Lariam Side Effects

by

QUESTION

How long does it take for the side effects of Lariam to disappear?

ANSWER

The manufacturers of Lariam report that it can take a “long” time for side effects to disappear, though they don’t specify an exact time frame.

While most people cease to experience side effects within a few days or weeks of stopping taking the drug (the half-life of the medication in the body is about 2-4 weeks), some people report side effects continuing for a period of months, and in a few rare cases, even years.

In order to minimise the occurrence of disturbing or even dangerous side effects, Lariam is not recommended for people with a history of depression or mental illness, or with heart or liver troubles. The physical side effects of Lariam can be just as dangerous and long-lasting as the more famous psychiatric side effects; in particular, long-term balance problems have been reported.

Medicines to Prevent Malaria?

by

QUESTION

Which medicines are used to prevent malaria?

ANSWER

There are a number of drugs used to prevent malaria infection, known as malaria prophylactic medication. These vary in terms of how they are taken, how long they are taken for, how much they cost and the typical side effects people experience while they are taking them. In addition, some are recommended more highly for certain types of malaria or certain regions of the world, due primarily to the emergence of resistance in certain areas.

The most common forms of malaria prophylaxis used are doxycycline, atovaquone/proguanil (sold under the brand name Malarone), chloroquine (sold as Aralen) and mefloquine (sold as Lariam). More information on these, on other types of prophylaxis and malaria prevention in general can be found on our Malaria Prevention page.

Anti-Malarial Tablets for Kenya

by

QUESTION

Which are the best tablets to take against malaria in Kenya?
Is there a malaria vaccination?

ANSWER

I’ll answer your second question first—no, there does not yet exist a commercially available malaria vaccine. Currently, one promising vaccine candidate is undergoing Phase 3 clinical trials in children in sub-Saharan Africa; recently published preliminary findings suggest that it provides roughly 50% protection against malaria.

As for which tablets you should take, there are a number of options, and choosing between them is basically a matter of personal preference. The three main kinds recommended for sub-Saharan Africa are doxycycline, atovaquone/proguanil combination (sold under the brand name Malarone) and mefloquine (sold as Lariam). These three differ in how you take them (usually once a day for doxycycline and Malarone and once a week for Lariam), how expensive they are (doxycycline is the cheapest, Malarone the most expensive) and the side effects you might experience (sun sensitivity is a big problem for some people on doxycycline, some people report hallucinations on Lariam, whereas Malarone usually has the fewest severe side effects).

If you’re not sure what’s best for you, you can always talk it over with your doctor when asking for the prescription, and they might have recommendations, based on their knowledge of your health and specific requirements.

It is worth noting that levels of chloroquine resistance are very high in sub-Saharan Africa, and so chloroquine is not recommended as a prophylactic when travelling to this region.

Malaria prophylaxis

by

QUESTION:

What name brand medicine should you take if you are traveling to area where malaria is present?

ANSWER:

That depends on a few factors, such as where exactly you are going, whether you have had bad experiences with any malaria preventative drugs (prophylactics) in the past, and how much money you want to spend! Common brand names of malaria prophylactic drugs include Lariam (generic name mefloquine) and Malarone (a combination of atovaquone and proguanil). Doxycycline is also a popular antimalarial, which is often sold under its generic name.

Malaria Prevention for Seniors

by

QUESTION:

I am a healthy senior citizen (73 years) and I am considering a trip with Semester at Sea. One of the ports they plan to visit is Ghana. I see the CDC says Ghana is a “high risk” area for malaria.

I think I remember being told (at the U of W Travel Medicine Clinic) a few years ago that the malaria drugs are problematic for Seniors.

With the Semester at Sea ship stopping at Takoradi, Ghana, how high a risk is malaria and what preventative measures could/should I take?

I have had no malaria treatment (preventive or due to illness) in the past.

Thank you.

