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Guidelines, Reviews and Health Information

Clinical guidelines

Defence has released clinical guidelines designed to assist Defence health practitioners with the management of members who are concerned about having been prescribed mefloquine. These guidelines may also be useful in managing patients with neuropsychiatric symptoms attributed to other medications or symptoms of unknown cause

IGADF inquiry report: Anti-malarial trials of the drug mefloquine between 2000 and 2002

From September 2015 to September 2016 the Inspector-General Australian Defence Force (IGADF) conducted an inquiry into a number of allegations relating to the conduct of anti-malarial drug trials involving ADF personnel in East Timor from 2000 to 2002. The subsequent report contains 72 findings and three recommendations.

RMA decision not to make statements of principles for brain injury caused by anti-malarial medications

In February 2017 the Repatriation Medical Authority (RMA) began an investigation in response to claims that exposure to mefloquine, tafenoquine or primaquine could cause chemically-acquired brain injury. The purpose of this investigation was to find out whether new Statements of Principles (SOPs) should be established.

In August 2017 the RMA published a declaration of its decision not to establish a new SOP based on its findings that there is insufficient sound medical-scientific evidence that exposure to mefloquine, tafenoquine or primaquine causes chronic brain injury.

The RMA has also published a statement of reasons for its findings, which includes information about the existing SOPs that list anti-malarial medications as possible causes of certain conditions.

Literature review: Neuropsychiatric effects of mefloquine

A review of the literature relating to the neuropsychiatric effects of mefloquine was conducted at the request of Defence by Professor Alexander McFarlane, Director of the Centre for Traumatic Stress Studies, the University of Adelaide.

Major findings of the review include that:

  • There are various theories on how mefloquine might cause neuropsychiatric effects based on its underlying action.
  • There are varying conclusions about its potential toxicity.
  • These variations are, in part, explained by the differences of the methodology used in the published reports.
  • The serious side effects of mefloquine have been known for many years, but continuation of effects after ceasing medication is a more recent concern.
  • There is no specific way to diagnose chronic mefloquine effects as many symptoms are shared with other conditions such as PTSD.
  • There is no specific treatment except to cease the drug when symptoms develop and to treat the symptoms.
  • The literature available at the time of this review does not address some questions, including:
    • Are some individuals pre-disposedc to adverse effects?
    • Does mefloquine modify the response to trauma?

Health monitoring in the ADF

Defence provides a comprehensive range of health care services to ADF members. These include the monitoring of general health status as well as occupational and operational fitness. Defence health practitioners follow the national guidelines for preventive health activities, as issued by the Royal Australian College of General Practitioners.