Lariam (antimalarial drug) side effects

Tanja

Comfortably Numb
Tanja
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Nov 15, 2003
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I am travelling to South Africa next week (how cool is that), and I will be spending a couple of days in Kruger National Park, where the risk of malaria is relatively high.

I have been reading a lot about antimalarials, and have been very intrigued by the side effects of Lariam (mefloquine), which is one of the most prescribed prophylactics.

On Wikipedia, the side effects are listed as:

Mefloquine may have severe and permanent adverse side-effects. It is known to cause severe depression, anxiety, paranoia, aggression, nightmares, insomnia, seizures, birth defects, peripheral motor-sensory neuropathy, vestibular (balance) damage and central nervous system problems.
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I know that the plural of anecdote is not data etc, but I am really interested in finding out if people here had taken Lariam, and whether they suffered any such side effects? In a way I am asking because they are interesting side effects, rather than to help me decide which antimalarial to take - I have made an apointment with my doctor for that reason.

One of my friends travelled to India, and the person she was travelling with had a panic attack when they entered a pastry shop "because he was so overwhelmed by the number of pastries they were selling". They were later laughing at the event because it was out of character for him, and attributed it to Lariam.
 
http://www.drugs.com/pro/lariam.html

from the "The official FDA-approved" Website:

(quote)

Contraindications

Use of Lariam is contraindicated in patients with a known hypersensitivity to mefloquine or related compounds (eg, quinine and quinidine) or to any of the excipients contained in the formulation. Lariam should not be prescribed for prophylaxis in patients with active depression, a recent history of depression, generalized anxiety disorder, psychosis, or schizophrenia or other major psychiatric disorders, or with a history of convulsions.
Warnings

In case of life-threatening, serious or overwhelming malaria infections due to P. falciparum, patients should be treated with an intravenous antimalarial drug. Following completion of intravenous treatment, Lariam may be given to complete the course of therapy.
Data on the use of halofantrine subsequent to administration of Lariam suggest a significant, potentially fatal prolongation of the QTc interval of the ECG. Therefore, halofantrine must not be given simultaneously with or subsequent to Lariam. No data are available on the use of Lariam after halofantrine (see PRECAUTIONS: Drug Interactions).
Mefloquine may cause psychiatric symptoms in a number of patients, ranging from anxiety, paranoia, and depression to hallucinations and psychotic behavior. On occasions, these symptoms have been reported to continue long after mefloquine has been stopped. Rare cases of suicidal ideation and suicide have been reported though no relationship to drug administration has been confirmed. To minimize the chances of these adverse events, mefloquine should not be taken for prophylaxis in patients with active depression or with a recent history of depression, generalized anxiety disorder, psychosis, or schizophrenia or other major psychiatric disorders. Lariam should be used with caution in patients with a previous history of depression.
During prophylactic use, if psychiatric symptoms such as acute anxiety, depression, restlessness or confusion occur, these may be considered prodromal to a more serious event. In these cases, the drug must be discontinued and an alternative medication should be substituted.
Concomitant administration of Lariam and quinine or quinidine may produce electrocardiographic abnormalities.
Concomitant administration of Lariam and quinine or chloroquine may increase the risk of convulsions. " (end of quote)



-it sounds like more than anecdote
-another thing I observed: it has a long half-life in the body, several weeks.

I, personally, wouldn't take it, being a donkey on the edge, 'n all.
 
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Just having a little fun, here.

From a 2003 PDR. Roche Labs. pg. 2913

Adverse Reactions, Clinical:

most frequent, 3%: vomiting.
less than 1%: Dizziness, syncope

Postmarketing: The most frequent reported adverse events are:
vomiting, loose stools or diarrhea, abd. pain, dizziness or vertigo, loss of balance, and neuropsychiatric events such as:

headache, somnolence, and sleep disorders. These are usually mild and may decrease despite continued use...

Occasionally, more severe neuropsych.:

(basically the same list)...Rare cases of suicidal ideation and suicide have been reported though no relationship to drug administration has been confirmed. (end quote)

So, rare cases. Malaria is much worse.
 
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I took it on two holidays about 15-17 years ago and had absolutely no problems with it, and none of my travel companions had any problems either. A travel agent I knew quite well at that time (from a former holiday in Croatia where we both had been with our parents while younger, and then met her again years later coincidentally, when I was asking about flight prices in various agencies, and surprise, surprise, she was one of the owners of one of those agencies. When we met the first time, we were not even living in the same city.) told me that it completely ruined one vacation of hers though, because she was depressed all the time. As far as I know, she did not have any mental issues before.
 
I hope you enjoyed your holiday in Croatia all those years ago (that's where I am originally from). :)
 
Tanja said:
I hope you enjoyed your holiday in Croatia all those years ago (that's where I am originally from). :)
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That´s why I wrote the story, otherwise it would not have made too much sense :). I think we have not communicated before, but I read a lot more threads here than I write in, so I remembered you mentioning that somewhere.
And yes, I enjoyed all (maybe ten to fifteen all in all, sometimes we went twice a year, and it was the place to go on holidays for my parents when I was a child) my croatia holidays a lot. Most of the times we went near Porec, and once made it further south to Dubrovnik. We mostly were on camping sites (does Koversada still exist?) to keep it cheap, but it was great fun.
 
Personally I would go with doxycycline instead if you think you are prone to things like vivid dreams. Do you really want to go to Africa and have bizarre late night dreams about giant mosquitos?

