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The Parade Square => The Canadian Military => Topic started by: Pugnacious on June 20, 2004, 19:15:18

Title: Mefloquine (a.k.a Lariam) anti-malarial in CF use (merged)
Post by: Pugnacious on June 20, 2004, 19:15:18
Greetings!
Sorry for a another silly Civi question.

Is Lariam (mefloquin) still in use as an anti Malaryia drug?
I've heard bad things about it from TV reports and troops that have taken it with its nasty side effects, Paranoia  -Night terrors etc to name a few.

If they still do issue it..why?, And could a person refuse it and provide there own anti malaryia drug.

I was just wondering.

Cheers!
P.
Title: Re: Is Lariam (mefloquin) still in use?
Post by: krugan on June 21, 2004, 10:33:59
I took Lariam in 2000 when I went to Zimbabwe to work and though I only bothered to take it for the first 6 weeks I didn't feel any kind of side effects, but that's just me.  My friend who I went with didn't experience any problems either.  I took 5-HTP and if you read up on the side effects of that you'll find people who talk about having increased dreams or nightmares and that is herbal medication!!

I stilll have the Consumer Information sheet Roche provides in the Lariam package and it states:

The following unwanted side effects have been reported to occur with Lariam: nausea, vomiting, dizziness, light-headedness or loss of balance, headache, sleepiness, inability to sleep, abnormal dreams, loose stools or diarrhea, and abdominal pain.  In rarer cases, loss of appetite, abnormal heartbeat, itching of the skin or skin rash, hair loss, eyesight problems, mucle pains, convulsions, and disturbances of mood (depressed mood, mental confusion, anxiety states) may occur.  Because many of these sysmptoms accompany malaria, it is often difficult to tell whether the symptons are due to malaria or are unwanted effects of 'Lariam'.   When 'Lariam' is used as malaria prevention, these events usually subside within a short period of time after drug administration.  If these adverse  events are not severe in nature and are tolerable, it is in your best interest to continue 'Lariam' since the consequences of contracting malaria are cause for greater concern.  It is best to avoid alcoloic drinks during treatment with 'Lariam'.

It also statesfor Special Precautions:

Lariam should not be used by:

1. Persons with a known sensitivity to mefloquine or related compounds. (Check with your Doctor).
2. Persons with a history of psychiatric disturbances.
3. Persons with a history of convulsions.
4. Persons suffering from severe liver or cardiac disease.
5. Woman who are or may become pregnant.
6. Nursing mothers
7. Children less then 3 yrs old.
Title: Re: Is Lariam (mefloquin) still in use?
Post by: Pugnacious on June 21, 2004, 12:32:36
So your saying Cananda still uses this drug in spite of the fact that members of our forces, and members of other militarys have have very serious psycotic side effects?   Just asking..I'd hate to join up, and then find out I'm going to be forced to take such a drug when there  are safer (yet more expensive) ones availble.

Cheers!
P.
Title: Re: Is Lariam (mefloquin) still in use?
Post by: devil39 on June 21, 2004, 13:00:36
So your saying Cananda still uses this drug in spite of the fact that members of our forces, and members of other militarys have have very serious psycotic side effects?     Just asking..I'd hate to join up, and then find out I'm going to be forced to take such a drug when there   are safer (yet more expensive) ones availble.

Cheers!
P.

We did use this drug as of two years ago.   I preferred Lariam to the real risk of malaria.   I do not recall any "serious psychotc side effects" (visible) in any of the hundreds of lariam users I saw every day.  

The new doses are apparently smaller than they were 10 years ago, however I am no medical expert.  

I would not be afraid of joining up.   Contrary to what some might claim the Canadian Forces really do have your best interests at heart.
Title: Re: Is Lariam (mefloquin) still in use?
Post by: 2FtOnion on June 21, 2004, 14:35:26
I had taken Mefloquine, in my 2001-2002 deployment, I beleave I took Mefloquine once a week, from what the doctor had told me, was that my blood work showed that I was more subceptable to malaria that than everyone else, they took doxycycline once a day.  I did have very vivid dreams, I often yelled in my sleep example Arrgh, this chair be high says I, Get me out of the box, and often I was told I would jump out of my rack in the berthing stand at attention and give drill commands, anyway I provided quite a bit of humor to the other Marines in the berthing.   

I beleave for malaria treatment you have either doxycycline or mefloquine, depending on what the medical doctors want, but after you get out of the Malaria zone you need to take Primaquine, for about 30 days.

Every drug has a list of crazy side effects, but it is alot better than contracting malaria. 
Title: Re: Is Lariam (mefloquin) still in use?
Post by: Sheep Dog AT on June 21, 2004, 16:02:54
Speaking of Malaria, there was a report in the news that 5 CDN troops came down with Malaria in Afganistan.  Others are under observation.
Title: Re: Is Lariam (mefloquin) still in use?
Post by: Gunner on June 21, 2004, 16:45:11
Lariam, or Mefloquine, is the still the prefered anti-malaria drug of choice for the CF.  However, the medical community is much more proactive (as of 1 month ago) in terms of informing deploying personnel on the benefits and risks of taking the drugs.  You now have a choice of Mefloquine, Doxycycline, or Malarone.  Anytime you use a drug there will be side effects.

I used Mefloquine in Africa and didn't have too many problems.  I am now deploying to Afghanistan in August and I was quite happy to take Mefloquine again.  In Africa, I saw too many victims (sick, very sick, dying and dead) of malaria and am more than happy to take what the CF system recommends.

CFL, the report your referred to is true:

  http://www.theglobeandmail.com/servlet/ArticleNews/TPPrint/LAC/20040621/AFGHANISTAN21/TPInternational/ (http://www.theglobeandmail.com/servlet/ArticleNews/TPPrint/LAC/20040621/AFGHANISTAN21/TPInternational/)
Title: Re: Is Lariam (mefloquin) still in use?
Post by: Sheep Dog AT on June 21, 2004, 16:58:26
Thanks for the link.
Title: Re: Is Lariam (mefloquin) still in use?
Post by: Kirsten Luomala on June 21, 2004, 17:24:35
Yes we still use Larium.  It is region specific,eg. Afghanistan gets it but Haiti doesn't. It has do to with the strain of malaria.  I took it 02 while in Afghanstan with only sleeping problems.  I know some who had very bad dreams but that was about it for side effects.
Title: Re: Is Lariam (mefloquin) still in use?
Post by: Pugnacious on June 21, 2004, 17:29:17
Thank you for you input.  :)
Yup malaryia is pretty bad.

Cheers!
P.
Title: Re: Is Lariam (mefloquin) still in use?
Post by: cheeky_monkey on June 21, 2004, 23:05:14
Quote
Consumer Information sheet Roche provides
Roche had some problems with their Acutane. Some people started killing themselves because the drug increases deppression.
Title: Re: Is Lariam (mefloquin) still in use?
Post by: Pugnacious on June 21, 2004, 23:26:14
Different drug.
Also Depression is a far cry from night terrors, and paranoia.
Glad to see you have alternative drugs now.

Cheers!
P.
Title: Re: Is Lariam (mefloquin) still in use?
Post by: cheeky_monkey on June 21, 2004, 23:34:32
"Different drug. Also Depression is a far cry from night terrors, and paranoia."


I'm aware of that, i was just sharing info. I was on Acutane and the doc recommended that I try to stay away from it.
Title: Re: Is Lariam (mefloquin) still in use?
Post by: Pugnacious on June 21, 2004, 23:55:54
Yes a good point!
Way back when I was 17 i was also on it..it was new then, and yes it worked great.
My doctor didn't know anything about depression being a side effect. 
And I have to admit ..there were some 'blue times'  nothing over the top though just out of character.
I know others that had far worse cases of deppression while on that drug.

I'm sure the Army will take good care of me...I hope.  ;D
Cheers!
P.
Title: Re: Is Lariam (mefloquin) still in use?
Post by: pbi on August 13, 2004, 00:36:41
Yes-I;m taking it right now in preparation for deployment to Afghanistan: no problems except a slight stomach upset. I took Mefloquin in 1993 for seven months-no problems. The fact is that both medications have been extensively tested by both Canada and the US, and are considered safe by Health Canada (notoriously tight on giving certification...) There are some side effects, but they vary from person to person and most are mild. It is true that a very, very few people may develop side effects so serious that they cannot carry out their duty, but these are on the order of 1 in 200,000 cases. And, anyway, none of them are near as bad as getting malaria itself, which is a horrible disease that in some forms (such as cerebral malaria) can kill in an extremely painful way. I'd rather take the upset gut, thanks. Cheers.

