Two years ago the Food and Drug Administration (FDA) stipulated that a black box warning be put on the label for the anti-malarial drug Larium for possible neurological and psychiatric side effects. The sad truth is that this drug has been driving people nuts for years, as I have written about extensively before. Most recently I wrote about the case of Robert Bates, the soldier in Afghanistan who went nuts and killed a bunch of civilians while on the drug. I had already warned about the psychiatric risks of this drug in my book Before You Take that Pill: Why the Drug Industry May be Bad For Your Health.
The psychiatric dangers of Larium have been known about for years, based on the results of controlled studies. Unfortunately, the military continued to require constricts going over seas to be subjected to this drug, in spite of the fact that there were safer alternatives. As described in a recent editorial in the New York Times, the military’s massive use of this drug may be one of the tragedies of our generation, as we continue to see people who have long-term psychiatric and neurological sequelae from this drug, and for no reason.
Mefloquine (Larium) has a number of neurological side effects including dizziness (96%), nausea (82%), and headache (73%). This drug has also been associated with an increase in psychiatric symptoms in 11-35% of patients (van Riemsdijk et al 2002). Possible psychiatric symptoms include paranoia, depression, and psychosis. Individuals taking mefloquine have increased depression, anxiety, and fatigue, and a loss of vigor as well as impairment in motor control.
Mefloquine users have a number of other symptoms, including vertigo in 96%, nausea in 82%, and headache in 73%. In general symptoms seem to be more common in females. These studies show that caution should be employed before using mefloquine in future overseas travelers.
The antimalarial drugs atovaquone and chloroguanine were not associated with neuropsychiatric effects and were equally efficacious as mefloquine for malarial prophylaxis. Dihydroartemisinin-piperaquine (Artekin) was shown to be equally efficacious as artesunate-mefloquine in the treatment of malaria infected children (Smithius, 2006). Since alternative medications like atovaquone and chloroguanine are equally effective at malarial prophylaxis and treatment as mefloquine, the latter drug should not be used, especially in patients with neuropsychiatric histories.
van Riemsdijk MM, Ditters JM, Sturkenboom MCJM, et al (2002): Neuropsychiatric events during prophylactic use of mefloqine before travelling. European Journal of Clinical Pharmacology 58:441-445.