Up until September 2018, mefloquine (trade name Lariam™) was one of only 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 used when other antimalarials are unsuitable. 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 has used 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.
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 19 members each year during 2011 to 2015.
Dispensing data for the last eight years (2010 to 2017) 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.
* In 2017 the Army Malaria Institute was renamed the Australian Defence Force Malaria and Infectious Diseases Institute.
Number of ADF members prescribed anti-malarial medication 2010-2017
*This number represents members prescribed doxycycline for any reason
The following table shows how many prescriptions were written each year in Australia from 2010-2017.
Estimated Australian Civilian Prescription Data
(Source: Australian statistics on medicines/Roche Products Pty Limited)