ARLINGTON, Va. — Seven U.S. servicemembers have been diagnosed with inner ear damage “most likely” caused by use of the anti-malaria drug Lariam, said a Navy surgeon treating them.
The five sailors and two soldiers, all who recently served in the Middle East, have “been diagnosed with ototoxicity, or damage to the inner ear, which mostly likely is caused by the Lariam,” said Dr. (Cmdr.) Michael Hoffer, 41, director of the Department of Defense Spatial Orientation Lab at the Naval Medical Center in San Diego. “But it’s a diagnosis for which there is no proof. I’m emphasizing that there is no proof, but it medically appears to be related to Lariam.”
Use of the drug is the only factor the seven members have in common, he said.
“Lariam studies have indicated that Lariam can damage the vessels and nerves of the brain, and the inner ear is subject to that same damage because it is part of the brain,” said Hoffer, an ear, nose and throat surgeon who has practiced in the field for 10 years.
Lariam is the brand name for the generic drug mefloquine.
“These cases in San Diego may represent a case series of balance disorders, but there is not yet sufficient epidemiologic evidence to draw any conclusions about causality,” said Perry Bishop, spokesman for the Defense Department’s Health Affairs office.
In spite of controversy surrounding Lariam, including reports that the drug can cause depression, suicidal thoughts, hallucinations and permanent brain damage, the DOD still prescribes the drug to troops deployed to areas of the world where the fatal strain, falciparum, is a threat and resistant to other anti-malaria drugs, Bishop said.
Those areas include Afghanistan, Central and South America, Haiti, Africa, the Indian subcontinent, Southeast Asia, parts of the Middle East and Oceania.
There are four known strains of malaria, with falciparum being the sole fatal strain. The others — vivax, ovale and malariae — generally cause fevers, vomiting, nausea, and chills.
Several studies are under way, looking into the DOD’s use of anti-malaria drugs to determine the effectiveness of the inventory and whether alternatives would work better, Bishop said.
Mefloquine and Lariam no longer are recommended for troops deployed to Iraq.
“Lariam was include in the initial portfolio of drugs to be used in Iraq, but it was subsequently discovered that falciparum is not prevalent in the area,” Bishop said.
Though FDA-approved, Lariam also comes with a FDA-issued warnings.
“The most frequently reported side effects with Lariam, such as nausea, difficulty sleeping, and bad dreams are usually mild and do not cause people to stop taking the medicine,” reads a portion reads a portion of the 2-page FDA information sheet on the drug. “However, people taking Lariam occasionally experience severe anxiety, feelings that people are against them, hallucinations (seeing or hearing things that are not there, for example), depression, unusual behavior, or feeling disoriented.
“There have been reports that in some patients these side effects continue after Lariam is stopped. Some patients taking Lariam think about killing the
mselves, and there have been rare reports of suicides. It is not known whether Lariam was responsible for these suicides.”
An Army survey done last summer and fall by a 12-member team of mental health experts following reports of 24 suicides in Iraq and Kuwait showed that one of the 24 had traces of Lariam. Experts did not link the suicide to the drug use.
There is no test available to predetermine how someone might react to the medication, he said.
Two Marines from the 26th Marine Expeditionary Unit deployed to Liberia in 2003 nearly died when they contracted the fatal strain, said Dr. (Cmdr.) David McMillan, the preventive medicine officer for the Marine Corps. Neither had taken anti-malaria drugs.
In spite of the side effects, the alternative could be worse, Hoffer said.
“A million people die every year from malaria,” he said. “Every medicine ever invented has some side effects. So you have to balance the side effects against the disease.”
