Malaria tablets: mefloquine

Latest update: 15 July 2024 - Authors: Nele Alders, Ula Maniewski

Mefloquine (Lariam®)

Prevention of malaria caused by Plasmodium falciparum.

one adult tablet contains 250mg mefloquine
tablets can be cut into quarters using a tablet cutter or the pharmacist can prepare a special formulation
no liquid formulation available

adults: 250mg once a week on the same day
children >5kg: can be used in adjusted dose based on the weight: 4-5 mg/kg/week to a maximum of 250 mg
duration: once a week, to start 2-3 weeks before entering risk zone and take until 28 days after leaving endemic area
in case of previous proven tolerability and a lack of time, it could be started shorter before entering a risk zone, but at least 3 tablets should have been taken before entering an endemic area:
- schedule with a loading dose of 250mg on day 1, 2 and 3 (or spread over the remaining days) with a fourth dose on day 10 and thereafter weekly, until 28 days after return

if mefloquine has never been taken: start at least 2-3 weeks before travel to monitor side-effects.
patient warning leaflet ( leaflet warning leaflet Nederlands/ Français): since 2014, it’s mandatory to inform patients for potential side effects and a patient warning leaflet warning leaflet needs to be signed and kept by the traveller during use
taking mefloquine in the evening can sometimes reduce some of the side-effects

90% or more: significant resistance of P. falciparum to mefloquine is a problem only in some areas of South East Asia but is reported sporadically from the Amazon basin

convulsions/ epilepsy: mefloquine antagnosis the anticonvulsant effect of antiepileptics and reduce the epileptogenic treshold, increasing the risk of convulsions
psychoneurological: depression, generalised anxiety disorders, psychosis, suicide risk
vestibular disorders
cardiac conduction abnormalities: concomittant use with other drugs that affect cardiac conduction may enhance risk of cardiac arrhytmias
history of blackwater fever
severe impairment of liver function
it can be used in those known to be G6PD-deficient

tiredness, stress, exhaustion, and excessive alcohol use can increase the potential psychoneurological side-effects
mefloquine is metabolised in the liver by CYP3A4, so caution of co-administered with medication that inhibit this enzyme due to increased mefloquine levels (e.g., itraconazole)
medications that induce metabolism of mefloquine may reduce mefloquine levels (e.g., rifampicin)

Advantages	Disadvantages
only to be taken once a week	side effects
relatively cheap compared to other options	not for last minute travellers
can be taken during pregnancy and breastfeeding