Title: Re: Is Lariam (mefloquin) still in use?
Post by: Yard Ape on August 13, 2004, 03:27:32
Yes we still use Larium.   It is region specific,eg. Afghanistan gets it but Haiti doesn't. It has do to with the strain of malaria.  
There are even some regions that Malaria has developed a resistance to both drugs (I think around Cambodia, but I don't recall the location for certain).
Title: Re: Is Lariam (mefloquin) still in use?
Post by: Rider Pride on August 13, 2004, 18:38:43
Since when is malaria spelt with a "y"?
There is no other medication that can be used as long as Larium, nor can be produced as cheaply for its all round effectiveness. Patient compliance is also effective because its only taken once a week. Doxycyciline was used during the DART mission in Honduras. It was to be taken 4x a day and caused bad nausea to some of the troops. There were 25+ cases of malaria after that tour, and one unexpected pregnancy. Not very effective as a prophalaxisis either way.
The W.H.O. has terrific sites about travel medicine and the use of antimalaria medications.

And if it's use by the CF is enough to keep Pugnacious out of the military.... ;D

I'm sure the Army will take good care of me...I hope. ;D
Cheers!
P.

I am SURE we will take care of you. :threat: :sniper:
Title: Re: Is Lariam (mefloquin) still in use?
Post by: Bruce Monkhouse on August 13, 2004, 18:48:48
Armymedic, next time I'm up there I owe you beers.!
Title: Re: Is Lariam (mefloquin) still in use?
Post by: Yard Ape on August 18, 2004, 02:54:23
Armymedic,
Malaria drugs inducing pregnancy!  :o
Don't let this get out or the ladies will have no use for us. :crybaby:
Title: If you are deployed to Afghanistan are you forced to take mefloquine?
Post by: a_himself on November 20, 2005, 20:26:16
I'm curious about other's who know this information.  I assume that personnel heading to Afghanistan would be given some sort of anti-malaria drug while they are there.  Does the CF force those going overseas to take mefloquine or known by the company name Lariam?  I'm asking because I've read numerous reports that say that this drug has been scientifically linked with an endless list of terrible side effects.  It can cause horrible depression and quite a few suicides have been suspected from its use.  Also I recently read an article in which a group of American soldiers returning from Iraq were diagnosed with permanent brain damage caused by mefloquine.  There is a big controversy over this apparnatly and many are calling on the US government to stop using it and switch to one of the other safer alternative medicines avaliable to prevent malaria.  So for those of you who have been over to Afghanistan or know this type of info, does the CF force those deploying to use Lariam or are alternatives used?
Title: Re: If you are deployed to Afghanistan are you forced to take mefloquine?
Post by: MCG on November 20, 2005, 21:07:06
You are not forced to take mefloquine.  There are two other drug choices.  Soldiers are given qualified medical advice and then are permitted to choose which anti-malarial drug they will take.
Title: Re: If you are deployed to Afghanistan are you forced to take mefloquine?
Post by: Rider Pride on November 20, 2005, 21:07:37
Forced.... no.
You are required to take some sort of anti malarial medications. Current approved medications for Ops in Afghanistan are:

Melfloquine (Lariam)-1 tablet a week starting 3 weeks prior until 4 weeks post exposure period
Malarone- Daily starting 1 week prior until 5 days after.
Doxycycline-1 per week.

There is also a post prophylaxis medication called Primiquimine which is taken for 4 weeks after you are complete the above meds.

I personally took Lariam on my tour earlier this yr.

I'm asking because I've read numerous reports that say that this drug has been scientifically linked with an endless list of terrible side effects.   It can cause horrible depression and quite a few suicides have been suspected from its use.   Also I recently read an article in which a group of American soldiers returning from Iraq were diagnosed with permanent brain damage caused by mefloquine.

Every drug has some sort of effect on your body. Some drugs have more them others.   In the case of Melfoquine, there are several mild to severe symptoms which vary in intensity on a individual basis. The question that must be asked "is the reason the drug is being used out weight the "side effects"? In this case does the prophylaxis effect of Larium in preventing soldiers in acquiring deadly strains of malaria out weight potential negative effects of the drug? In this specific case, the CF medical specialists say yes.

Also, if you further investigate the articles you mention, you will note addition mental and physical circumstance which are not quite so obvious or headline catching as the use of the antimalarial Larium. Melfoquine has been in use since the early 90's by literally hundreds of thousands of soldiers. Certainly a few murders in one distinct area by a specific group of people would have something more in common other then a medication they were using.


Title: Re: If you are deployed to Afghanistan are you forced to take mefloquine?
Post by: a_himself on November 20, 2005, 21:25:35
Yeah I'm looking to put in for the next task force when they start taking names in January so I'm all nervous and spending a lot of time researching all these little details.  But you answered my question perfectly, thanks a lot guys.
Title: Can someone tell me what the current malaria medication is
Post by: Sheep Dog AT on November 07, 2010, 15:28:06
that is being issued for those going overseas.  Thank you.
Title: Re: Can someone tell me what the current malaria medication is
Post by: ModlrMike on November 07, 2010, 15:36:35
The three most commonly used meds are:

Mefloquine;
Malarone; and
Doxycycline.

What you get depends on where you're going and whether you have any medical limitations vis-a-vis (allergy etc) these meds.
Title: Re: Can someone tell me what the current malaria medication is
Post by: Sheep Dog AT on November 07, 2010, 15:49:58
Thanks
Title: Re: Can someone tell me what the current malaria medication is
Post by: PMedMoe on November 07, 2010, 16:44:12
Malaria season is May-Nov inclusive.  If you stay in KAF there is no requirement for meds.

Normally, you will discuss with your MO and/or Pharm O which medication is best for you.
Title: Re: Can someone tell me what the current malaria medication is
Post by: Piper1911 on November 10, 2010, 11:35:10
Malarone is the good stuff, as long as you remember to take it daily. Worked in Africa!
Title: Re: Can someone tell me what the current malaria medication is
Post by: Sparkplugs on January 12, 2011, 10:15:25
Malarone is the good stuff, as long as you remember to take it daily. Worked in Africa!

It's great until you discover an unknown anaphylactic allergic reaction to it somewhere in the mountains of Afghanistan, lol!

People give me a funny look now at the MIR when I say "Malarone" as one of my allergies.   ;D
Title: Re: Can someone tell me what the current malaria medication is
Post by: Fishbone Jones on January 12, 2011, 11:28:08
I don't know if they're still using Mefloquine, but that crap can have some pretty adverse side effects in some individuals. I switched off it and took Doxycycline on a daily basis instead.
Title: Re: Can someone tell me what the current malaria medication is
Post by: PMedMoe on January 12, 2011, 11:41:10
I don't know if they're still using Mefloquine, but that crap can have some pretty adverse side effects in some individuals. I switched off it and took Doxycycline on a daily basis instead.

I agree.  IMHO, some health care personnel are not screening people properly.  Doxy isn't really the greatest either, as one of the side effects is sun sensitivity.  Of course, one should be using sunscreen in A'stan anyway.....    ;)
Title: Re: Can someone tell me what the current malaria medication is
Post by: dapaterson on January 12, 2011, 11:44:01
I guess I'm just a traditionalist - what's wrong with Gin and Tonic?

 >:D

Title: Re: Can someone tell me what the current malaria medication is
Post by: PMedMoe on January 12, 2011, 12:05:12
I guess I'm just a traditionalist - what's wrong with Gin and Tonic?

Just make sure you get the tonic that has quinine in it.   ;)
Title: Re: Can someone tell me what the current malaria medication is
Post by: PuckChaser on January 12, 2011, 13:06:07
I was on Mefloquine. Dreams were super vivid for the whole time I was on it, and for 2-3 days after taking the pill each week I had an upset stomach. Definitely was not a good feeling, but I heard worse about the other ones so I stuck with it, was only for 3 months.
Title: Re: Can someone tell me what the current malaria medication is
Post by: aesop081 on January 12, 2011, 13:09:36
I took Malarone with no issues.
Title: Re: Can someone tell me what the current malaria medication is
Post by: Occam on January 12, 2011, 13:19:28
I don't know if they're still using Mefloquine, but that crap can have some pretty adverse side effects in some individuals.

Yes, I remember a certain fella who decided that he was going to try to take over the bridge of a ship and bring it back to Halifax...from the Indian Ocean.   :)

'Tis strange stuff, that mefloquine!
Title: Re: Can someone tell me what the current malaria medication is
Post by: Alea on January 12, 2011, 14:08:42
I remember having to take 1 Nivaquine a day, 365/365...
 
For those who have access to Nivaquine, it is one of the good medication against malaria (except if you have liver problems).
That said, most people I know who've been under any malaria medication ended up by catching the disease one day or another. I personally had Malaria (Paludisme) at least 10 times in my life if not more. When you live in Africa, you get this like you'd get the flue here.

