Pronunciation:

ME-floe-kwin

Brand Names:

• Lariam

Dosage Forms:

• Tablet

Classifications:

Therapeutic—

Antimalarial

Uses of This Medicine:

Mefloquine belongs to a group of medicines called antimalarials. It is used to prevent or treat malaria, a red blood cell infection transmitted by the bite of a mosquito.

Malaria transmission occurs in large areas of Central and South America, Hispaniola, sub-Saharan Africa, the Indian subcontinent, Southeast Asia, the Middle East, and Oceania. Country-specific information on malaria can be obtained from the Centers for Disease Control and Prevention (CDC), or from the CDC's web site at http://www.cdc.gov/travel.

This medicine may cause some serious side effects. Therefore, it is usually used only to prevent the symptoms of malaria or to treat serious malaria infections in areas where it is known that other medicines may not work.

Mefloquine is available only with your doctor's prescription.

Before Using This Medicine:

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For this medicine, the following should be considered:

Allergies—

Tell your doctor if you have ever had any unusual or allergic reaction to this medicine or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.

Children—

Children should avoid traveling to areas where there is a chance of getting malaria, unless they can take effective antimalarial medicines such as mefloquine. Studies on this medicine have not been done in infants below the age of 6 months old.

Older adults—

Many medicines have not been studied specifically in older people. Therefore, it may not be known whether they work exactly the same way they do in younger adults or if they cause different side effects or problems in older people. There is no specific information comparing use of mefloquine in the elderly with use in other age groups. However, elderly people may be more sensitive to the adverse effects of mefloquine which may require caution.

Pregnancy—

	Pregnancy Category	Explanation
All Trimesters	C	Animal studies have shown an adverse effect and there are no adequate studies in pregnant women OR no animal studies have been conducted and there are no adequate studies in pregnant women.

Breast-feeding—

There are no adequate studies in women for determining infant risk when using this medication during breastfeeding. Weigh the potential benefits against the potential risks before taking this medication while breastfeeding.

Other medicines—

Using this medicine with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.

• Aurothioglucose
• Bepridil
• Cisapride
• Halofantrine
• Isradipine
• Levomethadyl
• Mesoridazine
• Pimozide
• Terfenadine
• Thioridazine
• Ziprasidone

Other interactions—

Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. Discuss with your healthcare professional the use of your medicine with food, alcohol, or tobacco.

Other medical problems—

The presence of other medical problems may affect the use of this medicine. Make sure you tell your doctor if you have any other medical problems, especially:

• Allergy to mefloquine or similar medicines such as quinine and quinidine or
• Psychiatric conditions such as
  • Active depression or recent history of depression or
  • Generalized anxiety disorder or
  • Psychosis or
  • Schizophrenia or
  • Other major psychiatric disorders or
• Convulsions, history of—Mefloquine should not be taken if you have any of these conditions.

• Depression previous history of—Mefloquine should be used with caution.

• Epilepsy or
• Seizure disorder—Mefloquine may make these conditions worse.

• Heart conditions or
• Liver problems—Mefloquine should be used with caution.

Proper Use of This Medicine:

Mefloquine is best taken with a full glass (8 ounces) of water and with food, unless otherwise directed by your doctor.

Mefloquine may be crushed and put in water, milk, or juice to make it easier to take.

For patients taking mefloquine to prevent the symptoms of malaria:

• Your doctor will want you to start taking this medicine one week before you travel to an area where there is a chance of getting malaria.
• Also, you should keep taking this medicine while you are in the area where malaria is present and for 4 weeks after you leave the area. No medicine will protect you completely from malaria. However, to protect you as completely as possible, it is important that you keep taking this medicine for the full time your doctor ordered. Also, if fever or “flu-like” symptoms develop during your travels or within 2 to 3 months after you leave the area, check with your doctor immediately.
• This medicine works best when you take it on a regular schedule. For example, if you are to take it once a week, it is best to take it on the same day each week. Do not miss any doses. If you have any questions about this, check with your health care professional.

For patients taking mefloquine to treat malaria:

• To help clear up your infection completely, take this medicine exactly as directed by your doctor.

Children taking mefloquine to treat malaria may vomit after taking this medicine. Your child may vomit some of the dose of medicine. Contact your child's doctor if vomiting occurs. The doctor may need for you to give your child more medicine.

Dosing—

The dose of this medicine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

The number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on whether you are using mefloquine to prevent or to treat malaria.