Then again last time I traveled to Africa I was already taking doxy for unrelated stuff so it was doing double duty. My wife took the Lariam and didn't have any side effects that I can remember except possibly more vivid dreams.
 
Again, anecdotal, but a friend who travelled who India ended up on the roof of the house he was staying in crying over an ex-girlfriend that he'd broken up with years before. Most definitely attributed to Larium.

He wrote a song about it later.. It was quite catchy. :)
 
Actually, as most of my dreams are quite unmemorable, I am quite intrigued by the opportunity to have very vivid dreams :D (I will still ask the doctor for Malarone)
 
Ripley Twenty-Nine said:
Again, anecdotal, but a friend who travelled who India ended up on the roof of the house he was staying in crying over an ex-girlfriend that he'd broken up with years before. Most definitely attributed to Larium.

He wrote a song about it later.. It was quite catchy. :)
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Oh, no - one of the people I am travelling with does that all the time even when he is not on Lariam. I wonder which medication he will be taking...
 
NewtonTrino said:
Personally I would go with doxycycline instead if you think you are prone to things like vivid dreams. Do you really want to go to Africa and have bizarre late night dreams about giant mosquitos?

Then again last time I traveled to Africa I was already taking doxy for unrelated stuff so it was doing double duty. My wife took the Lariam and didn't have any side effects that I can remember except possibly more vivid dreams.
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I did doxycycline when I went to Iraq the first time; I think I'd rather have Lariam. The constant antibiotics were a pain (you have to take them much more often) and caused some trouble with my intestinal fauna (I didn't poop right for quite some time).

But YMMV. Decide whether you want vivid dreams or vivid excretions :)
 
IIRC, part of the decision of which antimalarial you should take has to do with the drug-resistance (or lack thereof) in strains of malaria in the area you will be visiting.

Be sure that your doctor knows exactly where you will be travelling / staying.

Oh, the CDC has really cool data on various malaria strains, where they are found, and what does or does not work on them! It also has travel profiles for various countries.

http://wwwn.cdc.gov/travel/destinationSouthAfrica.aspx (linky)

Just going to CDC alerted me that Marburg has broken out in Uganda! Not something I'd heard about...it's one of the filoviruses, like Ebola, and it's often lethal. I am fascinated with, and horrified by, all hemorrhagic fevers...which is why the CDC is in my "Favorites" list of sites.

Have a great visit!!!
 
Tanja- add me to the "no side effects" list. I used it several times in the 90s with no problems. As always, read the instructions and note appropriate start and stop dates.
 
I've taken lariam and not noticed anything.

I've also had malaria which I contracted in Guatemala while taking chloroquine, which shows that prophylactics don't always work.

Malaria is horrible and definitely worth avoiding and I had one of the milder varieties.
 
Tanja said:
Actually, as most of my dreams are quite unmemorable, I am quite intrigued by the opportunity to have very vivid dreams :D (I will still ask the doctor for Malarone)
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Apparently they're really not fun dreams. My sister took Larium while in Kenya, as did several people with her, and most of them absolutely hated it.

Edit: I should note that as far as I know neither my sister or anyone else on that trip has ever suffered from any kind of depression or any other mental illness.

ectoplasm said:
I've also had malaria which I contracted in Guatemala while taking chloroquine, which shows that prophylactics don't always work.
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Yeah, my sister got malaria as well. I presume it was a side effect of mosquitoes rather than of the drugs.
 
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Commencing anecdotes:

My sister took Lariam when she went to Cameroon, and definitely suffered the classic symptoms (intense, upsetting dreams, mostly, leading in to feeling fairly wretched). She already wasn't (and still isn't) the most mentally robust, some tendency to mild depression - probably should have taken something else.

I went on a long-distance truck trip through eastern and southern Africa - I was on 'doxy' and felt fine (well, my guts weren't entirely stable but you'd have to expect that regardless of antimalarials)

Several people on the truck took Lariam, and seemed slightly competitive in describing their intense dreams, but no-one had any severe consequences.

If anything, the daily requirement to take doxy was easy to remember, while the weekly Lariam was more of a pain because they did have to plan around the side effects to some degree.

...anecdotes end.
 
Tanja said:
Actually, as most of my dreams are quite unmemorable, I am quite intrigued by the opportunity to have very vivid dreams :D (I will still ask the doctor for Malarone)
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[anecdote]When I first went to east Africa I took Lariam and it had not adverse affect. And I am prone to vivid dreams anyway. A number of our group claimed to have more vivid dreams when taking it, but nothing too unsettling. On recent trips to Ghana I took Malarone and found that it made me achy (flu-like aches in the joints). I used a paracetemol and a ibuprofen tablet every 4 hours to sort that out. A combination used at the suggestion of a specialist when I was dealing with a particularly "annoying" kidney stone [/anecdote]

Note I am not a doctor, nor do I play one on internet. I'd suggest discussing any of this with a properly qualified doc before taking any of the above into consideration!
 
EHocking said:
Note I am not a doctor, nor do I play one on internet. I'd suggest discussing any of this with a properly qualified doc before taking any of the above into consideration!
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Thanks! I saw my GP this morning, and she prescribed Malarone (she offered me the choice of Malarone or doxycycline and I opted for Malarone as she mentioned that doxycycline does not interact well with exposure to sun).

Anyway, it's less than I week till I go to South Africa, and I can hardly wait! During my visit to Kruger I will be staying in a tree house! :)
 
It's true that doxycycline doesn't interact well with the sunlight.

When I was in africa I pretty much wore full sleave pants and shirts anyway to keep off the mosquitos.
 
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