Combining mefloquine with halofantrine can cause significant increases in QTc intervals. Pregnancy and breastfeeding[ edit ] A retrospective analysis of outcomes in more than 2, women found no evidence that mefloquine was associated with an increased risk of birth defects or miscarriages. Its elimination in persons with impaired liver function may be prolonged, resulting in higher plasma levels and an increased risk of adverse reactions.

The mean elimination plasma half-life of mefloquine is between two and four weeks. During long-term use, the plasma half-life remains unchanged. Essentially, it is two drugs in one. Mefloquine hydrochloride tablets are indicated for the treatment of mild to moderate acute malaria caused by Mefloquine-susceptible strains of P.

There are insufficient clinical data to document the effect of Mefloquine in malaria caused by P. Patients with acute P. To avoid relapse, after initial treatment of the acute infection with Mefloquine, patients should subsequently be treated with an 8-aminoquinoline derivative e. Mefloquine hydrochloride tablets are indicated for the prophylaxis of P. Contraindications Use of Mefloquine hydrochloride tablets is contraindicated in patients with a known hypersensitivity to Mefloquine or related compounds e.

Mefloquine should not be prescribed for prophylaxis in patients with active depression, a recent history of depression, generalized anxiety disorder, psychosis, schizophrenia or other major psychiatric disorders, or with a history of convulsions. Warnings In case of life-threatening, serious or overwhelming malaria infections due to P. Following completion of intravenous treatment, mefloquine may be given to complete the course of therapy.

Ketoconazole should not be administered with Mefloquine or within 15 weeks of the last dose of Mefloquine due to the risk of a potentially fatal prolongation of the QTc interval. Concomitant administration of Mefloquine and quinine or quinidine may produce electrocardiographic abnormalities. Psychiatric and Neurologic Adverse Reactions Mefloquine may cause neuropsychiatric adverse reactions in adults and children.

Neuropsychiatric symptoms can be difficult to identify in children. Therefore, vigilance is required to monitor for the occurrence of these symptoms, especially in non-verbal children.

Psychiatric Adverse Reactions Psychiatric symptoms ranging from anxiety, paranoia, and depression to hallucinations and psychotic behavior can occur with Mefloquine use. Symptoms may occur early in the course of Mefloquine use. In some cases, these symptoms have been reported to continue for months or years after Mefloquine has been stopped.

Cases of suicidal ideation and suicide have been reported. Mefloquine should not be prescribed for prophylaxis in patients with active depression, generalized anxiety disorder, psychosis, or schizophrenia or other major psychiatric disorders. Mefloquine should be used with caution in patients with a previous history of depression. During prophylactic use, the occurrence of psychiatric symptoms such as acute anxiety, depression, restlessness or confusion suggest a risk for more serious psychiatric disturbances or neurologic adverse reactions.

In these cases, the drug should be discontinued and an alternative medication should be submitted. Neurologic Adverse Reactions Neurologic symptoms such as dizziness or vertigo, tinnitus, and loss of balance have been reported.

These adverse reactions may occur in the course of Mefloquine use and in some cases have been reported to continue for months or years after Mefloquine has been stopped. Dizziness or vertigo, tinnitus, and loss of balance have been reported to be permanent in some cases. During prophylactic use, if neurologic symptoms occur, the drug should be discontinued and an alternative medication should be substituted. Caution should be exercised with regard to activities requiring alertness and fine motor coordination, such as driving, piloting aircraft, operating machinery, and deep-sea diving, while symptoms persist.

Mefloquine may increase the risk of convulsions in patients with epilepsy. Concomitant administration of Mefloquine and quinine or chloroquine may increase the risk of convulsions. Ocular Effects Eye disorders, including but not limited to optic neuropathy and retinal disorders, have been reported during treatment with Mefloquine. Precautions Hypersensitivity reactions have been reported with Mefloquine use.