• For oral dosage form (tablets):
  • For prevention of malaria:
    • Adults and children weighing over 45 kilograms (kg) (99 pounds)—250 milligrams (mg) (1 tablet) one week before traveling to an area where malaria occurs. Then 250 mg once a week on the same day of each week and preferably after your main meal while staying in the area and every week for four weeks after leaving the area.
    • Children—Dose is based on body weight and must be determined by your doctor.
      • Children weighing 5 to 9 kg (11 to 20 pounds): 5 mg per kg of body weight one week before traveling to an area where malaria occurs.
      • Children weighing 10 to 19 kg (21 to 43 pounds): 62.5 mg (¼ tablet) one week before traveling to an area where malaria occurs. Then 62.5 mg once a week while staying in the area where malaria occurs and every week for four weeks after leaving the area.
      • Children weighing 20 to 30 kg (44 to 66 pounds): 125 mg (½ tablet) one week before traveling to an area where malaria occurs. Then 125 mg once a week while staying in the area and every week for four weeks after leaving the area.
      • Children weighing 31 to 45 kg (67 to 99 pounds): 187.5 mg (¾ tablet) one week before traveling to an area where malaria occurs. Then 187.5 mg once a week while staying in the area and every week for four weeks after leaving the area.
  • For treatment of malaria:
    • Adults—1250 mg as a single dose, or 750 mg as one dose, then a 500 mg dose 8 hours later, or may be determined by your doctor based on body weight
    • Children—Dose is based on body weight and must be determined by your doctor. The usual dose is 20 to 25 mg per kg (9 to 11 mg per pound) of body weight as a single dose or two doses (divide the single dose by two) taken 6 to 8 hours apart. Taking two doses may decrease the occurrence of unwanted side effects.

Missed dose—

If you miss a dose of this medicine, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses.

Storage—

Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Keep from freezing.

Keep out of the reach of children.

Do not keep outdated medicine or medicine no longer needed.

Precautions While Using This Medicine:

Mefloquine may cause vision problems. It may also cause some people to become dizzy or lightheaded or to have hallucinations (seeing, hearing, or feeling things that are not there). Make sure you know how you react to this medicine before you drive, use machines, or do anything else that could be dangerous if you are dizzy or are not alert or able to see well. This is especially important for people whose jobs require fine coordination. If these reactions are especially bothersome, check with your doctor.

Malaria is spread by the bite of certain kinds of infected female mosquitoes. If you are living in, or will be traveling to, an area where there is a chance of getting malaria, the following mosquito-control measures will help to prevent infection:

• If possible, sleep under mosquito netting, preferably netting coated or soaked with pyrethrum, to avoid being bitten by malaria-carrying mosquitoes.
• Remain in air-conditioned rooms to reduce contact with mosquitoes
• Wear long-sleeved shirts or blouses and long trousers to protect your arms and legs, especially from dusk through dawn when mosquitoes are out.
• Apply mosquito repellant, preferably one containing DEET, to uncovered areas of the skin from dusk through dawn when mosquitoes are out.
• Using a pyrethrum-containing flying insect spray to kill mosquitoes in living and sleeping quarters during evening and nighttime hours.

If you are taking quinidine (e.g., Quinidex) or quinine, talk to your doctor before you take mefloquine. While you are taking mefloquine, take mefloquine at least 12 hours after the last dose of quinidine or quinine. Taking mefloquine and either of these medicines at the same time may result in a greater chance of serious side effects.

If you are taking anticonvulsants (e.g., Tegetrol, Dilantin), halofantrine (e.g., Halfan), or typhoid vaccine, talk to your doctor before you take mefloquine. Taking mefloquine and any of these medicines at the same time may result in a greater chance of serious side effects.

For patients taking mefloquine to treat malaria:

• If your symptoms do not improve within a few days, or if they become worse, check with your doctor.

Side Effects of This Medicine:

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor immediately if any of the following side effects occur:

Rare

Aching joints and muscles

anxiety

blistering, loosening, peeling, or redness of the skin

chest pain or discomfort

chills, fever, and/or sore throat

confusion

convulsions (seizures)

dizziness

cough or hoarseness

depression

fainting

hallucinations (seeing, hearing, or feeling things that are not there)

irregular , pounding, slow, or fast heartbeat or pulse

irritability

lightheadedness

lower back or side pain

nervousness

painful or difficult urination

pinpoint red spots on skin

mood or mental changes, mental depression, and/or restlessness

red or irritated eye

sores, ulcers, and/or white spots in mouth or on lips

stiff neck

swelling of ankles, feet, and/or lower legs

unusual bleeding or bruising

unusual tiredness or weakness

vomiting

Incidence not determined

Blurred or loss of vision

convulsions

disturbed color perception

dizziness

double vision

halos around lights

hearing problems

loss of bladder control

muscle spasm or jerking of all extremities

night blindness

overbright appearance of lights

severe or continuing headache

shortness of breath and or wheezing

sudden loss of consciousness

troubled breathing

tunnel vision

Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

More common

Chills

continuing ringing or buzzing or other unexplained noise in ears or hearing loss

diarrhea

emotional problems

loss of balance

nausea

stomach pain

Less common

Abnormal dreams

loss of appetite

skin rash

trouble in sleeping

unusual tiredness or weakness

vertigo

Rare

Loss of hair

Mefloquine very rarely may cause partial loss of hair. After treatment with mefloquine has ended, normal hair growth should return.

Incidence not determined

Acid or sour stomach

belching

flushing, redness of skin

heartburn

indigestion

skin rash with a general disease

stomach discomfort, upset or pain

swelling

unusually warm skin

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.