Alarm bells sound for the anti-malaria drug known as mefloquine or Lariam


For years, there has been great concern about the anti-malaria drug mefloquine or Lariam as it is known by its brand name. Troops in Canada, the U.S., Holland, Australia, and Ireland especially have reported terrible adverse effects when they have been issued the drug on deployments to countries where malaria is prevalent.

During the past 20 years, we have learned adverse effects of mefloquine (Lariam) are severe enough to warrant banning the anti-malaria drug as a preventative treatment for travellers or troops embarking into zones where malaria dominates. Because of a genetic predisposition to brain damage when taking this drug, it is impossible to assess who will suffer the worst of mefloquine’s adverse effects, including liver and thyroid damage leading to death.

Essentially, there is an invisible lethal predisposition for individuals who are treated with the anti-malarial medication mefloquine. No one knows if they will suffer adverse effects until they take it. Then it’s too late.

Some soldiers say they have not had sufficient warning about the drug when they take it, so the first thing to learn is what procedures DND follows. A former medic assigned to Afghanistan explains what immunization steps the DND follows for overseas deployments and admits mefloquine remains the military’s choice of antimalaria drug for those serving in Afghanistan:

“Everything is done with the best intentions. That is why for Afghanistan the primary drug of choice is still Mefloquine.

“Let me explain: there are many different strains of malaria, some drugs are more effective than others, and some don’t work any more. The World Health Organization (WHO) is the one that provides the initial medical intel for the various regions: what strain is prevalent and what works best. WHO sends out advisories. Before we go to an area, all that info is reviewed plus information for local sources and allies. Then a decision is made as to the best preventive medicine measures for the area: this drug, that needle, eat here, etc..

“So, once we get the recommendations, the rest is a question of risk. Medication side effects vs catching malaria. By the way, malaria is deadly disease. You will die from it if untreated, versus you could be messed up for life if treated. I think that is what a lot of people tend to forget.

“Anyway: the number one choice for Afghanistan is mefloquine: most effective and highest compliance rate (you take it once weekly. Number two: Malarone: moderately effective, must take primiquine afterward as terminal prophylaxis (hard on the body), and Malarone must be taken daily. Number 3: Doxy: least effective and lots of common side effects, also the other stuff primiquine and taken daily.

“The choice is now left with the soldier after being briefed by doctor and pharmacist, but yes, they will tend to recommend Mefloquine for the reasons stated above unless it is contra-indicated (known problems with it or psychiatric history). Hope this helps.”

As of 2006, this was the procedure for issuing malaria prophylaxis in the military: 

1. Prior to a mission to an area, a threat assessment is done. Information is gathered from WHO, and from local health boards. The information is analyzed and a decision is made as to the type medications that are warranted (based on malaria type and mosquito type in that particular region). That information is then sent out to the deploying force (months in advance).

2. All the soldiers who are mobilizing for the mission have to go through a DAG (departure assistance group) where all sorts of things are checked and verified. From pay to training to medical stuff. So the medical stuff will include a complete physical, questionnaires, and mental health screening. All immunizations are checked. 

3. The first thing that will happen to a soldier who has never deployed before is a blood test to test for G6PD (an enzyme.) Without it, if you took primaquine (terminal treatment for malaria) you would get very sick (anemia).

4. Next, soldiers are briefed about the malaria type and the recommended medications. (Mefloquine, Chloriquine, Malarone, Doxycycline). They are told of side effects, and interactions. They then individually see a pharmacist: who goes over this information again, forms (health questionnaires) are completed to determine the best suitable medications. They then receive an Rx for that medication. They would then typically start this medication as recommended before they even leave Canada. If there are any problems they are to attend the medical center to get things switched up.

5. Soldiers can refuse to take medications outright, but then they are DAG’ed RED and then it is up to the individual mission commander to accept the risk or not.

For my summary of the study on mefloquine go to the new page created for the Mefloquine Controversy. You will find a complete history of the drug here: http://bonnie-toews.blogspot.com/p/hidden-face-of-military-suicides-and.html

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About Bonnie Toews and John Christiansen

Bonnie's Blog Posts invite our readers and free spirits everywhere to share life's adventures with us. I talk about writing my novels, reading books, chatting with other writers and John's and my journeys around the world. We welcome your anecdotes to our experiences and discussions.
This entry was posted in Afghanistan vets, Canadian Armed Forces, emotional trauma, Homecoming Vets, post traumatic stress disorder, suicide, veterans' affairs, veterans' assistance programs and tagged , , , , , , , , , , , , , , , . Bookmark the permalink.

40 Responses to Alarm bells sound for the anti-malaria drug known as mefloquine or Lariam

  1. It’s understandable that people aren’t ready to come forward to identify themselves over such a controversal issue as mefloquine and its adverse effects. However, I have just received a note from a former military doctor who views the DND’s procedures differently. He says:

    One point of clarification to the medic’s summary: the drug primaquine needs to be given upon return to Canada regardless of the chemoprophylaxis used in Afghanistan. Neither mefloquine, doxycycline, nor malarone kill the liver stage of the Plasmodium vivax malaria parasite. This is why primaquine is recommended for all travelers to countries where P. vivax is endemic. [He’s talking about the highly drug-resistant form of malaria that at one time only responded to the mefloquine treatment. Without it, patients did die.] Without primaquine, malaria often “relapses” typically 6-12 months after the initial infection, often escaping diagnosis by western physicians unused to the presenting signs and symptoms of the disease.

