Magazine article Drug Topics

Mefloquine Has a Three-Week Half-Life

Magazine article Drug Topics

Mefloquine Has a Three-Week Half-Life

Article excerpt

FDA SAFETY PAGE

Pharmacists should question "once daily" prescriptions

The Food and Drug Administration recently alerted pharmacists to medication error reports it has received concerning prescriptions written and dispensed for mefloquine (Lariam) "250 mg daily" rather than the recommended dose of 250 mg weekly for malaria prophylaxis. Some of these reported cases resulted in psychiatric adverse events and hospitalization.

Mefloquine has a mean elimination half-life of three weeks. Accordingly, administration of the drug more frequently than once a week can lead to toxicities. Mefloquine toxicities can manifest as increased risk of side effects or as side effects that are more pronounced. Most notably, mefloquine can cause dizziness, loss of balance, and psychiatric side effects such as anxiety, depression, paranoia, hallucinations, and psychotic behavior. Also, rare cases of suicidal ideation and suicide have been reported, though no relationship to drug administration has been confirmed. These psychiatric events can occur in patients without a history of psychiatric illness. Obviously, to experience psychiatric symptoms for the first time is disturbing; to experience them in an unfamiliar foreign country can be devastating.

Many U.S. pharmacists do not routinely dispense mefloquine. It is approved for the treatment and prophylaxis of malaria during travel to areas where malaria is endemic. Similarly, many U.S. physicians do not frequently write prescriptions for mefloquine. …

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