MEFLOQUINE (Systemic)

Some commonly used brand names are:

In the U.S.?

• Lariam

In Canada?

• Lariam

Category

• Antimalarial

Description

Mefloquine (ME-floe-kwin) belongs to a group of medicines called antimalarials.It is used to prevent or treat malaria, a red blood cell infection transmittedby the bite of a mosquito.

Malaria transmission occurs in large areas of Central and South America,Hispaniola, sub-Saharan Africa, the Indian subcontinent, Southeast Asia, theMiddle East, and Oceania. Country-specific information on malaria can be obtainedfrom the Centers for Disease Control and Prevention (CDC), or from the CDC'sweb site at http://www.cdc.gov/travel.

This medicine may cause some serious side effects. Therefore, it is usuallyused only to prevent the symptoms of malaria or to treat serious malaria infectionsin areas where it is known that other medicines may not work.

Mefloquine is available only with your doctor's prescription, in the followingdosage form:

Oral
• Tablets (U.S. and Canada)

Before Using This Medicine

In deciding to use a medicine,the risks of taking the medicine must be weighed against the good it willdo. This is a decision you and your doctor will make. For mefloquine, thefollowing should be considered:

Allergies?Tell your doctor if you have ever had any unusual orallergic reaction to mefloquine, quinidine (e.g., Quinidex), quinine, or anyrelated medicines. Also tell your health care professional if you are allergicto any other substances, such as foods, preservatives, or dyes.

Pregnancy?It is best if pregnant women can avoid travelingto areas where there is a chance of getting malaria. However, if travel isnecessary, mefloquine may be used for women traveling to areas where the parasiteis resistant to chloroquine. Pregnant women are advised to report to theirdoctor any side effects following the use of mefloquine.

Breast-feeding?Mefloquine passes into the breast milk in smallamounts. However, the amount in breast milk is not enough to prevent the infantfrom getting malaria. Mefloquine could cause unwanted effects in the breast-fedbaby. It may be necessary for you to take another medicine or to stop breast-feedingwhile taking mefloquine. Be sure you have discussed the risks and benefitsof the medicine with your doctor.

Children?Children should avoid traveling to areas where thereis a chance of getting malaria, unless they can take effective antimalarialmedicines such as mefloquine. Studies on this medicine have not been donein infants below the age of 6 months old.

Older adults?Many medicines have not been studied specificallyin older people. Therefore, it may not be known whether they work exactlythe same way they do in younger adults or if they cause different side effectsor problems in older people. There is no specific information comparing useof mefloquine in the elderly with use in other age groups. However, elderlypeople may be more sensitive to the adverse effects of mefloquine which mayrequire caution.

Other medicines?Although certain medicines should not be usedtogether at all, in other cases two different medicines may be used togethereven if an interaction might occur. In these cases, your doctor may want tochange the dose, or other precautions may be necessary. When you are takingmefloquine, it is especially important that your health care professionalknow if you are taking any of the following:

• Anticonvulsants (carbamazepine [e.g., Tegretol, Carbatrol], phenobarbital[e.g., Luminal], phenytoin [e.g., Dilantin], valproic acid [e.g., Depakote])?Effectsof the anticonvulsant (medicine to stop or reduce effects of seizures) notwork as well. Your doctor may need to change your dose of anticonvulsant medicine.

• Chloroquine (e.g., Aralen)?Use of chloroquine with mefloquinemay increase the chance of convulsions (seizures).

• Halofantrine (e.g., Halfan)?Use of halofantrine together withmefloquine may cause serious heart problems.
• Quinidine (e.g., Quinidex) or
• Quinine?Use of these medicines together with mefloquine mayresult in slow heartbeat and other heart problems; also, an increased chanceof convulsions (seizures) may occur when quinine is taken together with mefloquine.

Other medical problems?The presence of other medicalproblems may affect the use of mefloquine. Make sure you tell your doctorif you have any other medical problems, especially:

• Allergy to mefloquine or similar medicines such as quinine and quinidineor
• Psychiatric conditions such as
  • Active depression or recent history of depression or
  • Generalized anxiety disorder or
  • Psychosis or
  • Schizophrenia or
  • Other major psychiatric disorders or
• Convulsions, history of?Mefloquine should not be taken if youhave any of these conditions.