    Additionally, I should also point out that the principal side effect of doxycycline, photosensitivity, is really of questionable relevance in a combat environment where 95% of one’s skin is covered by one’s uniform and body armor. In practice, the U.S. military has found doxycycline to be exceptionally well-tolerated. It is now specifically recommended as the drug of choice over mefloquine, as a result of historically demonstrated inappropriate prescribing of mefloquine and its resultant risk of neuropsychiatric side effects.

    Although the scientific literature does not yet substantiate an epidemiological link between mefloquine use and long-term psychiatric disorders, the drug manufacturer Roche explicitly acknowledged the possibility of long-term harm from the drug, and also that such serious harm is more likely to occur as a result of the drug’s misuse, particularly among those experiencing mental health symptoms during dosing. There is now a substantial biological literature that demonstrates mefloquine disrupts basic neurophysiological processes in the emotional centers, such as the amygdala. This provides the biological rationale for the claim that mefloquine-induced disturbances in amygdala function may mimic the effects of transient stress which might then produce permanent changes similar to PTSD.

    Additionally, while mefloquine is rapidly falling out of favor as a malaria chemotherapeutic agent, it is emerging as a potent adjunct therapy against a range of aggressive neurological conditions, including glioblastoma multiforme brain cancer, and CJD, precisely because of its documented neurotoxic effects.

    I imagine some years from now we will look back on mefloquine, as we do now with thalidomide, and ask ourselves, what were we thinking?

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  34. CDR Bill Manofsky USN(ret) says:

    I do not know where you get your information from, but you are not correct. You are spreading misinformation to the troops in contracdiciton to current US policy. Mefloquine is not the anti malaria of choice in Afghansitan or anywhere else the US military is deployed. In 2009, the Army surgeon gerneral and the Undersecretary of Defense for Health switched to Doxycycline as the primary drug of choice. Mefloquine is to only be used on service members who have a reaction to Doxy.
    See the following links to the policy memos:

    http://www.pdhealth.mil/downloads/DASG_Memorandum.pdf
    http://www.lariaminfo.org/pages/wp-content/uploads/policy-memo-re-use-of-mefloquine-lariam-in-malaria-prophylaxis.pdf

    In addition, a paper recently authored in 2010 by doctors at Bethesda Naval Hospital, Walter Reed, and the CDC and published in the AUG 2010 issue of The American Society of Tropical Medicine and Hygene reported on 44 Marines who contracted falciparum malaria while deployed to Liberia in 2003 while taking Mefloquine.

    The paper concluded:

    “……for the next precipitous deployment into a high transmission area, such as these Marines experienced in Liberia, the use of a drug that is dosed weekly, can take up to 7 to 9 weeks to achieve protective concentrations, and requires four weeks of post-exposure dosing is clearly suboptimal…….

    …..Loading-dose regimens of MQ achieve protective drug levels in four days, but using MQ in this manner is not FDA approved. Although clearly supported by the peer-reviewed medical literature, Department of Defense policy does not permit the U.S. military to use medical products in a manner that is not FDA approved. Therefore prescribing a loading dose of MQ cannot be used operationally by the U.S. military…..

    ….The use of chemoprophylactic drugs such as atovaquone/proguanil or doxycycline, which provide protection after the first dose, would offer more rapidly attainable malaria chemoprophylaxis in deployment circumstances such as those encountered by the 26th Marine Expeditionary Unit…..”

    Here’s the paper:

    Whitman T.J., Coyne P., Magill A., Blazes D., Green M., Milhous W., Burgess T., Freilich D., Tasker S., Azar R., Endy T., CLagett C., Deye G., Shanks G., Martin G. (2010). “An Outbreak of Plasmodium falciparum Malaria in U.S. Marines Deployed to Liberia”. The American Society of Tropical Medicine and Hygene 83 (2): 258-265. doi:10.4269/ajtmh. 2010.09-0774. PMC PMC2911167. PMID 20682864

    • Thank you, Bill, for taking time to comment and update information about mefloquine or Lariam. I am copying your responses to post them as a separate blog entry because not everyone reads responses.

      Best regards,

      Bonnie

  35. CDR Bill Manofsky USN(ret) says:

    To corrobrate the statements regarding the neurotoxicity of Mefloquine, please refer to the papers from Dr. Dow of Walter Reed and from researchers at Brown University regarding connexin blockage on the wikipedia.org page for Mefloquine.

  36. CDR Bill Manofsky USN(ret) says:

    for a greater array of peer reviewed research papers on Mefloquine, please access lariaminfo.org. On the right, click on “research on Mefloquine(Lariam).

  37. Pingback: U.S. vet clarifies latest official position on the use and neurotoxicity of mefloquine or Lariam | Homecoming Vets at the Crossroads of Humanity

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