Alea
Title: Re: Can someone tell me what the current malaria medication is
Post by: medicineman on January 13, 2011, 00:32:49
Took Mefloquine in Afghanistan - only had one cool dream that someone interrupted, otherwise no probs.  Took Malarone in Haiti - no biggy.  Some people there were on Chloroquine, which causes gut rot in some (as does Malarone), others were on Doxy.  Of course, it's all location dependant. 

MM
Title: Re: Can someone tell me what the current malaria medication is
Post by: captloadie on January 13, 2011, 04:16:47
When I was in Trenton, they did a blood test, which they explained to me was to determine which medication would be best for me. Then they put it in my med files and my vaccination booklet. I was however aircrew at the time.
Title: Re: Can someone tell me what the current malaria medication is
Post by: PMedMoe on January 13, 2011, 08:48:38
When I was in Trenton, they did a blood test, which they explained to me was to determine which medication would be best for me. Then they put it in my med files and my vaccination booklet. I was however aircrew at the time.

The blood test is for the presence or absence of G6PD (a blood enzyme) to determine if you can take Primaquine (terminal prophylaxis).  It doesn't determine which other medication you can take.  If your G6PD is "normal", you're good to go.  If the G6PD is "deficient", you cannot take Primaquine.  There are some experts who believe that a G6PD deficient person may have a natural immunity to malaria as it does not survive well in a G6PD deficient environment.

For those who have access to Nivaquine, it is one of the good medication against malaria (except if you have liver problems).

AFAIK, this medication is not available in the CF.

I personally had Malaria (Paludisme) at least 10 times in my life if not more. When you live in Africa, you get this like you'd get the flue here.

No, you probably have the type of malaria that remains dormant in the liver and periodically releases mature parasites into the bloodstream, causing recurring attacks of symptoms.  Either Plasmodium vivax or Plasmodium ovale.

Also, even when taking medication, insect discipline is important.  Medications (like vaccines) are not always 100% effective.
Title: Re: Can someone tell me what the current malaria medication is
Post by: medicineman on January 13, 2011, 16:44:22

AFAIK, this medication is not available in the CF.

It's choloroquine, so yes it is :)

MM
Title: Re: Can someone tell me what the current malaria medication is
Post by: PMedMoe on January 13, 2011, 16:46:48
It's choloroquine, so yes it is :)

MM

Whoopsy!  I stand corrected.  No good for most places, though.  Isn't Africa (mostly) chloroquine resistant?  That would explain some things.........   :nod:
Title: Re: Can someone tell me what the current malaria medication is
Post by: ArmyDoc on January 14, 2011, 00:42:36
I agree.  IMHO, some health care personnel are not screening people properly.  Doxy isn't really the greatest either, as one of the side effects is sun sensitivity.  Of course, one should be using sunscreen in A'stan anyway.....    ;)
You're making some pretty broad brush statements, and I disagree with them.  The vast majority of our CF pers are properly screened by multiple pers at multiple levels (e.g. PMed, MO, Pharm O)  and prescribed the appropriate chemoprophylaxis prior to deployment.  My biggest concern is for the augmentee that arrives at the last minute, usually as a replacement for someone on the TO&E.  Furthermore, all medications have potential adverse effects.  The hoopla over malarone use in the CF came out of the Somalia scandal with the CAR, when individuals claimed the neuropsychiatric side effects caused them to torture and murder a civilian.  It doesn't.
Title: Re: Can someone tell me what the current malaria medication is
Post by: medicineman on January 14, 2011, 01:36:43
Whoopsy!  I stand corrected.  No good for most places, though.  Isn't Africa (mostly) chloroquine resistant?  That would explain some things.........   :nod:

I seem to recall that there is alot of choloroquine resistance in Africa.

MM
Title: Re: Can someone tell me what the current malaria medication is
Post by: PMedMoe on January 14, 2011, 08:55:24
You're making some pretty broad brush statements, and I disagree with them.  The vast majority of our CF pers are properly screened by multiple pers at multiple levels (e.g. PMed, MO, Pharm O)  and prescribed the appropriate chemoprophylaxis prior to deployment.

I agree that the vast majority are screened properly.  Did you notice I said some?

When I was in Ottawa, we (PMed) had to fill out a medication recommendation for the doctors as they were not "familiar" with the medications used.   ::)

Do they ask about past issues of depression?  That's a big no-no when prescribing Mefloquine.

http://www.cmaj.ca/cgi/content/full/167/10/1147 (http://www.cmaj.ca/cgi/content/full/167/10/1147)

http://chealth.canoe.ca/drug_info_details.asp?brand_name_id=1128&rot=4 (http://chealth.canoe.ca/drug_info_details.asp?brand_name_id=1128&rot=4)

As an example, I do contact tracing on people who are given the "single" dose of Zithro but not told that it still takes seven days to take effect and as a result, play Chlamydia ping-pong with their partner(s). 

Our military MOs, NO, PAs, etc are great.  It's mostly the civilians I have issues with.

The hoopla over malarone use in the CF came out of the Somalia scandal with the CAR, when individuals claimed the neuropsychiatric side effects caused them to torture and murder a civilian

It was Mefloquine, not Malarone.

Interesting reading about that issue here:  http://www.forces.gc.ca/somalia/vol5/v5c41e.htm (http://www.forces.gc.ca/somalia/vol5/v5c41e.htm)

But we digress......back to your regularly scheduled thread. 
Title: Re: Can someone tell me what the current malaria medication is
Post by: ArmyDoc on January 14, 2011, 12:36:18
Moe,  you're absolutely right on the mefloquine (meflomares) vice malarone, my brain said mefloquine but my fingers typed malarone. 
Title: Malaria drug for Canadian troops called dangerous
Post by: Pieman on April 11, 2012, 20:00:24
http://www.cbc.ca/news/canada/story/2012/04/10/malaria-drug-mefloquine.html

Someone please remind me, there was a weekly malaria pill and a daily pill for 2009 tours.  What were they called?

Which is the drug they are talking about here?

I am worried this could have implications for veterans who are being treated.
Title: Re: Malaria drug for Canadian troops called dangerous
Post by: Pieman on April 11, 2012, 20:17:34
Just to answer my own question: http://en.wikipedia.org/wiki/Mefloquine

It appears to be the once per week drug that I believe that lots of people took overseas. I opted for the once a day pill Doxycycline.  Interesting point here:
 
Quote
In the Somalia Affair, some Members of Parliament and doctors postulated that this drug may have been a cause of the brutal beating death of Shidane Arone by Canadian Forces personnel, some of whom had been given experimental treatment using the drug. Dr. Michele Brill-Edwards resigned in protest from Health Canada over her belief that the drug could produce "dangerous psychiatric reactions" in the soldiers before the Somalia Affair took place.
Title: Re: Malaria drug for Canadian troops called dangerous
Post by: dangerboy on April 11, 2012, 20:19:49
In 2006 I took Mefloquine once a week for however long was required.  I did not suffer any of the side effects and as far as I know no one in my section has either.
Title: Re: Malaria drug for Canadian troops called dangerous
Post by: E.R. Campbell on April 11, 2012, 20:25:34
In 2006 I took Mefloquine once a week for however long was required.  I did not suffer any of the side effects and as far as I know no one in my section has either.


Ditto, although I'm not sure what the drug was, three times, for periods ranging from a few weeks to about nine months, between 1975 and 1990ish. We heard all kinds of horror stories but I never saw nor heard, first hand, any real evidence about ill effects.

Title: Re: Malaria drug for Canadian troops called dangerous
Post by: Pieman on April 11, 2012, 20:28:53
I'm not seeing any numbers with regards to how many people they think are effected long term. Then this quote: "Long-term neuropsychological effects and reports of suicide ideation or suicide have not be confirmed, the agency says."

So....is it really a problem or bogus reporting?
Title: Re: Malaria drug for Canadian troops called dangerous
Post by: MCG on April 11, 2012, 20:34:31
http://www.cbc.ca/news/canada/story/2012/04/10/malaria-drug-mefloquine.html

Someone please remind me, there was a weekly malaria pill and a daily pill for 2009 tours.  What were they called?

Which is the drug they are talking about here?

I am worried this could have implications for veterans who are being treated.
The option to use the other drug has been around at least since the end on 2005.  If troops started to experience symptoms, they could be switched from one drug to the other.
Title: Re: Malaria drug for Canadian troops called dangerous
Post by: Rider Pride on April 11, 2012, 21:15:53
If you have received a weekly medication to prevent Malaria from the CF since about 1992ish, it was most likely Melfloquine, otherwise known as Larium.

Most recently the dosage was 250mg starting 3 weeks prior to departure, until 4 weeks after return.

