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News
Safety
first
Monitoring
the use of mefloquine
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This
picture is representitive of mefloquine tablets and not
the actual tablets. Photo by Pte John Wellfare, Army newspaper
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By
LS Rachel Irving
THE ADF is taking a conservative approach to the use of the anti-malaria
drug mefloquine following concerns raised over its side-effect profile
by the US Department of Defense.
Mefloquine has been most recently linked to vestibular dysfunctions
(balance disorders) in nearly a dozen cases of US service members
returning from Op Enduring Freedom and Op Iraqi Freedom.
While other causes for the disorders are being investigated, such
as loud noises, jet fuel and explosives, 10 out of 11 patients under
review took the drug mefloquine.
Vestibular adverse events are widely recognised and is one reason
why the drug is not recommended by the ADF for aircrew and those
involved in flying operations.
Mefloquine, a product of US Army research, has also been investigated
in the past for its psychological effects on patients. There have
been questions raised, though no substantial proof, linking mefloquine
to violent episodes and suicide.
DG-Defence Health Services Air-Cdre Tony Austin said that while
the official US position is there is no link between violence and
mefloquine, it is something the ADF is very mindful of.
“Our approach is always to minimise the risk of adverse events
for all our members. We will always go for the safest possible
option for the shortest period of time.
“The issue coming out of the Middle East and Afghanistan of
psychiatric effects with possible links to an increase in violence
and suicide is very difficult to determine.
“You have sent people to a war zone so it is almost impossible
to say whether it is the stressful environment which is the trigger
or the drug. But the fact that there are questions over the drug
is enough for the ADF not to use it as their frontline drug of choice
and to limit and monitor its use.”
Air-Cdre Austin said that the Australian military experience with
mefloquine, or Larium as it is more commonly referred to in Australia,
is minimal although mefloquine was studied in 2RAR and 4RAR (Cdo)
in East Timor – and was also used as a comparator in a trial
of Tafenoquine.
“THE drug is not our preferred choice within the ADF though
it is recommended by the World Health Organisation (WHO) and approved
by the Australian Therapeutic Goods Administration, and is in fact
still the drug of choice by many civilian travellers,” Air-Cdre
Austin said.
“The Army Malaria Institute (AMI) conducted research on mefloquine
but has elected to recommend Doxycycline as the preferred frontline
treatment for anti-malaria in the ADF.”
The vast majority of Defence personnel who have served or are serving
in malarial regions, such as those on Op Anode, would have been
prescribed Doxycycline, though there are still arguments, from a
command perspective, for the use of mefloquine as it could be more
easily administered and monitored.
Air-Cdre Austin said that mefloquine is a world recognised drug
as a malaria prevention working on a weekly dose, which makes it
attractive for travellers.
But it is the side effects of mefloquine that are of most concern
to the ADF.
The ADF constantly monitors literature so that it is aware of problems
as they occur and reviews its policies accordingly.
“As a result of the information coming out of the US on the
use of mefloquine, we are becoming even more conservative with our
use of that particular drug.
That is not to say that we are convinced that there are significant
problems with the use of the drug but we are being conservative
until absolutely sure.”
Mefloquine is only used in small numbers in the ADF when members
are unable to tolerate Doxy, though the ADF has ramped up the warnings
given to people who go on to mefloquine and personnel who require
the drug undergo trial loading doses before any deployment.
“We believe that Doxycycline works better within the military
environment without the concerns (founded or unfounded) for neuropsychiatric
adverse effects.”
If members have any concerns they should speak with their ADF medical
officer.
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