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The History of Lariam (Mefloquine)

Partially in response to the danger of American soldiers contracting malaria during their service in the Vietnam War, the Walter Reed Army Institute of Research, in 1963, began a search for new anti-malarial drugs. During their research the institute found mefloquine to be one of the more successful potential drugs. Further development of mefloquine for the mass-market was given over to Swiss company Hoffman LaRoche, who eventually released mefloquine to the public during the mid-1980s. The Food and Drug Administration approved mefloquine for use in the United States in May of 1989. Currently, the Roche Laboratories markets the drug under the name Lariam, Mepha markets under the name Mephaquine, and Cipla-Medpro markets under the name Melfiam.

Each year thousands of people traveling abroad, as well as U.S. military personnel and members of the Peace Corp take mefloquine as a means of preventing malaria. Some doctors and researchers suspect that mefloquine may cause neuropsychiatric side affects, including suicidal tendencies, hallucinations, paranoid delusions and depression. Roche Laboratories acknowledges reports of suicide and suicidal thoughts attributed to Lariam, and has begun alerting doctors and placing a new warning label on the anti-malaria drug.

The military uses mefloquine widely to prevent malaria among soldiers because the dose is given once a week instead of other treatments that a soldier must take on a daily basis. The Pentagon believes that the outbreak of domestic killings at Fort Bragg, North Carolina relates to the administration of mefloquine. While in only one case have investigators determined that the soldier had taken mefloquine, three of the four Fort Bragg soldiers involved in domestic killings had been deployed to Afghanistan where the risk of malaria is high, suggesting that mefloquine may have been administered. Two of the soldiers killed themselves after killing their wives.

The World Health Organization (WHO) estimates the incidence of serious neuropsychiatric effects from mefloquine at 5 in 100,000. Many experts believe these figures are low, and that as many as twenty-five percent of all users experience some side effects. According to the WHO, between 1 in 6,000 to 1 in 10,000 individuals who take mefloquine experience some kind of serious adverse reaction. The WHO also estimates that perhaps as many as 50 million cases of malaria occur each year and more than 1 million people die of the disease worldwide.

From October 2000 to October 2001, the FDA received approximately 600 reports of adverse reaction in relation to mefloquine. More than half of the reports, a higher percentage than with most drugs, included at least one psychiatric side effect, ranging from confusion to delusions. Among those reporting psychiatric side effects, thirteen experienced suicidal thoughts, four attempted suicide, and one committed suicide.

In October 2001, European researchers provided results from the first clinical trial of melfoquine in travelers, ranging in age from 4 to 80. As part of the trial, 483 travelers took Lariam and 493 took Malarone, a new anti-malaria medication that combines two drugs, atovaquone and proguanil.

Neither the patients nor their doctors knew which medicine the travelers received. After 60 days, 139 (29 percent) of the people who took Lariam reported at least one psychiatric side effect, with 92 of them (19 percent) rating the effects moderate or severe. Both percentages were roughly double those reported by the Malarone group. Side effects became so severe in the Lariam group that 5 percent of the patients stopped taking the drug, four times the rate of patients who dropped out of the Malarone group.

Mefloquine does not produce side effects in everyone, and both alternative medications can have side effects, as well. Malarone and doxycycline can cause nausea. Doxycycline can also cause sun sensitivity and yeast infections in women. While doxycycline is unlikely to cause psychological effects, Malarone can cause vivid dreams, insomnia, and dizziness.

Most doctors suggest patients who suffer from epilepsy, seizures, heart-rhythm disorders, or psychiatric problems, including depression, avoid mefloquine. Individuals with liver disease or who are pregnant should not take doxyxycline, while those with kidney failure should avoid Malarone. Though no consensus exists among experts as to the severity and prevalence of side effects, even the maker of Lariam, Hoffman LaRoche admits that, "Occasionally, more severe nuerophychiatric disorders have been reported such as: sensory and motor neuropathics convulsions, agitations or restlessness, anxiety, depression, mood changes, panic attacks, forgetfulness, confusion, hallucinations, aggression, psychotic or paranoid reactions, and encephalopathy. Rare cases of suicidal ideations and suicide have been reported though no relationship to drug administration has been confirmed."

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