The dosing for this weekly medication has, over the last 20 yrs has decreased as it has been shown higher does are no more effective than lower doses to prevent malaria, while having a significant adverse effect rates.

It was seen at 1000mg (Somalia doses) that vivid dreams, nightmares, nausea, and occasionally seizures were an issue. Latest Kandahar dose of 250 mg per week still have a 1 in 10 occurrence of vivid dreams on the night of the dose, but that effect is mitigated by taking the medications earlier in the day.

BTW, the Mefloquine patient information card specifically states anyone who has suffered from depression, anxiety or  schizophrenia should avoid the medications as the vivid dreams can aggravate the underlying condition. Anyone who claims that the medication "caused" them to have a mental illness after taking it, should be very careful to not have any mental health issues prior to taking the drug.

I have an electronic version of the patient info cards for Mefloquine and Malarone on my computer. If people want to see them, I can attach them.

BTW; 3 tours of Afghanistan, seen lots of blood and badness. Took Mefloquine all three times. Had dreams. Had nausea. All went away once drug was discontinued after I was home....every time.

My position: every medication has its role, and adverse effects. As a medical professional, we constantly balance the drugs affects with its effects. Mefloquine remains the most reliable drug for long term use in a hot, sunny climate. The US Army tended to dose their soldiers higher than the CF, which may explain some of the issues. In the last year, the US forces have switched to Doxycycline (an antibiotic) as their primary malaria prophylaxis medication. My take is they did it because of the cost. Malarone is a very expensive drug, at about $4 per tab vs 50 cents for Doxy.
Title: Re: Malaria drug for Canadian troops called dangerous
Post by: Pieman on April 11, 2012, 21:56:34
Thanks for the info Rider. 

I am curious to know what percentage of people are effected long term as sited in the media report? It has to be low considering how long the drug has been around. 
Title: Re: Malaria drug for Canadian troops called dangerous
Post by: E.R. Campbell on April 11, 2012, 22:00:30

Ditto, although I'm not sure what the drug was, three times, for periods ranging from a few weeks to about nine months, between 1975 and 1990ish. We heard all kinds of horror stories but I never saw nor heard, first hand, any real evidence about ill effects.


Sorry, I should have said "any real evidence about long term ill effects." There were, indeed, some (many?) cases of headaches, sleep troubles and so on while members were taking the drug.
Title: Re: Malaria drug for Canadian troops called dangerous
Post by: Fishbone Jones on April 11, 2012, 22:12:48
I had trouble with it and switched to Doxy for the rest of the tour. Once I was off the mefloquine I was fine (at least I think so, others aren't sure)
Title: Re: Malaria drug for Canadian troops called dangerous
Post by: Snaketnk on April 11, 2012, 22:30:22
Unfortuantely, it's hard to track things like that over the long term.... Nobody's ever asked me about psychological effects since my tour (except for that 5 minute social worker interview shortly after returning), and I definitely didn't get a follow up asking me about how my regimen of Mefloquin went.

Even I don't know what the symptoms were; so many things were going on, I could attribute psychological symptoms/irregularities to any number of things.
Title: Re: Malaria drug for Canadian troops called dangerous
Post by: PuckChaser on April 11, 2012, 22:39:14
Definitely going to try another anti-malarial if I have to try again. I didn't dream in colour with Mefloquine, it was Bluray high-def. That, combined with the nausea for 3 days after made me thankful I only had to take it for a few months as I got a winter tour. All the stuff seemed to go away a few weeks after completing the meds though.
Title: Re: Malaria drug for Canadian troops called dangerous
Post by: ModlrMike on April 11, 2012, 22:54:12
I was on Mefloquine in 94, 06 and 08. No ill effects noted, either acutely or long term. There were millions of doses prescribed to civilians prior to the CF taking it on board.
Title: Re: Malaria drug for Canadian troops called dangerous
Post by: medicineman on April 11, 2012, 22:55:44
I'm with RP on this with one small exception - chloroquine is also a once weekly med that people still get to take in certain areas.  I took Lariam for my mini tour in 03 - the one night I actually had a cool dream, someone interrupted it and woke me up.  To be honest, I think that side effect is a little over exaggerated at the dose it's given at - like the vast majority of folks, I had more gut rot issues with it than anything.

Like it or lump it, in the dose it's given now, I'd say that you're unlikely (I didn't say not ever, though one does have to wonder about placebo here sometimes  :)) to have any issues with the stuff...and if you notice things, you can just go in and ask to be switched to the alternate. 

Pieman, given that they didn't cite any stats, they're having problems finding them (and so are we for that matter) but are trying to infer that there are many.  Just like the drug was "declared dangerous" - by one physician.  The PHAC or any other regulatory agency in this country haven't come out saying so, and we've been using it for a number of years now.  If someone were to decide that mefloquine was dangerous, PHAC and Health and Welfare Canada would have to acknowledge that...and to be honest, if it were to get pulled, they'd better start pulling some considerably more dangerous medications and other products off the shelves shortly afterwards.

To paraphrase Paracelsus - ALL substances are poisons...the difference between a remedy and a toxin is the dose.

 :2c:

MM

Title: Re: Malaria drug for Canadian troops called dangerous
Post by: Rider Pride on April 11, 2012, 23:05:07
Alcohol is a dangerous substance whose byproducts include formaldehyde. Most people have no problem over dosing on it.


On a completely different thought:
Ask anyone who has had malaria....they'd rather have some bad dreams, instead of living in one for 10-14days.
Title: Re: Malaria drug for Canadian troops called dangerous
Post by: Pieman on April 11, 2012, 23:08:15
Quote
Pieman, given that they didn't cite any stats, they're having problems finding them (and so are we for that matter) but are trying to infer that there are many.  Just like the drug was "declared dangerous" - by one physician.  The PHAC or any other regulatory agency in this country haven't come out saying so, and we've been using it for a number of years now.  If someone were to decide that mefloquine was dangerous, PHAC and Health and Welfare Canada would have to acknowledge that...and to be honest, if it were to get pulled, they'd better start pulling some considerably more dangerous medications and other products off the shelves shortly afterwards.

Seems like some pretty terrible reporting by the CBC, once again......I know that must come as a shock to many of you. ha! I'm not sold this is a real issue unless they come up with some stats showing long term effects one way or the other.
Title: Re: Malaria drug for Canadian troops called dangerous
Post by: medicineman on April 11, 2012, 23:08:51
Alcohol is a dangerous substance whose byproducts include formaldehyde. Most people have no problem over dosing on it.


On a completely different thought:
Ask anyone who has had malaria....they'd rather have some bad dreams, instead of living in one for 10-14days...or longer

There - FTFY.  Saw my first malaria attack when I was 9 - my grandfather started cycling on a plane ride back from the UK with me.  He contracted it in SE Asia during the Second World War and never got rid of it.

Edit for spelling.

MM
Title: Re: Malaria drug for Canadian troops called dangerous
Post by: mark-space on April 12, 2012, 00:56:20
Mefloquin turned me into a newt!

Wacky Wednesdays on ROTO 0 in Kandahar...my nightmares were more entertaining than anything else in that dust pit.....
Title: Re: Malaria drug for Canadian troops called dangerous
Post by: Beadwindow 7 on April 12, 2012, 09:47:33
In 2007, I took Malarone, one of the daily pill because I didn't have enough workup time before deploying to get on mefloquin. Didn't like it because 1. I always forgot to take it, and 2. it seemed to mess with my appetite.

In 2009, I wanted mefloquin, particularly to see what the "vivid dreams" would bring me. First Mefloquin monday, nothing at all...and the same followed for the following 10 months. What a rip.

We did however have a guy who did get the terrors, pretty bad ones too. Easy enough, go to the medics, "Hey, mefloquin f**** me up", and prescription promptly changed.
Title: Re: Malaria drug for Canadian troops called dangerous
Post by: Hatchet Man on April 12, 2012, 09:48:37
I took mefloquine, and got the crazy dreams (don't know about nightmares, but I would definately wake up, with a sense of well that was f'ed up).  I still get the dreams though, and I have been back for over a year.
Title: Re: Malaria drug for Canadian troops called dangerous
Post by: Hamish Seggie on April 12, 2012, 09:51:49
I had trouble with it and switched to Doxy for the rest of the tour. Once I was off the mefloquine I was fine (at least I think so, others aren't sure)

You are correct in your assessment sir and I heartily concur!!

A few  troops from the Airborne told me they had "meflomares". All anecdotal though and no real evidence.
Title: Re: Malaria drug for Canadian troops called dangerous
Post by: Occam on April 12, 2012, 11:21:29
You are correct in your assessment sir and I heartily concur!!

A few  troops from the Airborne told me they had "meflomares". All anecdotal though and no real evidence.

