Anti-malaria drug limited due to risks
Stars and Stripes March 5, 2009
Read Army memo about the use of Mefloquine for malaria
ARLINGTON, Va. — The Army has limited the use of the anti-malaria drug mefloquine, widely known by the brand name Lariam, because of its risks for soldiers with other health issues.
In cases where mefloquine and doxycycline are both effective in preventing malaria, doxycycline should be the "drug of choice," the Army surgeon general wrote in a Feb. 2 memo.
Mefloquine should be used only in cases where soldiers cannot take doxycycline, Lt. Gen. Eric Schoomaker wrote.
While mefloquine has been used extensively to prevent malaria, Schoomaker wrote, it can be risky to use for soldiers who are taking other medications or who face medical conditions such as the following:
DepressionTraumatic brain injury or symptomatic TBI.Convulsions.Generalized anxiety disorders, psychosis, schizophrenia or any other major psychiatric disorder.Schoomaker wrote that in rare cases mefloquine can cause psychiatric symptoms and suicidal thoughts.
The new policy was issued after it was reported that some soldiers were given mefloquine who shouldn’t have received the drug, said Col. Scott Stanek of the Army surgeon general’s office.
Stanek did not say why those soldiers were given the drug or what happened to them.
Lariam gained attention in 2002 when media outlets reported that the drug could have been a factor in a spate of murders and suicides at Fort Bragg, N.C. An Army investigation into the incidents found no link between Lariam and the deaths.
The fear that mefloquine can drive people crazy is based on urban myth, said Dr. Chris Plowe, a medical professor at the University of Maryland, who specializes in malaria.
While mefloquine can give people insomnia or vivid dreams or lead to drastic mood changes, Plowe said he is comfortable prescribing either mefloquine or doxycycline.
He added that mefloquine’s side effects are generally mild and affect a relatively small percentage of people who take the drug.
The bigger danger is that troops forget to take their medication and come down with malaria, Plowe said.
That’s why it might be easier for troops to take doxycycline daily instead of mefloquine, which they only have to take once a week. A daily routine is easier to follow, he said.
Another reason doxycycline might be preferable for U.S. troops is that it could be dangerous to develop side effects to mefloquine while downrange, Plowe said.
"It’s one thing if you are having insomnia and a little bit of a mood change when you’re on [vacation]; it’s another thing if you’re piloting a helicopter under the fire or if you’re patrolling streets in Fallujah," he said.