Neuro-psychiatric effects of antimalarials

Riemsdijk, Melanie M. van; Klauw, Melanie M. van der; Heest, J. A. C. van; Reedeker, F. R.; Ligthelm, Robert J.; Herings, Ron M. C.; Stricker, Bruno H. Ch.

doi:10.1007/s002280050240

Cited by 49 publications

(32 citation statements)

References 10 publications

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“…Two studies have employed a validated symptom measure, the POMS. One of these was not randomized, and found no differences between mefloquine, proguanil or no drug [115]. However, the single randomized study using the POMS reported elevated scores in mefloquine- compared to chloroquine-treated patients [116].…”

Section: Resultsmentioning

confidence: 99%

Drug-Induced Depression: A Systematic Review to Inform Clinical Practice

Patten

Barbui

2004

Psychother Psychosom

110

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Background: Certain medications may contribute to the etiology of depressive symptoms and disorders. Research in this area, however, has been hampered by methodological and conceptual problems. This review had two objectives: to identify evidence linking medical drugs to depressive symptoms and disorders, and to summarize this evidence in a clinically meaningful way. Methods: Electronic literature searches were performed and studies were reviewed with reference to critical methodological features. Results: No medications causing the typical major depressive syndrome were identified. Evidence was found linking corticosteroids, interferon-α, interleukin-2, gonadotropin-releasing hormone agonists, mefloquine, progestin-releasing implanted contraceptives and propranolol to the etiology of atypical depressive syndromes. Conclusions: A small number of drugs have been shown capable of inducing depressive symptoms. Drug-induced depression appears to differ symptomatically from classical major depression.

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Section: Resultsmentioning

confidence: 99%

Drug-Induced Depression: A Systematic Review to Inform Clinical Practice

Patten

Barbui

2004

Psychother Psychosom

110

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“…Two types of neuropsychiatric adverse events have been attributed to the use of mefloquine: (1) a sensation of dizziness, dysphoria, light-headedness and difficulty in concentrating which occurs within 6 h after intake and usually resolves during the following days; (2) acute psychosis with agitation or depression, occurring in the second week after starting prophylaxis [6]. In a previous study, we found that women in particular developed insomnia on mefloquine [7]. Other studies also found more neuropsychiatric effects in women than in men [8,9].…”

Section: Introductionmentioning

confidence: 99%

Neuropsychiatric events during prophylactic use of mefloquine before travelling

Riemsdijk

Ditters

Sturkenboom

et al. 2002

European Journal of Clinical Pharmacology

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Introduction: It has been suggested that neuropsychiatric events during use of mefloquine are more common in females than in males and are partly explained by the psychological stress of travelling. Therefore, we investigated neuropsychiatric events in females and males on mefloquine in the 3-week prophylactic period that precedes travelling. Furthermore, we investigated whether first-time users had a higher risk of neuropsychiatric adverse events than subjects with a history of mefloquine use. Methods: We enrolled all patients who visited a Travel Clinic for mefloquine prophylaxis during the period 1 May 1999 to 7 March 2000. Each patient was followed from baseline (prior to starting mefloquine) up to 3 weeks after the start of mefloquine but before travelling. We asked patients to register any adverse event in a diary and measured the intra-individual change in scores on the Dutch Shortened Profile Of Mood States (POMS) at baseline and at the end of follow-up. Results: The final cohort consisted of 179 subjects with a mean age of 3 years. Females reported adverse events more frequently than males (P=0.005). Overall, we observed a small but significant increase in the score on the domain fatigue [0.74 points, 95% confidence interval (CI) 0.18, 1.30]. The effect was exclusively present in females and not in males. First-time users of mefloquine increased 2.81 points (95% CI 0.70, 4.92) on the total score of the POMS, and among those, women showed the largest increase of 4.58 points (95% CI 0.74, 8.43). Conclusion: The use of mefloquine was associated with neuropsychiatric adverse effects. Females encountered neuropsychiatric effects more frequently than males, which could be confirmed by validated psychological tests. Neuropsychiatric effects were more common in first-time users than in individuals who had used mefloquine before.

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“…Compliance with quinine is challenging, especially in the 7-to 10-day dosing regimens commonly used for pregnant women and children in Southeast Asia. Mefloquine remains efficacious in most areas of the world but is associated with stillbirth in pregnancy (13), and concerns about neuropsychiatric reactions (19) may limit its use. Artesunate requires 5-to 7-day treatment regimens to achieve acceptable cure rates, and it is therefore usually combined with mefloquine (23).…”

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confidence: 99%

Assessment of Azithromycin in Combination with Other Antimalarial Drugs against Plasmodium falciparum In Vitro

Ohrt

Willingmyre

Lee

et al. 2002

Antimicrob Agents Chemother

130

100

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Initial field malaria prophylaxis trials with azithromycin revealed insufficient efficacy against falciparum malaria to develop azithromycin as a single agent. The objective of this in vitro study was to determine the best drug combination(s) to evaluate for future malaria treatment and prophylaxis field trials. In vitro, azithromycin was tested in combination with chloroquine against 10 representative Plasmodium falciparum isolates. Azithromycin was also assessed in combination with eight additional antimalarial agents against two or three multidrug-resistant P. falciparum isolates. Parasite susceptibility testing was carried out with a modification of the semiautomated microdilution technique. The incubation period was extended from the usual 48 h to 68 h. Fifty percent inhibitory concentrations (IC 50 s) were calculated for each drug alone and for drugs in fixed combinations of their respective IC 50 s (1:1, 3:1, 1:3, 4:1, 1:4, and 5:1). These data were used to calculate fractional inhibitory concentrations and isobolograms. Chloroquine-azithromycin studies revealed a range of activity from additive to synergistic interactions for the eight chloroquine-resistant isolates tested, while an additive response was seen for the two chloroquine-sensitive isolates. Quinine, tafenoquine, and primaquine were additive to synergistic with azithromycin, while dihydroartemisinin was additive with a trend toward antagonism. The remaining interactions appeared to be additive. These results suggest that a chloroquineazithromycin combination should be evaluated for malaria prophylaxis and that a quinine-azithromycin combination should be evaluated for malaria treatment in areas of drug resistance.

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Neuro-psychiatric effects of antimalarials

Abstract: Insomnia was more commonly encountered during use of mefloquine than proguanil or during non-use of antimalarials.

Cited by 49 publications

References 10 publications

Drug-Induced Depression: A Systematic Review to Inform Clinical Practice

Drug-Induced Depression: A Systematic Review to Inform Clinical Practice

Neuropsychiatric events during prophylactic use of mefloquine before travelling

Assessment of Azithromycin in Combination with Other Antimalarial Drugs against Plasmodium falciparum In Vitro

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