Cochrane Review on the Effectiveness, Side Effects of Mefloquine


Researchers from LSTM Cochrane Infectious Diseases Group published two reviews in Cochrane Database of Systematic Reviews, provides better insight into the safety of mefloquine (Lariam) for preventing malaria in travellers.

The study lead author Dr Tickell-Painter, said, Mefloquine is effective as other treatment decisions, but patients and decision-makers need consistent information about common side-effects before they could make informed decisions.

Mefloquine has been connected with psychological side effects since its introduction in the 1980s. The Cochrane review involved over 50 randomized and non-randomized studies, enrolling over 1,000,000 participants, and compares mefloquine with all conventional drugs in common use.

It is confirmed that mefloquine causes more sleeplessness, abnormal dreams, anxiety and depression than the other drugs. “But the review clarifies that these are symptoms reported by people taking mefloquine and not formal psychiatric diagnoses. Serious side effects with mefloquine seem to be rare, less than 1% of users and increases in formal diagnoses of depression and psychosis have not been seen in people returning from travel in any of the large database studies,” Dr Tickell-Painter.

The researchers carried an additional study to assess the severity of those side effects. The comprehensive research involved the systematic methods to find and evaluate all case reports of mefloquine associated deaths and suicide attempts. From 527 case reports, the authors could only consistently attribute causality for one suicide attempt and a possible association between two deaths, which was due to the atypical drug reactions. The authors considered all other reports of links unlikely or containing insufficient information to make a judgement.

The authors hope that the review provides clarity in the argument about mefloquine. We could ensure adequately informed discussions between doctors and patients regarding the relative merits of mefloquine, atovaquone-proguanil (Malarone), and doxycycline, by contributing more consistent estimates of the frequency and severity of common side effects, Dr Tickell-Painter concluded.