• Depression previous history of?Mefloquine should be used withcaution.

• Epilepsy or
• Seizure disorder?Mefloquine may make these conditions worse.

• Heart conditions or
• Liver problems?Mefloquine should be used with caution.

Proper Use of This Medicine

Mefloquineis best taken with a full glass (8 ounces) of water and with food, unlessotherwise directed by your doctor.

Mefloquine may be crushed and put in water, milk, or juice to make it easierto take.

For patients taking mefloquine to prevent the symptoms of malaria:

• Your doctor will want you to start taking this medicine one weekbefore you travel to an area where there is a chance of getting malaria.
• Also, you should keep taking this medicine whileyou are in the area where malaria is present and for 4 weeks after you leavethe area. No medicine will protect you completely from malaria. However,to protect you as completely as possible, it is importantthat you keep taking this medicine for the full time your doctor ordered.Also, if fever or ?flu-like? symptoms develop during your travelsor within 2 to 3 months after you leave the area, checkwith your doctor immediately.
• This medicine works best when you take it on a regular schedule.For example, if you are to take it once a week, it is best to take it on thesame day each week. Do not miss any doses. Ifyou have any questions about this, check with your health care professional.

For patients taking mefloquine to treat malaria:

• To help clear up your infection completely, take this medicine exactly as directed by your doctor.

Children taking mefloquine to treat malaria may vomit after taking this medicine. Your child mayvomit some of the dose of medicine. Contact your child's doctor if vomitingoccurs. The doctor may need for you to give your child more medicine.

Dosing?The dose of mefloquine will be different fordifferent patients. Follow your doctor's orders or thedirections on the label. The following information includes only theaverage doses of mefloquine. If your dose is different,do not change it unless your doctor tells you to do so.

The number of doses you take each day, the time allowedbetween doses, and the length of time you take the medicine depend on whetheryou are using mefloquine to prevent or to treat malaria.

• For oral dosage form (tablets):
  • For prevention of malaria:
    • Adults and children weighing over 45 kilograms (kg) (99 pounds)?250milligrams (mg) (1 tablet) one week before traveling to an area where malariaoccurs. Then 250 mg once a week on the same day of each week and preferablyafter your main meal while staying in the area and every week for four weeksafter leaving the area.
    • Children?Dose is based on body weight and must be determinedby your doctor.
      • Children weighing 5 to 9 kg (11 to 20 pounds): 5 mg per kg of bodyweight one week before traveling to an area where malaria occurs.
      • Children weighing 10 to 19 kg (21 to 43 pounds): 62.5 mg (1/4tablet) one week before traveling to an area where malaria occurs. Then 62.5mg once a week while staying in the area where malaria occurs and every weekfor four weeks after leaving the area.
      • Children weighing 20 to 30 kg (44 to 66 pounds): 125 mg (1/2tablet) one week before traveling to an area where malaria occurs. Then 125mg once a week while staying in the area and every week for four weeks afterleaving the area.
      • Children weighing 31 to 45 kg (67 to 99 pounds): 187.5 mg (3/4tablet) one week before traveling to an area where malaria occurs. Then 187.5mg once a week while staying in the area and every week for four weeks afterleaving the area.
  • For treatment of malaria:
    • Adults?1250 mg as a single dose, or 750 mg as one dose, thena 500 mg dose 8 hours later, or may be determined by your doctor based onbody weight
    • Children?Dose is based on body weight and must be determinedby your doctor. The usual dose is 20 to 25 mg per kg (9 to 11 mg per pound)of body weight as a single dose or two doses (divide the single dose by two)taken 6 to 8 hours apart. Taking two doses may decrease the occurrence ofunwanted side effects.

Missed dose?If you miss a dose of this medicine, take it assoon as possible. This will help to keep you taking your medicine on a regularschedule. However, if it is almost time for your next dose, skip the misseddose and go back to your regular dosing schedule. Do not double doses.