Use in Patients with Hepatic Impairment In patients with impaired liver function, the elimination of Mefloquine may be prolonged, leading to higher plasma levels and a higher risk of adverse reactions. Long-Term Use This drug has been administered for longer than one year. The effect of Mefloquine on the compromised cardiovascular system has not been evaluated. The benefits of Mefloquine therapy should be weighed against the possibility of adverse effects in patients with cardiac disease.

For example, resistance of P. Laboratory Tests Periodic evaluation of hepatic function should be performed during prolonged prophylaxis. Information for Patients Medication Guide: As required by law, a Mefloquine Medication Guide is supplied to patients when Mefloquine is dispensed. An information wallet card is also supplied to patients when Mefloquine is dispensed. Patients should be instructed to read the Medication Guide when Mefloquine is received and to carry the information wallet card with them when they are taking Mefloquine.

The complete text of the Medication Guide and information wallet card is reprinted at the end of this document. Patients should be advised: Drug Interactions Drug-drug interactions with Mefloquine have not been explored in detail. The effects of Mefloquine on the compromised cardiovascular system have not been evaluated. Other Antimalarial Drugs Concomitant administration of Mefloquine and other related antimalarial compounds e.

If these drugs are to be used in the initial treatment of severe malaria, Mefloquine administration should be delayed at least 12 hours after the last dose. Clinically significant QTc prolongation has not been found with Mefloquine alone. There are no data that conclusively establish whether the concomitant administration of Mefloquine and the above listed agents has an effect on cardiac function.

A case report of possible rhabdomyolysis related to mefloquine use has been reported. There are no previously reported cases of rhabdomyolysis possible related to mefloquine that have been reported in the literature. The case that was reported was a years-old man who presented to the hospital with complaints of malaise, fatigue, and difficulty functioning in his daily activities.

The symptoms had been ongoing over several weeks and he noted that they after receiving mefloquine for prophylaxis against malaria during a recent trip to Nigeria. No fevers were reported by the patient so a extensive work-up was performed which included blood tests. All other tests that were sent were negative which ruled out other possible causes including malaria, hepatitis, dengue fever and chikungunya.

Within 2 days all blood tests were normal and he was back to his normal state of health. The complete texts of the Medication Guide and information wallet card are reprinted at the end of this document. Patients should be advised: Drug Interactions Drug-drug interactions with mefloquine have not been explored in detail.

The effects of mefloquine on the compromised cardiovascular system have not been evaluated. Halofantrine Halofantrine should not be administered with mefloquine or within 15 weeks of the last dose of mefloquine due to the risk of a potentially fatal prolongation of the QTc interval see WARNINGS.

Other Antimalarial Drugs Concomitant administration of mefloquine and other related antimalarial compounds e. If these drugs are to be used in the initial treatment of severe malaria, mefloquine administration should be delayed at least 12 hours after the last dose. Clinically significant QTc prolongation has not been found with mefloquine alone. Ketoconazole should not be administered with mefloquine or within 15 weeks of the last dose of mefloquine due to the risk of a potentially fatal prolongation of the QTc interval see WARNINGS.

There are no data that conclusively establish whether the concomitant administration of mefloquine and the above listed agents has an effect on cardiac function. Anticonvulsants In patients taking an anticonvulsant e. Vaccines When mefloquine is taken concurrently with oral live typhoid vaccines, attenuation of immunization cannot be excluded. Vaccinations with attenuated live bacteria should therefore be completed at least 3 days before the first dose of mefloquine hydrochloride tablets.

Rifampin should be used cautiously in patients taking mefloquine. Thus, concomitant administration of mefloquine hydrochloride tablets and substrates of the CYP enzyme system is not expected to result in a drug interaction. Therefore, mefloquine hydrochloride tablets should be used with caution when administered concomitantly with CYP3A4 inhibitors. Therefore, mefloquine hydrochloride tablets should also be used with caution when administered concomitantly with CYP3A4 inducers.