I have no numbers, but many shipmates (myself included) described suffering from nightmares after we deployed to Somalia on HMCS Preserver.  Some of them continued long after we stopped taking the medication.  Again, no numbers, and nobody official has ever solicited my input as part of a study to find out how prevalent the problem was.
Title: Re: Malaria drug for Canadian troops called dangerous
Post by: PuckChaser on April 12, 2012, 11:49:27
Problem is, I don't think there is a study on how the drug affects patients who are taking it coupled with a highly-stressful environment like deployed operations in a war zone. There may be a majority who have no ill-effects, but we can't call BS on the members who are having issues without scientific backing.
Title: Re: Malaria drug for Canadian troops called dangerous
Post by: 2 Cdo on April 12, 2012, 11:51:10
Vivid technocolour dreams on the day I took it, but fine the other six days of the week with no lingering issues.
Title: Re: Malaria drug for Canadian troops called dangerous
Post by: Pieman on April 12, 2012, 13:35:35
Quote
There may be a majority who have no ill-effects, but we can't call BS on the members who are having issues without scientific backing.
I totally agree there. The numbers could super low, but does not mean it does not happen to people.
Title: Re: Malaria drug for Canadian troops called dangerous
Post by: Jarnhamar on April 12, 2012, 14:20:31
Not a single bad dream.

*flexes*

No big D.
Title: Re: Malaria drug for Canadian troops called dangerous
Post by: Gronk on April 12, 2012, 20:20:00
Took the pills on 02 tour, gave me vivid gory violent dreams. stopped taking it after I started hallucinating. Still have the dreams- couldn't say whether pills are partly to blame or not.
Title: Re: Malaria drug for Canadian troops called dangerous
Post by: Rider Pride on April 12, 2012, 23:50:11
Here is the Health Canada site giving drug warnings about Larium...AKA Mefloquine:

http://www.hc-sc.gc.ca/dhp-mps/medeff/advisories-avis/public/_2005/lariam_pa-ap-eng.php

Two key points I will highlight, as does Health Canada:

1. Do not take 'Lariam' to prevent malaria if you

    have or had depression
    have had recent mental illness or problems, including anxiety disorder, schizophrenia (a severe type of mental illness), or psychosis (losing touch with reality)
    have or had seizures (epilepsy or convulsions)
    are allergic to quinine or quinidine (medicines related to 'Lariam')

2. If you use 'Lariam' to prevent malaria and you develop a sudden onset of unexplained anxiety, depression, restlessness or irritability, or confusion (possible signs of more serious mental problems), or you develop other serious side effects, including a persistently abnormal heart beat or palpitations, contact a doctor or health care provider. It may be necessary to stop taking 'Lariam' and use another malaria prevention medicine instead.


This was known in 2005.

If you were not completely honest on your questionnaire (which I know was done in 2005) before you got the meds, or did not report adverse symptoms while on the meds, then you should not be surprised how the government lawyers will present the case against you.

Title: Re: Malaria drug for Canadian troops called dangerous
Post by: AJFitzpatrick on April 12, 2012, 23:57:10
Anecdotal:

 Myself and friend going to Honduras: same malaria medication and dosage.

Me : no effect
Friend:  strange dreams

I'll stick to Gin and Tonics or better Rum and Tonics
Title: Re: Malaria drug for Canadian troops called dangerous
Post by: medicineman on April 13, 2012, 00:12:15
Anecdotal:

 Myself and friend going to Honduras: same malaria medication and dosage.

Me : no effect
Friend:  strange dreams

I'll stick to Gin and Tonics or better Rum and Tonics

It's quinine resistant there and most other places now.  Nice try though...at least you'll have fun while you're getting sick though :nod:.

MM
Title: Re: Malaria drug for Canadian troops called dangerous
Post by: dapaterson on April 13, 2012, 00:34:33
I took mefloquine, and got the crazy dreams (don't know about nightmares, but I would definately wake up, with a sense of well that was f'ed up).  I still get the dreams though, and I have been back for over a year.

Find a military health provider and talk about it.  If they're recurring, it's probably not a medication issue.  There are plenty of resources out there, and there are folks who are there to help.

(Indeed, there are a few on here who can steer you in the right direction - PM me if you want to get in touch with one).
Title: Re: Malaria drug for Canadian troops called dangerous
Post by: Hamish Seggie on April 13, 2012, 00:36:21
Find a military health provider and talk about it.  If they're recurring, it's probably not a medication issue.  There are plenty of resources out there, and there are folks who are there to help.

(Indeed, there are a few on here who can steer you in the right direction - PM me if you want to get in touch with one).

Or PM me too.
Title: Re: Malaria drug for Canadian troops called dangerous
Post by: Fishbone Jones on April 13, 2012, 01:07:01
Here is the Health Canada site giving drug warnings about Larium...AKA Mefloquine:

http://www.hc-sc.gc.ca/dhp-mps/medeff/advisories-avis/public/_2005/lariam_pa-ap-eng.php

Two key points I will highlight, as does Health Canada:

1. Do not take 'Lariam' to prevent malaria if you

    have or had depression
    have had recent mental illness or problems, including anxiety disorder, schizophrenia (a severe type of mental illness), or psychosis (losing touch with reality)
    have or had seizures (epilepsy or convulsions)
    are allergic to quinine or quinidine (medicines related to 'Lariam')

2. If you use 'Lariam' to prevent malaria and you develop a sudden onset of unexplained anxiety, depression, restlessness or irritability, or confusion (possible signs of more serious mental problems), or you develop other serious side effects, including a persistently abnormal heart beat or palpitations, contact a doctor or health care provider. It may be necessary to stop taking 'Lariam' and use another malaria prevention medicine instead.


This was known in 2005.

If you were not completely honest on your questionnaire (which I know was done in 2005) before you got the meds, or did not report adverse symptoms while on the meds, then you should not be surprised how the government lawyers will present the case against you.

Except none of that was explained to us in 03. I was almost bounced from my tour because I would take it on Wed, turn into Mr Hyde  for Thurs, Fri, Sat. Start to level out on Sun, Mon. Have a normal day Tues and start all over again on Wed, when I had to remedicate. Once I went onto Doxy, at my request, no, demand, I levelled out and was OK. They did not want to switch me. I had to make the MO put it in writing that it was my request.  I served with Samolia vets in Afghanistan that were given three times the dose we received. Given the pshycotic episodes I had at my dose, I can only imagine what they had to endure.

If you were lucky, and didn't endure any effects, good on you. Please don't discount those that did have effects and are still bothered by symptoms today. The Army always seems to be the guinea pig of any weird drug trial the government needs doing without incurring cost.

Proof being: Were military pers told at the time of the side effects that civilians are told of now? Of course not. We were told to take it or be charged. That was our choice.
Title: Re: Malaria drug for Canadian troops called dangerous
Post by: Hatchet Man on April 13, 2012, 02:23:30
Find a military health provider and talk about it.  If they're recurring, it's probably not a medication issue.  There are plenty of resources out there, and there are folks who are there to help.

(Indeed, there are a few on here who can steer you in the right direction - PM me if you want to get in touch with one).

Appreciate it , although I am not totally sure if its a mental thing, drug thing, or something I should be worried about.  My dreams don't concern me persay...cause they aren't nightmares really, its just they are just really ******* weird and wild, think the movie suckerpunch,  with totally random disjointed  but vivid as hell imagery, and I don't have the same dreams its a new ride every night.  I guess whereas a coworker will say hey I had this crazy dream where I won the lottery, blah blah blah, I will be like meh, I dreamt The Joker (Heath Ledger's Joker Character from the movie) was at my house for thanksgiving, and said my moms cooking was terrible then flipped the table and tried stabbing me in the face.  Thats the kind of stuff I experience, no nightmares just, waking up going ok... that was weird.
Title: Re: Malaria drug for Canadian troops called dangerous
Post by: stealthylizard on April 13, 2012, 02:56:10
My only reaction to mefloquine was diarrhea, a couple days after taking it, each week.  Thankfully that ended by the time I deployed.  Unfortunately, no vivid dreams.
Title: Re: Malaria drug for Canadian troops called dangerous
Post by: TN2IC on April 13, 2012, 14:43:15
My only reaction to mefloquine was diarrhea, a couple days after taking it, each week.  Thankfully that ended by the time I deployed.  Unfortunately, no vivid dreams.

I was the same. Nothing really strange.
Title: Re: Mefloquine (a.k.a Lariam) anti-malarial in CF use (merged)
Post by: milnews.ca on January 30, 2016, 21:58:41
Bumped with the latest call for a ban (http://edmontonjournal.com/news/insight/new-push-for-ban-on-mefloquine), from an interesting quarter ...
Quote
Former soldiers from the disbanded Canadian Airborne Regiment are pushing for a ban on the controversial anti-malaria drug mefloquine that some say plagued the disastrous 1993 Somalia mission.

