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Mefloquine

Mefloquine (trade name Lariam™) is one of three anti-malarial medications approved by the Therapeutic Goods Administration (TGA) for malaria prevention in the Asia-Pacific region. It is commonly prescribed in the broader Australian community. In the ADF it is currently used as the third line anti-malarial, meaning it is only used when neither doxycycline nor atovaquone/proguanil is suitable. Previously used as second line after doxycycline, in 2006 it became the third choice once atovaquone/proguanil became available in Australia for malaria prevention.

For malaria prevention, mefloquine is taken once weekly, which is an advantage over other medications that have to be taken daily. It can be used for both malaria prevention and for treatment.

Taken weekly, it takes several weeks for mefloquine to reach protective levels in the body. This is a problem for getting forces ready for deployment. The ADF uses a loading dose prior to deployment to achieve protective levels more quickly.  This involves taking one dose on each of three days in the week before deployment.  This also allows any side effects to be seen before deployment and the medication stopped if necessary.

Individuals with particular medical conditions or those taking some other medications cannot take mefloquine. In particular, mefloquine should not be taken for malaria prevention by people who have, or have had, a psychiatric condition, seizures, kidney disease or liver disease. For these reasons, Defence health policy requires ADF members be properly informed of the potential side-effects of mefloquine and the drug may only be prescribed by a qualified medical practitioner after the member has provided their informed consent.

Mefloquine can cause psychiatric symptoms in some people, including disturbed sleep, anxiety, paranoia, depression, hallucinations and psychosis.  Dizziness and loss of balance have also been reported as side effects from the use of mefloquine. For this reason, the medication is not used in ADF aircrew.

Normally, side effects resolve within days to weeks after stopping the medication. Because mefloquine is long acting, in some people side effects have been reported to persist for several months. In rare cases some neurological side-effects may be long lasting or permanent.

Use of mefloquine in the ADF

Outside of the Army Malaria Institute (AMI) studies conducted in Timor-Leste from 2000-2002, mefloquine has not been prescribed in large numbers in the ADF. Centralised prescribing information is available since 2000; prior to that prescribing and dispensing information was held on paper records and local systems in individual health centres and pharmacies.

In the period 2001-2016, 660 ADF members were prescribed mefloquine (excluding those members who participated in the AMI studies). The number of ADF members prescribed mefloquine each year has fallen in that time: on average 76 members each year during 2001-2005, 33 members each year during 2006-2010 and 22 members each year during 2011 to 2015.

Dispensing data for the last six years (2010 to 2015) shows that mefloquine is prescribed less frequently than Malarone, and much less frequently than doxycycline. The following table shows how many ADF members were prescribed these medications.

Number of ADF members prescribed anti-malarial medication 2010-2015

Year
Mefloquine
Malarone
Doxycycline*
2010
25
105
3536
2011
26
100
4721
2012
13
152
7313
2013
20
187
6436
2014
35
183
5954
2015
15
101
5951
*This number represents members prescribed doxycycline for any reason

The following table shows how many prescriptions were written each year in Australia from 2005-2010.

Australian Civilian Prescription Data

Anti-malarial 2010 2011 2012 2013 2014 2015
Mefloquine 14,149 16,512 13,674 14,030 13,770 12,713
(Source: Australian statistics on medicines)

More information:

Consumer medicine information for Lariam is available at https://www.ebs.tga.gov.au/ebs/picmi/picmirepository.nsf/pdf?OpenAgent=&id=CP-2010-CMI-01105-3

Product information for prescribers is also available at https://www.ebs.tga.gov.au/ebs/picmi/picmirepository.nsf/pdf?OpenAgent&id=CP-2010-PI-01046-3

Loading dose

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