Mefloquine


Concise Prescribing Info
Indications/Uses
Listed in Dosage.
Dosage/Direction for Use
Adult : PO Malaria Initial: 15 mg/kg followed by 10 mg/kg after 6-24 hr. Malaria prophylaxis 250 mg/wk taken 1-3 wk before exposure and continuing for 4 wk after leaving the malarious area.
Dosage Details
Oral
Prophylaxis of malaria
Adult: 250 mg once wkly taken 1-3 wk before exposure and continuing for 4 wk after leaving the malarious area.
Child: 5-10 kg: 31.25 mg; 11-20 kg: 62.5 mg; 21-30 kg: 125 mg; 31-45 kg: 187.5 mg; >45 kg: 250 mg. All doses should be taken once wkly. Start prophylaxis 1-3 wk before exposure and continue for 4 wk after leaving the malarious area.
Elderly: No dosage adjustment needed.

Oral
Malaria
Adult: Initially, 15 mg/kg followed by 10 mg/kg after 6-24 hr.
Child: Same as adult dose.
Elderly: No dosage adjustment needed.
Renal Impairment
Severe: Contraindicated.
Administration
Should be taken with food. Best taken w/ meals & a full glass of water.
Contraindications
Hypersensitivity to related compounds (e.g. quinine and quinidine); history of blackwater fever; prophylactic use in patients w/ history of psychiatric (including depression) or convulsive disorders; retreatment w/ mefloquine. Severe hepatic impairment. Concomitant use w/ halofantrine.
Special Precautions
Patients w/ epilepsy, acute anxiety, restlessness or confusion, cardiac conduction disorders. Renal impairment. Pregnancy and lactation.
Adverse Reactions
Diarrhoea, nausea, vomiting, pruritus, rash, abdominal pain, anorexia, dizziness or vertigo, loss of balance, somnolence and sleep disorders (e.g. insomnia and abnormal dreams). Neuropsychiatric disturbances including motor and sensory neuropathies, ataxia, tremor, visual disorders (e.g. retinal degeneration or optic neuropathy), tinnitus and hearing impairment, convulsions, anxiety, depression, hallucinations, confusion, panic attacks, emotional instability, aggression and agitation, and acute psychosis, suicidal ideation; hair loss, myalgia. Decreased haematocrit and increased transaminase value; thrombocytopenia and leucopenia.
Patient Counseling Information
May impair ability to drive and operate machineries.
MonitoringParameters
Periodic evaluation of liver function and ophthalmologic examinations (long-term prophylaxis). Neuropsychiatric symptoms; atypical behaviour (suicidal ideation and behaviour) during and after therapy.
Overdosage
Symptoms: Hallucinations, vertigo, nausea, dizziness, tachycardia, hypotension and seizures. Treatment: Symptomatic and supportive treatment. Induced emesis or gastric lavage may be used to empty the stomach. Monitor cardiac function (ECG if possible), neurological and psychiatric status for at least 24 hr.
Drug Interactions
Increased risk of ECG abnormalities w/ quinine or chloroquine, antihistamines, TCAs and phenothiazines. May increase risk of seizure w/ quinidine or quinine. Concomitant use w/ valproic acid, phenobarbital, carbamazepine and phenytoin may cause loss of seizure control and lower plasma levels of anticonvulsants. Increased risk of QT prolongation and arrhythmia w/ ketoconazole. Concomitant use w/ digoxin, Ca channel blockers, antiarrhythmics and β-blockers may increase the risk of cardiotoxicity. Increased risk of ventricular arrhythmias w/ amiodarone. Concomitant use w/ TCAs, SSRIs, buprion, antipsychotic, tramadol may increase the risk of convulsions. Increased plasma levels w/ metoclopromide. May compromise adequate immunisation by live typhoid vaccine. Vaccinations w/ attenuated live bacteria should be completed at least 3 days prior the 1st dose of mefloquine.
Potentially Fatal: Avoid concomitant use w/ halofantrine as potentially fatal cardiac arrhythmias may occur.
Action
Description: Mefloquine is a 4-methanolquinine antimalarial agent and a blood schizontocide which acts by interfering w/ the parasite's ability to metabolise and utilise erythrocyte Hb. It is active against most Plasmodium spp and is used for prophylaxis and treatment against malaria.
Pharmacokinetics:
Absorption: Well absorbed from the GI tract. Food increases absorption. Time to peak plasma concentration: Approx 17 hr.
Distribution: Widely distributed; crosses placenta and enters breast milk (small amounts). Volume of distribution: Approx 20L/kg. Plasma protein binding: Approx 98%.
Metabolism: Undergoes hepatic metabolism via CYP3A4 isoenzyme to 2,8-bistrifluoromethyl-4-quinoline carboxylic acid (inactive) and other metabolites.
Excretion: Primarily via bile and faeces; urine (9% as unchanged drug, 4% as metabolites). Elimination half-life: Approx 3 wk.
Storage
Store at 25°C.
MIMS Class
References
Anon. Mefloquine. Lexicomp Online. Hudson, Ohio. Wolters Kluwer Clinical Drug Information, Inc. https://online.lexi.com. Accessed 19/11/2013.

Buckingham R (ed). Mefloquine. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 19/11/2013.

Joint Formulary Committee. Mefloquine. British National Formulary [online]. London. BMJ Group and Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 19/11/2013.

McEvoy GK, Snow EK, Miller J et al (eds). Mefloquine. AHFS Drug Information (AHFS DI) [online]. American Society of Health-System Pharmacists (ASHP). https://www.medicinescomplete.com. Accessed 19/11/2013.

Mefloquine Hydrochloride: Drug Safety Communication - Label Changes Due To Risk of Serious Psychiatric and Nerve Side Effects. U.S. FDA. https://www.fda.gov/. Accessed 19/11/2013.

Disclaimer: This information is independently developed by MIMS based on Mefloquine from various references and is provided for your reference only. Therapeutic uses, prescribing information and product availability may vary between countries. Please refer to MIMS Product Monographs for specific and locally approved prescribing information. Although great effort has been made to ensure content accuracy, MIMS shall not be held responsible or liable for any claims or damages arising from the use or misuse of the information contained herein, its contents or omissions, or otherwise. Copyright © 2020 MIMS. All rights reserved. Powered by MIMS.com
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