Two events — the 2013 U.S. military ban on mefloquine for Special Forces and new scientific studies showing toxicity from the drug can cause permanent brain damage — should force a review of Canadian policy, says John Dowe, a former airborne soldier.

Two former military doctors also agree, given the new studies show evidence of long term, adverse effects similar to symptoms linked to post-traumatic stress disorder.

Dowe was witness to the horrific events in March 1993 — the beating death by two airborne soldiers of Somali civilian Shidane Arone, who stole into the Canadian desert compound in Belet Huen.

And he thinks mefloquine, with its many adverse side-effects, played a role in the appalling conduct of the two soldiers. Those side-effects include nightmares, insomnia, depression, cognitive impairment, mood swings and aggression.

Last fall, Dowe began to work with the International Mefloquine Veterans Alliance that is calling for a ban of the drug “in military forces worldwide.”

There are advocacy groups in Australia, the U.K., and Canada, Dowe said ...
More from the same reporter (http://news.nationalpost.com/news/canada/it-takes-everything-veteran-went-off-the-grid-after-torturing-teen-in-somalia-left-him-with-ptsd), speaking to Kyle Brown.
Title: Re: Mefloquine (a.k.a Lariam) anti-malarial in CF use (merged)
Post by: AirDet on February 20, 2016, 10:28:00
This definitely something for us to keep an eye on. Most of us here have been on it over the years.

I remember having some really cool "day-mares" on it in East Timor. We often asked what other effects it was having on us.
Title: Re: Mefloquine (a.k.a Lariam) anti-malarial in CF use (merged)
Post by: mariomike on May 26, 2016, 16:15:56
May 25, 2016

Risky anti-malaria drug given to thousands of Canadian veterans
https://www.thestar.com/news/world/2016/05/25/risky-anti-malaria-drug-given-to-thousands-of-canadian-veterans.html
Dave Bona, a veteran of the Canadian Airborne Regiment, says the Canadian military should follow the recommendations of a new U.K. report on mefloquine.

For 12 years, Bona said he took every treatment possible for PTSD, but he got little relief until his long-time psychologist told him his symptoms matched mefloquine toxicity.
Title: Re: Mefloquine (a.k.a Lariam) anti-malarial in CF use (merged)
Post by: sidemount on May 26, 2016, 19:44:19
I am very glad i opted not to take it when I went to the stan....I was given doxycyline(spelling?)  since I am a diver and would be diving on hlta. And even then, after a week of not seeing mosquitos i stopped taking that as well. After hearing the stories of wacky wednesdays and all the reports on the dangers of it...I cant believe it was given to us
Title: Re: Mefloquine (a.k.a Lariam) anti-malarial in CF use (merged)
Post by: medicineman on May 27, 2016, 08:43:15
I am very glad i opted not to take it when I went to the stan....I was given doxycyline(spelling?)  since I am a diver and would be diving on hlta. And even then, after a week of not seeing mosquitos i stopped taking that as well. After hearing the stories of wacky wednesdays and all the reports on the dangers of it...I cant believe it was given to us

Anopheles mosquitoes are night biters...probably wouldn't have seen many.  Of course, certain altitudes and season also decrease odds of seeing them/getting bitten by them.

As I tell my patients "All substances are poisons...There are none that are not...The dose differentiates a poison from a cure."  Yes even, oxygen and water are poisonous if taken inappropriately.  I'm still amazed at how many folks I'd see daily blaming their anti-malarials on anything or everything, yet guzzle down unquantifiable amounts of dietary supplements, alcohol, anti-inflammatories, etc.  Having seen malaria first hand on a number of occasions and a grandfather that was still getting cycling fevers 50 years after contracting it during the Second World War in SE Asia, I get more than annoyed from seeing people basically suffering from a self inflicted injury because their cousin's boyfriend's sister's girlfriend's uncle's brother in law had some problems with a drug.  Things were getting so bad in the US military at one point that there were parades daily/weekly for whatever drug was required - I witnessed this in Haiti with some Marines stationed near us.  The Commandant of the USMC decreed that anyone that got malaria from not taking their meds would be charged and their immediate commanders would also be charged, as a lot of folks were getting knocked out of action in Afgh and Iraq.

Some people are in fact more prone to problems than others, as after market research showed.  This is actually quite similar to other drugs like Zyban, where I've had a lot of experience with smoking cessation of people becoming maniacal because their brain chemistry was already messed up with unreported/underdiagnosed mental health issues.  It is for this reason there is a special screening for anti-malarials alone on a deployment DAG, with the meds being tailored based on general health issues and the sensitivity of the malaria organisms where you're going.

Anecdotally, I used mefloquine for 3-4 months in Kabul and only once did I remotely have anything resembling hallucinations - I get more vivid dreams taking melatonin than ever with Lariam.  I know friends that had some funky dreams and very few folks I looked after that had any real issues with the stuff.  Not so anecdotally, people are very varied in how they handle a wide variety of medication, especially if they're taking stuff over the counter and don't happen to mention it during a screening or they add alcohol to the mix.  For what it's worth, I still recommend it to folks civvy side if that's what the stuff is sensitive to where they're travelling...difference is of course, I still screen the snot out of them and make sure they're well aware of the side effect profile.

One last thing - beware the single article about someone with an axe to grind and a potentially large monetary settlement involved...

$0.02 Cdn

MM
Title: Re: Mefloquine (a.k.a Lariam) anti-malarial in CF use (merged)
Post by: sidemount on May 27, 2016, 09:22:54
To me it was a risks/benefits analysis. After reading about the possible side effects especially wrt diving i opted from the ease of once a week to a (imo) safer once a day pill. Even then after a short time i opted away from that. Would I do it again....depends on the situation....would I ever take mefloquine....no, too much of a risk again imo.

YMMV
Title: Re: Mefloquine (a.k.a Lariam) anti-malarial in CF use (merged)
Post by: Humphrey Bogart on May 27, 2016, 09:26:27
To me it was a risks/benefits analysis. After reading about the possible side effects especially wrt diving i opted from the ease of once a week to a (imo) safer once a day pill. Even then after a short time i opted away from that. Would I do it again....depends on the situation....would I ever take mefloquine....no, too much of a risk again imo.

YMMV

What if you're ordered to take it?  Oh wait this is the CAF, where orders are just suggestions   ;D
Title: Re: Mefloquine (a.k.a Lariam) anti-malarial in CF use (merged)
Post by: Journeyman on May 27, 2016, 09:55:41
.....yet guzzle down unquantifiable amounts of dietary supplements, alcohol, anti-inflammatories, etc.
  Hell ya!!   :cheers:


Oh, you meant that as a negative thing
Title: Re: Mefloquine (a.k.a Lariam) anti-malarial in CF use (merged)
Post by: Humphrey Bogart on May 27, 2016, 10:01:27
  Hell ya!!   :cheers:


Oh, you meant that as a negative thing

Ibuprofen is like my go to hangover cure.  Lately I've been taking it a lot  :cheers:
Title: Re: Mefloquine (a.k.a Lariam) anti-malarial in CF use (merged)
Post by: Journeyman on May 27, 2016, 10:04:52
Ibuprofen is like my go to hangover cure.  Lately I've been taking it a lot  :cheers:
Ah, well once you find stasis by eliminating that nasty "sobering up" phase.....    ;D
Title: Re: Mefloquine (a.k.a Lariam) anti-malarial in CF use (merged)
Post by: medicineman on May 27, 2016, 14:38:08
What if you're ordered to take it?  Oh wait this is the CAF, where orders are just suggestions   ;D

To me it was a risks/benefits analysis. After reading about the possible side effects especially wrt diving i opted from the ease of once a week to a (imo) safer once a day pill. Even then after a short time i opted away from that. Would I do it again....depends on the situation....would I ever take mefloquine....no, too much of a risk again imo.

YMMV

Interesting question from HB - if it were the only drug the local organisms were sensitive to and you were ordered to take it but didn't AND then got sick and were off duty for a long time and or repatted as a result, if I were your boss I'd charge your ***.  If the malaria threat were high and you didn't want to take it and said so, I'd ensure you weren't deployed and make a NTF as to why...and ensure that any time there was a mission to a tropical area, you wouldn't go.  As a medical person, I could probably make a case for a geographic PCat for someone who won't take anti-malarials...kinda like we do with folks with bad frostbite.  It's like with immunizations - after a certain point you don't get a choice in the matter.  Ok, well you do sort of - take em or leave...the military.

Also as an observation, you should be probably choosing things you take/do around operational roles first, not HLTA, you know, since the op has primacy over your vacation IMHO.

