Classes
DEA Class; Rx
Common Brand Names; Lariam
- Antimalarials
Description
Oral antimalarial agent used for malaria prophylaxis or treatment. Prophylactic dosing should begin 1 week before entering endemic area and continue for 4 weeks after leaving. Alternative antimalarial in areas where chloroquine- and proguanil-resistant strains of malaria exist (i.e., European countries). Treatment of choice for malaria in the United States.
Indications
Indicated for the treatment of mild-to-moderate acute malaria caused by mefloquine-susceptible strains of P. falciparum (both chloroquine-susceptible and resistant strains) or by Plasmodium vivax
Contraindications
Hypersensitivity to mefloquine, related drugs (eg, quinidine, quinine)
Do not prescribe for prophylaxis in patients with active or recent history of depression, generalized anxiety disorder; history of psychosis, schizophrenia, other major psychiatric disorders, or convulsions
Adverse Effects
- Anxiety
- Difficulty concentrating
- Headache
- Insomnia
- Lightheadedness
- Vertigo
- Vomiting
- Diarrhea
- Stomach pain
- Nausea
- Visual disturbances
- Tinnitus
Warnings
In case of life-threatening, serious or overwhelming malaria infections due to P. falciparum, patients should be treated with an IV antimalarial drug; following completion of IV treatment, mefloquine may be given to complete the course of therapy
May increase QT interval; caution with other drugs known to prolong QT interval; halofantrine or strong CYP3A4 inhibitors (eg, ketoconazole) should not be administered concomitantly or within 15 weeks of last dose of mefloquine due to risk of a potentially fatal prolongation of QTc interval
Transitory and clinically silent ECG alterations have been reported during therapy; alterations included sinus bradycardia, sinus arrhythmia, first-degree AV-block, and abnormal T waves; benefits of therapy should be weighed against possibility of adverse effects in patients with cardiac disease
Caution with hepatic impairment
If drug is to be administered for a prolonged period, periodic evaluations including liver function tests and evaluations for neuropsychiatric effects should be performed
Agranulocytosis and aplastic anemia reported
Geographical drug resistance patterns of P. falciparum occur and the preferred choice of malaria prophylaxis might be different from one area to another
Periodic ophthalmic examinations recommended; retinal abnormalities seen in humans with long-term chloroquine use have not been observed with mefloquine use; however, long- term feeding of mefloquine to rats resulted in dose-related ocular lesions
Pregnancy and Lactation
Pregnancy Category: B
Lactation: Minimally excreted in human breast milk; based on a study in a few subjects, low concentrations (3% to 4%) excreted; caution advised
Maximum Dosage
1,250 mg PO once for treatment or 250 mg PO once/week for prophylaxis.
1,250 mg PO once for treatment or 250 mg PO once/week for prophylaxis.
more than 45 kg: 20 to 25 mg/kg PO (Max: 1,250 mg) once for treatment or 250 mg PO once/week for prophylaxis.
30 to 45 kg: 20 to 25 mg/kg PO once for treatment or 187.5 mg (3/4 tablet) PO once/week for prophylaxis.
more than 45 kg: 20 to 25 mg/kg PO (Max: 1,250 mg) once for treatment or 250 mg PO once/week for prophylaxis.
30 to 45 kg: 20 to 25 mg/kg PO once for treatment or 187.5 mg (3/4 tablet) PO once/week for prophylaxis.
20 to 29 kg: 20 to 25 mg/kg PO once for treatment or 125 mg (1/2 tablet) PO once/week for prophylaxis.
less than 20 kg: Safety and efficacy have not been established; however, 20 to 25 mg/kg PO once for treatment or 62.5 mg (1/4 tablet) PO once/week for prophylaxis has been recommended.
6 to 11 months and weighing 5 kg or more: Safety and efficacy have not been established; however, 20 to 25 mg/kg PO once for treatment or 5 mg/kg/dose PO once/week for prophylaxis has been used.
1 to 5 months or weighing less than 5 kg: Safety and efficacy have not been established.
Safety and efficacy have not been established.
How supplied
Mefloquine
tablet
- 250mg