Storage?To store this medicine:

• Keep out of the reach of children.
• Store away from heat and direct light.
• Do not store in the bathroom, near the kitchen sink, or in otherdamp places. Heat or moisture may cause the medicine to break down.
• Do not keep outdated medicine or medicine no longer needed. Be surethat any discarded medicine is out of the reach of children.

Precautions While Using This Medicine

Mefloquinemay cause vision problems. It may also cause some people to become dizzy orlightheaded or to have hallucinations (seeing, hearing, or feeling thingsthat are not there). Make sure you know how you reactto this medicine before you drive, use machines, or do anything else thatcould be dangerous if you are dizzy or are not alert or able to see well.This is especially important for people whose jobs require fine coordination.If these reactions are especially bothersome, check with your doctor.

Malaria is spread by the bite of certain kinds of infected female mosquitoes.If you are living in, or will be traveling to, an area where there is a chanceof getting malaria, the following mosquito-control measures will help to preventinfection:

• If possible, sleep under mosquito netting, preferably netting coatedor soaked with pyrethrum, to avoid being bitten by malaria-carrying mosquitoes.
• Remain in air-conditioned rooms to reduce contact with mosquitoes
• Wear long-sleeved shirts or blouses and long trousers to protectyour arms and legs, especially from dusk through dawn when mosquitoes areout.
• Apply mosquito repellant, preferably one containing DEET, to uncoveredareas of the skin from dusk through dawn when mosquitoes are out.
• Using a pyrethrum-containing flying insect spray to kill mosquitoesin living and sleeping quarters during evening and nighttime hours.

If you are taking quinidine (e.g., Quinidex) or quinine,talk to your doctor before you take mefloquine. While you are taking mefloquine,take mefloquine at least 12 hours after the last dose of quinidine or quinine. Taking mefloquine and either of these medicines at the same timemay result in a greater chance of serious side effects.

If you are taking anticonvulsants (e.g., Tegetrol,Dilantin), halofantrine (e.g., Halfan), or typhoid vaccine, talk to your doctorbefore you take mefloquine.Taking mefloquine and any of these medicinesat the same time may result in a greater chance of serious side effects.

For patients taking mefloquine to treat malaria:

• If your symptoms do not improve within a few days, or if they becomeworse, check with your doctor.

Side Effects of This Medicine

Along with its needed effects, a medicine may cause some unwanted effects.Although not all of these side effects may occur, if they do occur they mayneed medical attention.

Check with your doctor immediately if any ofthe following side effects occur:

Rare

Aching joints and muscles; anxiety; blistering, loosening, peeling, or redness of the skin; chest pain or discomfort; chills, fever,and/or sore throat; confusion; convulsions (seizures); dizziness; cough or hoarseness; depression; fainting; hallucinations (seeing, hearing, or feelingthings that are not there); irregular , pounding,slow, or fast heartbeat or pulse; irritability; lightheadedness; lower back or sidepain; nervousness; painfulor difficult urination; pinpoint red spots on skin; mood or mental changes, mental depression, and/orrestlessness; red or irritated eye; sores, ulcers, and/or white spots in mouth or on lips; stiff neck; swelling of ankles, feet,and/or lower legs; unusual bleeding or bruising; unusual tiredness or weakness; vomiting

Incidence not determined

Other side effects may occurthat usually do not need medical attention. These side effects may go awayduring treatment as your body adjusts to the medicine. However, check withyour doctor if any of the following side effects continue or are bothersome:

More common

Chills; continuing ringing or buzzingor other unexplained noise in ears or hearing loss; diarrhea; emotional problems; loss of balance; nausea; stomach pain

Less common

Abnormal dreams; loss of appetite; skin rash; trouble in sleeping; unusual tiredness or weakness; vertigo

Rare

Mefloquine veryrarely may cause partial loss of hair. After treatment with mefloquine hasended, normal hair growth should return.

Incidence not determined

Other side effects not listedabove may also occur in some patients. If you notice any other effects, checkwith your doctor.