To all you Ibuprofen or Naproxen abusers, if I had a dime for every case of GI bleeding, gastritis or high blood pressure I'd seen related to over use of anti-inflammatory drugs, my job would be a hobby and Mike B. here would be very rich since I'd have bought the site off of him.  Sadly, I still have to wait to win the Lotto Max for that to happen.

MM
Title: Re: Mefloquine (a.k.a Lariam) anti-malarial in CF use (merged)
Post by: Fishbone Jones on May 29, 2016, 19:05:19
It's not a single article. The US and the British have recognised the problems and have stopped issuing it. I know people that have claimed no problem and others that were totally ****ed for three days every week after taking it. ÝMMV. Just because you had no problem doesn't mean others didn't. I've never seen a medic, especially a senior one, diagnose a group of people, over the Internet, based on their own experience.

Let's also not forget how the CF lied to get the stuff into Canada by saying it was for medical trials through Health Canada and then issued it to guinea pig soldiers . There are no test results at either organisation . So much for studies and those injured by the callous disregard of the liberal government of the time and others after them.



Title: Re: Mefloquine (a.k.a Lariam) anti-malarial in CF use (merged)
Post by: Fishbone Jones on May 29, 2016, 19:20:26
This thread is about mefloquine, it's effects and what results are affecting people. Not someone's adherence to the Code of Service Discipline.

---Staff---
Title: Re: Mefloquine (a.k.a Lariam) anti-malarial in CF use (merged)
Post by: medicineman on June 03, 2016, 17:38:49
It's not a single article. The US and the British have recognised the problems and have stopped issuing it. I know people that have claimed no problem and others that were totally ****ed for three days every week after taking it. ÝMMV. Just because you had no problem doesn't mean others didn't. I've never seen a medic, especially a senior one, diagnose a group of people, over the Internet, based on their own experience.

Let's also not forget how the CF lied to get the stuff into Canada by saying it was for medical trials through Health Canada and then issued it to guinea pig soldiers . There are no test results at either organisation . So much for studies and those injured by the callous disregard of the liberal government of the time and others after them.

I never made a diagnosis - an observation...and oddly that observation is based on not only my own experience with the stuff, but my experience prescribing it and my experience dealing with patients that have been on it, often more than once.  I read all the testimony from the hearings in Parliament back in the 90's - it was pure BS *** covering from both sides of the coin.  I've also read a large number of articles, some I'd call quality ones and others I'd call sensationalist fire starter.  All, including the monographs from the 90's state that there are potential neuropsychiatric issues with using it...oddly enough, worsened by the effects of alcohol, something of an issue with both Canadian and British forces up until recently...and all US/UK/Cdn forces while on leave.  Not so funnily enough, those same side effects are prevalent in certain population groups with a couple of very commonly prescribed antibiotics in Canada and the world over...but I've yet to be called in front of a Ministerial Inquiry/Inquisition because I made some folks see purple elephants or ghosties that weren't there by following what is considered standard of care with those drugs.  I stopped the medications and switched to one of the alternatives...which if people on mefloquine had actually asked, would have happened and continues to today, since most of the drugs used for prevention cause a lot of gut rot and other issues, including neuropsychiatric ones.

As for the rather emotional statement of yours about guinea pigs - something not for a rational/logical debate on anything, least of all here - the actual human guinea pigs were not in fact Canadian or British or American soldiers - they actually were US federal penitentiary inmates in the 70's while the drug was undergoing its Phase III trial.  It was based on that human safety trial that it was released to the public...and to the US Army for use in Vietnam, where many soldiers were being incapacitated or worse by various strains of falciparum malaria.  Non soldiers were using it for quite sometime in a wide variety of countries long before it landed here for use.  In the same vein, you may or may not have noted that many of our drugs or devices used in the CAF over the years were allowed to bused under Health Canada's Special Access Program.  Things like Quik Clot, Combat Gauze and other hemostatic agents, CAT or SOF-T's, morphine and valium auto injectors, HI-6, and pyridostigmine to name a few, were not licensed in Canada for what they're intended for up until recently (IIRC, the CBRN stuff still isn't - someone can correct me if I'm out of date there), yet was fired out the door to make sure soldiers had stuff to protect themselves, treat themselves or prevent badness from happening to them if they were exposed to it.  Believe me, the only complaints I heard in the early 2000's were about why we didn't have some of this stuff.

To make a long story short, while I'm sure there are a good number of people out there who have had issues with this stuff, I think you'll find that there are an awful lot more that didn't.

Lastly, I hope you didn't bruise your teddy when you threw him in the corner with your last post - a very legitimate question was asked and answered - the optics are that you didn't hear what you wanted to hear and you pulled your Mod Card out.  I'm not usually one to complain about things here, but, IMHArmyO that was offside.

:2c:

MM
Title: Re: Mefloquine (a.k.a Lariam) anti-malarial in CF use (merged)
Post by: Fishbone Jones on June 03, 2016, 22:54:18
The Staff warning was to keep the thread on track as some were starting it down the path of obeying orders, legal scenarios, etc. That's why it was a stand alone post. Accusing me for doing my job, well, that's what's offside.

BTW, I don't have a teddy bear. I killed him years ago. His head is on the wall of my mancave and the rest of him is vacuum packed in the deep freeze. (Technically, I still have a teddy bear but in name only)

I just found it odd the a senior medic would dismiss people out of hand before ever meeting them. No matter what they've seen or done. Perhaps I misread and apologize if I did. :salute:

The rest of the stuff (auto injectors and such) is really just a straw argument and really doesn't mean anything to the subject.

But if you say the crap is good to go, I wonder why all these countries are withdrawing millions of dollars worth of the stuff. If you have inside info as to why they are so mistaken, I'd like to hear it. Seriously. I watched lots of friends do the Dr Jekyll/ Mr Hyde scenario when they were taking it. Including myself, which may explain my passion for the subject.
Title: Re: Mefloquine (a.k.a Lariam) anti-malarial in CF use (merged)
Post by: medicineman on June 04, 2016, 12:16:29
One of the reasons it's being withdrawn from first line use is newer agents are finally coming on the market that will hopefully fill that gap - the problem is that it is still considered one of the most effective first line agents for multidrug resistant falciparum malaria, which is the stuff that kills you and causes more problems more frequently than the other 4 species.  I did a travel medicine consult on someone not long ago, and the US CDC travellers website still had it as a drug of choice for sub-Saharan Africa, where these folks were going.

The other reason is the public outcry over the stuff being used by the armed forces of various nations and having (what appears to be) an oddly higher than normal side effect occurrence rate than in the general civilian populations being prescribed the medication.  Some of that I believe (my opinion only) is because of exposure issues to things that cause PTSD, and it magnifying it because of it's affect on the central nervous system.  Don't forget, a lot of these drugs have to cross the blood brain barrier because you can get cerebral malaria as well, which as you might imagine is quite serious.  Add some hallucinations, lack of sleep and increased anxiety because of those as well as where you are, you have a potentially nasty cocktail of problems that might be brewed in some folks.  The other issue with our military populations is a preponderance for alcohol consumption - this drug, especially in those that are having higher psychiatric side effects, doesn't mix well with booze AT ALL.  It's cleared by the liver first off, so it's competing with the alcohol and secondly, the alcohol has disinhibitory effects and messes with the sleep cycle, so people are more apt to freak out, since the stuff isn't clearing the body the way it's supposed to.

I'm probably one of the least dismissive medical people you'll meet...I can be quite blunt with people about what's wrong with them and what they should do about it, but that's after I've heard them  out and looked them over.  One of the problems with this particular issue is the emotion it brings out in people...the other side of it is the problem of "association doesn't always mean causation" when it comes to this problem, since there are many factors involved.  Your comment about the Special Access Program actually has much relevance to this topic, since pyridostigmine bromide, a drug licensed in Canada and many other places to treat myasthenia gravis, a neuro muscular disorder, is NOT LICENSED for use as a nerve agent protective agent, but was granted special access due to animal research and mechanism of action.  It was used during Desert Storm by all coalition forces and was something thought to have a role in so called Gulf War Syndrome...something we don't hear about as much.

Lastly and most importantly, THANK YOU FOR YOUR APOLOGY and thanks for hearing me out.

MM
Title: Mefloquine Article of Interest
Post by: bigdaddyfatback on November 15, 2016, 21:00:11
http://www.theglobeandmail.com/news/politics/sajjan-puts-onus-on-troops-while-defending-use-of-harmful-malaria-drug/article32846896

I and many others have taken this drug. The sell at the time was take it or get malaria. Complications from malaria may not be pensionable if you turned down the mefloquine.

I don't remember really having a choice around taking it either.

