Mefloquine (a.k.a Lariam) anti-malarial in CF use (merged)

[medicineman]

AFAIK, this medication is not available in the CF.

It's choloroquine, so yes it is

MM

 

[PMedMoe]

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:

 

[CombatDoc]

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.

 

[medicineman]

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

 

[PMedMoe]

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://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

But we digress......back to your regularly scheduled thread. 

 

[CombatDoc]

Moe,  you're absolutely right on the mefloquine (meflomares) vice malarone, my brain said mefloquine but my fingers typed malarone. 

 

[Pieman]

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.

 

[Pieman]

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:

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.

 

[dangerboy]

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.

 

[Edward Campbell]

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.

 

[Pieman]

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?

 

[McG]

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.

 

[Armymedic]

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.

 

[Pieman]

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. 

 

[Edward Campbell]

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.

 

[Fishbone Jones]

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)

 

[Snaketnk]

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.

 

[PuckChaser]

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.

 

[ModlrMike]

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.

 

[medicineman]

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