Anti-malaria mefloquine’s neurotoxicity remains a lifetime battle for victims

Dr. Remington Nevin, public health physician and epidemiologist currently serving as a Major in the U.S. Army Medical Corps.

The following paper is Dr. Remington Nevin’s most recent update on scientific studies investigating the neurotoxicity of the anti-malaria drug mefloquine or Lariam, as it is better known to travellers. The paper is written to U.S. readers, but it applies to our Canadian experience as well. Dr. Nevin is an advocate against the military innoculation of personnel with mefloquine (Lariam) as the preferred anti-malaria preventive treatment. There are two other anti-malaria drugs (albeit more expensive ones) equally capable of preventing the most severe forms of malaria that do not cause the horrendous adverse effects reported by those who have been unfortunate victims. At this time, the Canadian government — in particular the Department of National Defence, Surgeon General, Health Canada and Veterans Affairs Canada — has NOT acknowledged the risk it exposes troops and citizen travllers to in its continued use of mefloquine (Lariam) as its anti-malaria drug of choice. I was pleased to hear from a friend who is visiting Africa on her vacation that she was not issued mefloquine but rather malarone (equally effective), so some doctors are paying attention. We have to thank Dr. Nevin for his tireless scientific investigation into the brain damage caused by mefloquine (Lariam) in some people or the drug’s victims would have no hope of recovery treatments or compensation at all. BONNIE

Mefloquine Neurotoxicity:

PTSD, Traumatic Brain Injury, and Mental Illness in DoD

By Remington Nevin, MD, MPH

Mefloquine is an anti-malarial medication developed by the U.S. military in the 1970s after a decade-long drug discovery effort overseen by the Walter Reed Army Institute of Research. The drug has recently fallen out of favor for civilian use both in treatment and prevention of malaria, but it remains widely available within the U.S. military where it has historically been preferred owing to its weekly dosing schedule, which facilitates command-supervised administration.

The drug is structurally related to a number of similar compounds called quinolines first synthesized in the U.S. in the 1940s and 1950s in collaboration with military researchers. Since discovery these compounds have been linked to a rare neurotoxicity syndrome and in susceptible individuals are known to induce symptoms of severe anxiety, psychosis, memory loss, dissociation and personality change that may mimic some features of PTSD. The underlying cause is a limbic encephalopathy that is dose-dependent and idiosyncratic and which, in its most severe form, may feature the impulsivity observed in PCP or ketamine toxicity. In the presence of such encephalopathy, the drug may also cause microscopic damage to the brainstem resulting in permanent disability including balance problems, subtle visual disorders, and other symptoms that may later mimic or be mistaken for some forms of traumatic brain injury (TBI).

During the drug’s development and testing, and despite these effects being well known among other members of the quinoline class, mefloquine was initially thought to be safe and free of these side effects.

At the time, the Food and Drug Administration (FDA) did not require formal neurotoxicity testing and potential brainstem injury was not formally evaluated with careful animal studies.

Mefloquine was tested as an Investigational New Drug among military personnel during the 1980s and possibly late 1970s. It is not clear whether testing among military personnel, who typically underreport mental health symptoms and concerns, may have biased early studies in favor of concluding the drug’s safety. After FDA licensure in 1989, the drug became widely adopted for first-line use within the U.S. military during operations in the Middle East and Somalia in the 1990s. Its use during this period was anecdotally linked to numerous reports of serious side effects including suicide. These concerns were heightened during the early 2000s when reports surfaced of clusters of violence linked to the drug’s use in Iraq and Afghanistan. Later reports of clusters of long-term vertigo led to calls for further careful research. In response to these concerns, Congress was promised further study by DoD, but of the numerous formal investigations undertaken during this period, only a single study of hospitalization risk has yet been published. Promised publications investigating suicide risk and vertigo remain incomplete.