ANSWER:

It is correct that Ghana is a high risk zone for malaria, and wise of you to investigate ways to prevent infection. This is especially the case given that there is evidence to suggest that senior citizens and travellers over the age of 60 may be more at risk of serious complications from malaria. As such, it is especially important for these high risk groups, which also includes pregnant women and children, to be well aware of ways to reduce the risk of exposure and infection.

Having said that, I have done some research and I don’t think there is any evidence that the standard drugs for preventing malaria work less well in older people. In fact, one study I found suggested that younger people were more likely to report side effects from taking malaria preventative medicine (see Mittelholzer et al., “Malaria prophylaxis in different age groups” in volume 3 of the Journal of Travel Medicine, published in 2006).

The only potential problem could be cross-reaction of the malaria drugs with other prescribed medicine. As such, I would recommend you enquire with your doctor prior to the trip, to ask about being prescribed drugs to prevent malaria that are appropriate for the region you are travelling to (probably Malarone, Lariam or doxycycline, since you will be travelling to an area with chloroquine-resistant forms of malaria) that furthermore won’t harmfully interact or have reduced efficacy when ingested alongside other medication you might already be taking.

Lariam Legacy

by

In 1990, Lariam (mefloquine) became the drug of choice for malaria prevention.  It was endorsed by the Centers for Disease Control (CDC) and prescribed for travelers, government workers, and the U.S. military who were going to regions where malaria was present. It was even given to airline crews who flew to malaria regions.

Mefloquine has been responsible for psychotic breakdowns, suicides and a host of other side effects.  Many people taking it stopped on their own because they were able to realize it was the drug that was causing the problems.

Here is a vignette of my experience with the drug after it was first released in 1990.

I was in charge of the health unit for a film being made in northern Thailand.  I was aware that there was chloroquine resistant malaria in that region.  I contacted the CDC and talked to the head of the Malaria Prevention Department. He told me that the drug of choice was Lariam. I was unable to obtain it in the USA but was able to get a supply in Europe.

I wrote a letter to the crew instructing them to take the drug while in Thailand. I  think now it was fortunate that many stopped taking the drug because they recognized it was causing “ weird” feelings. I myself took the drug and noticed no effects from it.  However about 3 weeks into the “shoot” a camera-crane operator went suddenly berserk.  It took 5 people to hold him down and get him to the hospital, where eventually enough valium calmed him down. He was however still paranoid and irrational, and had to be evacuated back to England.

I had, at the time, no idea what the cause was for his breakdown.  It wasn’t until two years later when reports started appearing about the drug’s side effects that I realized what the cause was.  I shuddered to think about some of the airline pilots and U.S. military who were being given the drug.

I would be interested to hear if anyone has had personal experiences, or friends who have experienced side-effects from the drug.

Malaria Treatment

by

Malaria can be a severe, potentially fatal disease (especially when caused by Plasmodium falciparum) and treatment should be initiated as soon as possible.

Patients who have severe P. falciparum malaria or who cannot take oral medications should be given the treatment by continuous intravenous infusion.

Most drugs used in treatment are active against the parasite forms in the blood (the form that causes disease) and include:

  • chloroquine
  • atovaquone-proguanil (Malarone®)
  • artemether-lumefantrine (Coartem®)
  • mefloquine (Lariam®)
  • quinine
  • quinidine
  • doxycycline (used in combination with quinine)
  • clindamycin (used in combination with quinine)
  • artesunate (not licensed for use in the United States, but available through the CDC malaria hotline)

In addition, primaquine is active against the dormant parasite liver forms (hypnozoites) and prevents relapses. Primaquine should not be taken by pregnant women or by people who are deficient in G6PD (glucose-6-phosphate dehydrogenase). Patients should not take primaquine until a screening test has excluded G6PD deficiency.

How to treat a patient with malaria depends on:

  • The type (species) of the infecting parasite
  • The area where the infection was acquired and its drug-resistance status
  • The clinical status of the patient
  • Any accompanying illness or condition
  • Pregnancy
  • Drug allergies, or other medications taken by the patient

If you have or suspect you have malaria, you should contact your doctor immediately.

Source: Centers for Disease Control (CDC)