Keeping Score on Psychiatric Drug Effects: Is Mefloquine Safe for Malaria Chemoprophylaxis?

Abstract

Background:

Armed servicemen or tourists visiting Asian and African continents bear the risk of contracting falciparum malaria. Chemoprophylaxis, for certain individuals, is recommended. All drugs marketed for prophylaxis of malarial infection have adverse effects. Notably, antimalarial drugs can impose neuropsychiatric harm. Mefloquine is a widely used malaria chemoprophylactic despite its association with neuropsychiatric symptoms including panic attacks, seizures, headaches, visual and auditory hallucinations, sleeplessness, paranoia, and psychosis.

Objective:

To emphasize caregiver counseling and ensure patient follow-up for nonimmune travelers to malaria indigenous regions when mefloquine chemoprophylaxis is scheduled.

Data Sources and Selection:

A literature search was conducted through May 1, 2004, for reports of psychologic or neurologic adverse effects following mefloquine therapy. After review of MEDLINE, EMBASE, and EMBR citations, pertinent articles were selected if they were thought to be of special interest to physicians and pharmacists handling mefloquine.

Data Synthesis:

Literature to date indicates a higher rate of drug-provoked neuropsychiatric adverse effects than that acknowledged by mefloquine's manufacturer, Hoffman LaRoche. There is also evidence supporting a greater incidence of adverse effects for specific groups. Neuropsychiatric adverse effects are more often reported by females, particularly low body-weight females. Individuals who ingest mefloquine while under stress appear more at risk for neuropsychiatric adverse effects.

Conclusions:

Professional consult and therapeutic follow-up for all patients receiving mefloquine chemoprophylaxis is warranted.