Use of mefloquine among those with pre-existing mental illness or using psychotropic drugs is associated with a significantly increased risk of harm. Such use may result in symptoms of a developing limbic encephalopathy being erroneously attributed to the pre-existing condition, or being masked by the drug, risking the development of more serious neurotoxicity. With rising rates of mental illness and psychotropic drug use among deployed military personnel, in 2007, researchers confirmed that mefloquine had been widely misprescribed to those with mental health conditions or who had been previously prescribed psychotropic medications, including anti-depressants. In response, in February 2009, the U.S. Army sharply restricted the drug’s use. A similar recommendation by DoD Health Affairs followed in September 2009. Both the U.S. Central Command and the U.S. Africa Command have issued similar policies prohibiting the drug’s use as first-line agent, although these are poorly enforced. Recent case reports suggest DoD continues to issue the medication without proper mental health screening and without issuance of the mandatory medication guide and FDA-mandated wallet card describing under which conditions the drug should be discontinued. Additionally, despite hundreds of veterans noting a consistent syndrome resembling PTSD and TBI linked to their use of the drug, there remains no formal DoD or VA referral center dedicated to evaluate the side effects of the drug, and no dedicated research agenda to study the potential long-term effects of mefloquine neurotoxicity.


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.
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10 Responses to Anti-malaria mefloquine’s neurotoxicity remains a lifetime battle for victims

  1. ann says:

    Notice the date Feb 2009, and Sept 2009
    My spouse received after that

  2. Bonnie Toews says:

    Has your spouse experienced any adverse effects as a result of taking it? Perhaps he is one of the lucky ones. Not everyone is susceptible to the toxic build-up because their bodies can process out the mefloquine. It’s important to drink a lot of water while on it.


    • ann says:

      Since mefloquine toxicity is not yet recognized by DOD or VA I cant state that my spouse’s problems are caused by that , plus with all the burn pit/chemical exposure as well
      But I can say that his symptoms fall inline with the symptoms that Dr Nevin state are related to mef Also with many symptoms overlapping many illnesses I dare not stop at mef for fear of missing something else….
      I can tell you that my spouse has never seen the “original” packaging (using the Military terms) and he was never informed officially of any side effects, or to stop the drug if certain side effects were experienced. Sorry to be so techincal but dealing with the military is all about regulation and techincal wording…..

  3. Bonnie Toews says:

    I understand, Ann. That is why Dr. Nevin is persisting with scientific studies to get VAC in Canada and VA in the USA to recognize mefloquine adverse effects/toxicity in order to back up vets’ claims. The FB groups formed about mefloquine’s adverse effects help members discuss symptoms and what they are doing to cope with their symptoms. This is how the subject of DNA testing came up because there is growing proof of brain damage mefloquine has caused and this is a foolproof method of providing evidence that can’ be swept under bureacratic rugs.


  4. Pingback: URGENT! National news wants to interview Canadian veterans who have experienced adverse anti-malaria drug effects re: Mefloquine (Lariam) immediately | Homecoming Vets at the Crossroads of Humanity

  5. Dwayne Spencer says:

    I had taken this drug while I was in Rewanda and Somalia mademe quite sick

    • Marc says:

      Dwayne, I had to take this crap, too, while working the HOA region in 06-07. I feel your pain. If I may, what do you do to keep yourself on balance from day to day?

  6. deroy320 says:

    I had also taken this drug for a long time, and now I have to take two oder medication beceause I don’t fell good.

  7. There is already quite a cottage industry that adapts his insights to
    the business world. The winning odds range from 1 in 28,579 to 1 in 45.

    They still do decent damage, and you’re ready to fire again almost instantly after a miss, kills just take a few more shots.

  8. Marc says:

    I had been put on Mefloquin by the Navy for four months in 1990 and for 8 months during 2006-2007, The VA does not want to hear Mefloquin and PTSD in the same sentence, much less in the same psychologic evaluation. Thank you for this document

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