Substrates and Inhibitors of P-glycoprotein It has been shown in vitro that mefloquine is a substrate and an inhibitor of P-glycoprotein.

Mefloquine

The tablets may be crushed and suspended in a small amount of water, milk or other beverage for administration to small children and other persons unable to swallow them whole. There is evidence that Mefloquine is excreted mainly in the bile and feces, mefloquine 5 mg. Within 2 days all blood tests were normal and he was back to his normal state of health, mefloquine 5 mg. Concomitant administration of Lariam mefloquine and other mefloquine compounds eg, mefloquine 5 mg, quinine, quinidine and chloroquine may produce electrocardiographic abnormalities and increase the risk of convulsions see WARNINGS. Use in Patients with Hepatic Impairment In patients with impaired liver function the elimination of mefloquine may be prolonged, leading to higher plasma levels and a higher risk of adverse reactions. It has important information about Mefloquine and should be carried with you at all times while you take Mefloquine. Mutagenesis The mutagenic potential of mefloquine was studied in a variety of assay systems including: If you vomit within 30 minutes after taking mefloquine, mefloquine 5 mg, take another full dose. Do not take this medicine in larger or smaller amounts or for longer than recommended. The effect of mefloquine on mefloquine compromised mefloquine system has not been mefloquine. Who should not take Mefloquine? Cross-resistance between Mefloquine and halofantrine and cross-resistance between Mefloquine and quinine have been observed in some regions. Not all of these drugs work equally as well in all areas of the world where there is malaria. Do not take halofantrine used to treat malaria mefloquine ketoconazole used for fungal infections with Mefloquine or within 15 weeks of your last dose of Mefloquine. Other reported clinical experience has not identified differences in responses between the elderly and younger patients. Five tablets mefloquine Mefloquine hydrochloride to be given as a single oral dose. The clinical relevance of these interactions is not known to date, mefloquine 5 mg.

Substance-induced psychosis

More severe neuropsychiatric disorders have been reported such as: The clinical relevance of these interactions is not known mefloquine date. Early vomiting was cited in some reports as a possible cause of treatment failure. However, transitory and clinically silent ECG alterations have been reported during the use of mefloquine. Call your doctor for medical advice about side effects. Mefloquine should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. You can get information about the areas of the world where malaria occurs from the Centers for Disease Control and Prevention CDC and from local authorities in the countries you visit. In clinical trials, the concomitant administration of sulfadoxine and pyrimethamine did not alter the mefloquine reaction profile of Mefloquine. Other Antimalarial Drugs Concomitant administration of Mefloquine and other related antimalarial compounds e. Thus, mefloquine 5 mg, concomitant administration of Mefloquine hydrochloride tablets and substrates of the CYP enzyme system is not mefloquine to result in a drug interaction. Ames testmefloquine 5 mg, a host-mediated assay in mice, mefloquine 5 mg, fluctuation tests and a mouse micronucleus assay. Therefore, the dosage for children has been extrapolated from the recommended adult dose.

However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. This is not a complete list of side effects and others may occur. If you are taking this medicine to prevent malaria: Please read the Medication Guide for additional information on Lariam mefloquine. If you cannot take Lariam mefloquineyou may be able to take a different medicine to prevent malaria. The most frequently reported adverse reactions are nausea, vomiting, mefloquine 5 mg, loose stools or diarrhea, abdominal pain, dizziness mefloquine vertigo, mefloquine 5 mg, loss of balance, and neuropsychiatric events such as headache, somnolence, mefloquine 5 mg, and sleep disorders insomnia, abnormal dreams. Mefloquine can also act against the JC virus. Children weighing 5 to 9 kg: In pregnant travelers, it appears to pose minimal risk to the fetus. The safety and effectiveness of mefloquine mefloquine the treatment of malaria in mefloquine patients below the age of 6 months have not been established.

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© Copyright 2017 Mefloquine 5 mg. M.D. recommended.