Mefloquine

Should be taken with food. Best taken w/ meals & a full glass of water.

Hypersensitivity to mefloquine and related compounds (e.g. quinidine, quinine). Prophylactic use in patients with psychosis, generalised anxiety disorder, suicidal ideations, behaviour, or attempts, active and recent history of depression, history of convulsions of any origin, schizophrenia, or other major psychiatric disorders; history of Blackwater fever. Concomitant use with halofantrine or within 15 weeks after the last dose of mefloquine.

Patient with significant cardiac disease; previous history of depression; history of convulsions (if used as treatment). In cases of life-threatening, serious, or overwhelming P. falciparum malarial infections, patients should be treated with IV antimalarial drugs and mefloquine may be given orally to complete the course. Renal and hepatic impairment. Children. Pregnancy and lactation. Patient Counselling This drug may cause dizziness, and vertigo, if affected, do not drive or operate machinery. Monitoring Parameters Monitor LFTs, evaluate neuropsychiatric effects, and perform eye examinations periodically if to be administered for a prolonged period. Monitor blood concentration of anti-seizure medicines if used concomitantly with mefloquine.

Significant: Neuropsychiatric effects (e.g. attempted suicide, suicidal thoughts and behaviour, anxiety disorders, depression, bipolar disorder, paranoia, hallucinations, mood swings, panic attacks, psychotic and paranoid reactions, insomnia, abnormal dreams or nightmares, restlessness, confusion, dizziness, vertigo, loss of balance); hypersensitivity reactions; altered cardiac conduction (e.g. ECG alterations, 1st-degree atrioventricular block, sinus bradycardia, sinus arrhythmia, QTc interval prolongation, abnormal T waves); increase risk of convulsions in patients with epilepsy; polyneuropathy; ocular effects (e.g. retinal disorders, optic neuropathy); pneumonitis of possible allergic aetiology; agranulocytosis, aplastic anaemia; hypoglycaemia (particularly in patients with congenital hyperinsulinaemic hypoglycaemia). Blood and lymphatic system disorders: Leucopenia, leucocytosis, thrombocytopenia. Cardiac disorders: Extrasystoles. Ear and labyrinth disorders: Vestibular disorders, tinnitus, impaired hearing, hyperacusis, partial deafness (sometimes prolonged). Eye disorders: Visual impairment, blurred vision, cataract. Gastrointestinal disorders: Nausea, vomiting, diarrhoea, abdominal pain, dyspepsia, pancreatitis. General disorders and administration site conditions: Asthenia, malaise, fatigue, pyrexia, chills, chest pain, oedema. Hepatobiliary disorders: Hepatitis, jaundice, hepatic failure. Investigations: Transient increased in ALT, AST, gamma-glutamyl transferase (GGT); increased blood creatinine, decreased haematocrit. Metabolism and nutrition disorders: Decreased appetite. Musculoskeletal and connective tissue disorders: Arthralgia, myalgia, muscle weakness and spasms. Nervous system disorders: Cranial nerve paralysis, amnesia, somnolence, speech disorder, memory impairment, gait disturbance, balance disorder, peripheral sensory and motor neuropathy including paraesthesia, tremor, and ataxia. Renal and urinary disorders: Nephritis, acute renal failure. Respiratory, thoracic and mediastinal disorders: Pneumonia, dyspnoea. Skin and subcutaneous tissue disorders: Pruritus, Stevens-Johnson syndrome, rash, erythema multiforme, urticaria, hyperhidrosis, alopecia. Vascular disorders: Hypotension, hypertension, flushing, syncope.

Increased plasma concentration and elimination half-life with ketoconazole. May cause ECG abnormalities and increase the risk of convulsions with other related compounds (e.g. chloroquine, quinine, quinidine). May diminish the therapeutic effect by lowering the plasma concentrations of anticonvulsants (e.g. carbamazepine, valproic acid, phenytoin, phenobarbital). May increase the risk of convulsions with TCAs, SSRIs, bupropion, tramadol, antipsychotics, or some antibiotics. Decreased plasma concentration with CYP3A4 inducers (e.g. rifampicin).

Antimalarials

P01BC02 - mefloquine ; Belongs to the class of methanolquinoline antimalarials.