite; methods to block parasite development in the mosquito vector; and multistage vaccines against asexual and sexual stages to block both the pathophysiology and the transmission of disease. Key Words: Drug-resistant malaria, Plasmodium falciparum, Plasmodium vivaxTraitement pharmacologique du paludisme réfractaire OBJECTIF : Passer en revue l'impact du paludisme réfractaire aux médicaments sur le traitement courant des infections plasmodiales. SOURCES DES DONNÉES :Une interrogation du Réseau MEDLINE sur la littérature médicale de langue anglaise publiée entre 1985 et 1995, bibliographies d'articles sélectionnés, experts-conseils internationnaux sur le paludisme. SYNTHÈSE DES DONNÉES : Les associations de dérivés d'artémisinine, de méfloquine ou d'atovaquone plus proguanil semblent être les schémas médicamenteux les plus efficaces contre le paludisme à falciparum résistant à plusieurs médicaments, en provenance de l'Asie du sud-est. Le traitement optimal dans les cas de Plasmodium vivax résistant à la chloroquine est inconnu, mais selon des données récentes, l'halofantrine ou la chloroquine avec dose élevée de primaquine sont efficaces. CONCLUSIONS : L'incidence du paludisme résistant aux médicaments continue d'augmenter à un taux qui excède la vitesse de mise au point de nouveaux médicaments. Éventuellement, la maîtrise du paludisme exigera des approches plus créatrices que le simple développement d'autres médicaments inhibiteurs. Parmi ces approches, l'identification des voies biochimiques empruntées par ce parasite (comme l'efflux des médicaments et la polymérisation de l'hème) rendra possible la conception de nouvelles classes d'agents antipaludéens sélectivement toxiques à l'endroit du parasite, de méthodes en vue de bloquer le développement du parasite dans le vecteur même et de vaccins à plusieur...

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Mefloquine Dangers – Fact or Fancy?

Cited by 4 publications

References 5 publications

Psychiatric effects of malaria and anti-malarial drugs: historical and modern perspectives

Psychiatric effects of malaria and anti-malarial drugs: historical and modern perspectives

Implications of Changes to the Mefloquine Product Monograph

Chemotherapy of Drug‐Resistant Malaria

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