What is everyone else's experience around this issue?
Title: Re: Mefloquine Article of Interest
Post by: LunchMeat on November 16, 2016, 01:02:15
Another item of interest:

Quote
Veterans urge second look at soldier’s role in torture death of Somali teen in light of malaria drug’s side effects

Sheila Pratt, Postmedia News
Monday, Nov. 14, 2016

SASKATOON — Former Canadian Airborne soldier Clayton Matchee lives in a North Battleford, Sask., home afflicted with brain damage from a suicide attempt — a desperate act after he was charged in the murder of a Somali teenager.

That was more than 20 years ago, during Canada’s ill-fated Somali mission. Since then, Matchee’s name has carried the shame of that episode of Canadian military history.

But there’s a move afoot to change that view. Some of his fellow soldiers and a prominent U.S. medical expert now believe Matchee was experiencing severe psychological side effects of the controversial antimalarial drug mefloquine when he was involved in the beating death of Somali Shidane Arone in 1993.

Those veterans urged federal MPs on the parliamentary committee on veterans affairs to consider re-examining the incident in light of new research on the drug’s harmful side effects.

Lalancette changed his mind after learning of new research into the side effects of mefloquine, which include heightened aggression, paranoia, anxiety and vivid dreams.

“I feel shame because I put blame on Clayton Matchee and (Edmonton soldier) Kyle Brown,” Lalancette told the veterans affairs committee. (Brown spent four years in jail for his role in the beating death.)

“We should reach out to the victims of this pill and the first two would be Kyle Brown and the Matchee family,” Lalancette said.

In 1992-93, the 900 Canadian Airborne soldiers were among the very first Canadians to take mefloquine as part of a clinical drug trial run by the Canadian army. The side effects were not well understood or explained to soldiers.

Some of his fellow soldiers and a prominent U.S. medical expert now believe Clayton Matchee, shown here at a 2004 hearing in Saskatoon, was experiencing severe psychological side effects of the controversial antimalarial drug mefloquine when he was involved in the beating death of Shidane Arone in 1993.
That’s why the Matchee case should be reopened, said Dr. Remington Nevin, the leading U.S. expert on mefloquine’s neuropsychiatric side effects.

“I feel confident I can render an opinion as to whether his behaviour during that time may have been in some way affected by the drug,” Nevin told the MPs on the committee.

Given the new research into the drug, “many of the points of confusion that dominated discussion then no longer apply,” he said.

“We could come to a more solid mutual conclusion about the events of that day and the role of the drug in his particular case,” Nevin told the committee.

Leon Matchee, father of Clayton Matchee, reacted cautiously to the suggestion that his son’s case should be reopened. After so many years, it is difficult to hear about those terrible events again, he said in a phone call from his home in Meadow Lake, Sask.

John Dowe was one of the few Canadian Airborne soldiers to witness the beating of the Somali teen, who had stolen supplies from the Canadian Forces’ compound. He’s also convinced Matchee was hallucinating at the time and that his heightened aggression was a result of the drug’s side effects.

He described Matchee striking the bunker walls and the prisoner Arone with a wooden baton, calling out that he was killing camel spiders when clearly there were no spiders in the bunker.

“Him beating spiders that were not there — he was hallucinogenic,” Dowe said.

The 1996 Somalia Inquiry into those fateful events was shut down just a few days before evidence on mefloquine was to be heard, former Canadian army psychiatrist Greg Passey told the committee.

The inquiry commission’s final report said it was “not able to explore fully the impact of mefloquine.” The committee said it could only report some “general conclusions.”

“If mefloquine did in fact cause or contribute to some of the misbehaviour that is the subject of this inquiry, CF personal who were influenced by the drug might be partly or totally excused for their behaviour. However we were not able to reach a final conclusion on the issue,” the report said.


LINK (http://news.nationalpost.com/news/canada/veterans-urge-another-look-at-clayton-matchee-case-in-light-of-malaria-drugs-side-effects)
Title: Re: Mefloquine Article of Interest
Post by: Brihard on November 16, 2016, 01:43:58
I remember being given three options for antimalarials, and no information on them beyond how frequent the doses were to be taken. I remember a lawful order to pick one and take it. With nothing else to go on, I picked the weekly option, Mefloquine. There was no 'informed consent'. That's utter hogwash.
Title: Re: Mefloquine Article of Interest
Post by: PMedMoe on November 16, 2016, 08:39:58
I remember being given three options for antimalarials, and no information on them beyond how frequent the doses were to be taken. I remember a lawful order to pick one and take it. With nothing else to go on, I picked the weekly option, Mefloquine. There was no 'informed consent'. That's utter hogwash.

Depends on when you deployed (and maybe with who).  I remember having to give briefings on all three meds as early as 2005 and everyone had to see a pharmacist with their choice.  YMMV.
Title: Re: Mefloquine (a.k.a Lariam) anti-malarial in CF use (merged)
Post by: Occam on November 16, 2016, 09:35:31
On HMCS Preserver in 92/93 for Op Deliverance (supporting the Canadian Airborne Regiment in Somalia), we were given mefloquine and the directions that everyone will take it - except personnel from the HelAirDets in flying positions.  They took doxycycline.
Title: Re: Mefloquine Article of Interest
Post by: Jarnhamar on November 16, 2016, 10:05:33
Quote
Defence Minister Harjit Sajjan is defending his department’s continued prescription of an anti-malarial drug that Health Canada now agrees can cause permanent brain damage, saying troops make their own informed decisions about whether to take it.

Awesome.


I remember being given three options for antimalarials, and no information on them beyond how frequent the doses were to be taken. I remember a lawful order to pick one and take it. With nothing else to go on, I picked the weekly option, Mefloquine. There was no 'informed consent'. That's utter hogwash.
Same here.
First time we were told we will take it or be charged with disobeying a lawful order. That included the usual threats that we wouldn't be covered under VA if we got sick.
Next time we were given 3 options and ordered to pick one with no information beyond dosage.
Title: Re: Mefloquine Article of Interest
Post by: AirDet on March 30, 2017, 16:48:45
Awesome.

Same here.
First time we were told we will take it or be charged with disobeying a lawful order. That included the usual threats that we wouldn't be covered under VA if we got sick.
Next time we were given 3 options and ordered to pick one with no information beyond dosage.

We were given the same line in East Timor but no choice. Mefloquine or a charge and sent home.

We named our days by the drug:
-Mefloquine Mondays
-Terror Tuesdays
-Nightmare Wednesdays... etc.

Some of us even reported "daymares" after the Monday dosage.
Title: Re: Mefloquine (a.k.a Lariam) anti-malarial in CF use (merged)
Post by: milnews.ca on June 01, 2017, 14:25:12
The latest from the Surgeon General (https://www.canada.ca/en/department-national-defence/news/2017/06/the_surgeon_generalannouncesfindingsfromthereviewontheoperationa.html) - highlights mine ...
Quote
The Government of Canada is committed to protecting and enhancing the health and well-being of Canadian Armed Forces (CAF) members. Today, the Department of National Defence and the CAF announced the release of the findings from the Surgeon General’s Review on the Operational Use of Mefloquine. The review looked at available literature on mefloquine use and how it is used in an operational setting.

Mefloquine will now only be recommended for use if a CAF member requests it, or if there are contraindications to the member being prescribed other anti-malarials.

Quotes

    “The health and well-being of our people is directly linked to the operational effectiveness of the Canadian Armed Forces. Because of this, I have a duty to ensure everyone under my command has access to the best options for medical care currently available. I am confident the Surgeon General’s recommendations, which are supported by third-party evidence, are consistent with ensuring the overall health of our women and men.”

    General Jonathan Vance, Chief of the Defence Staff

    “We are recommending mefloquine as a second line drug only, because of the unique operational environment that we work in. This direction should not be applied to a non-military environment. We will continue to monitor and review all relevant scientific literature on mefloquine.”

    Brigadier-General Colin MacKay, Surgeon General


Quick Facts

    Canadian Clinical Practice Guidelines for malaria prevention are consistent with other national and international guidelines in that mefloquine is considered a first-line option.

    Compared to currently recommended alternatives, the body of evidence suggests mefloquine is not consistently associated with an excess overall risk of adverse effects, nor is it associated with an excess risk of not being able to perform occupational duties.

    No evidence was found (that met the inclusion criteria) that would suggest potential long-term adverse effects of mefloquine on human health.

    The report also recommended caution for the CAF, because the deployment of large numbers of personnel within a short period of time can pose challenges for adequately screening individuals for potential contraindications. Additionally, the dispersed deployment of personnel, limiting access to physicians on operations, may reduce opportunities to assess for adverse effects and if necessary to provide alternative medications to CAF personnel taking mefloquine. Also, the nature of the short term side effects associated with mefloquine could impact an individual’s performance and could be confused with usual responses to operational situations, which would in turn complicate the management of adverse effects ...
Full report attached.