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Mefloquine.

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VOL: 102, ISSUE: 16, PAGE NO: 32

Generic and proprietary names

Generic and proprietary names
- Mefloquine.

- Lariam.

Action
- Active against the erythrocytic stage of the plasmodium species.

Classification
- Antimalarial.

Indications
- Prophylaxis of malaria in areas with a high risk of chloroquine-resistant falciparum malaria.

Contraindications

- History of neuropsychiatric disorders including depression and convulsions.

- Hypersensitivity to quinine.

Cautions
- Pregnancy - avoid pregnancy while taking and for three months after.

- Breastfeeding.

- Severe hepatic impairment.

- Cardiac conduction disorders.

- Epilepsy.

- Infants under three months of age or less than 5kg in weight.

Common side-effects
- Nausea, vomiting, diarrhoea and abdominal pain.

- Dizziness and loss of balance.

- Headache.

- Sleep disorders.

- Neuropsychiatric reactions.

- Tinnitus and vestibular disorders.

- Visual disturbances.

- Circulatory and cardiac problems.

- Dyspnoea.

- Myalgia and arthralgia.

- Rash.

- Alopecia.

- Asthenia.

- Fever and malaise.

- Fatigue.

- Loss of appetite.

- Leucopenia or leucocytosis.

- Thrombocytopenia.

Interactions
- Anticonvulsants.

- Other antimalarial drugs.

- Beta-blockers.

- Calcium-channel blockers.

- Digitalis drugs.

Administration
- Tablets.

- Taken only once a week.

- Start 2.5 weeks before entering endemic area and continue for four weeks after leaving.

Nursing considerations
- Mefloquine doses in the BNF may differ from those in product literature.

- Travellers should be informed about adverse reactions and, if they occur, that they should seek medical advice on alternative antimalarials before the next dose is due.

- Travel to malarious areas should be avoided during pregnancy; if it is unavoidable, effective prophylaxis must be used but mefloquine should be avoided as a matter of principle. However, studies of mefloquine use in pregnancy (including in the first trimester) indicate that it can be considered for travel to chloroquine-resistant areas.

- Mefloquine is considered to be appropriate for use by people with renal impairment and does not require dosage reduction.

Patient teaching
- Warn travellers they should still avoid mosquito bites.

- Ensure travellers understand the importance of taking prophylaxis regularly.

- Advise travellers to seek urgent medical attention if ill within one year and especially within three months of return.

- Dizziness or a disturbed sense of balance may affect performance of skilled tasks such as driving.

- The patient information leaflet that describes adverse reactions should always be provided with mefloquine.

Nurses should refer to manufacturer's summary of product characteristics and to appropriate local guidelines

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