This is a new one!

We have been taking this medicine for years, and none of us hashad any adverse effects.



New concerns rising over antimalaria drug




By Patricia Kime - Staff writer
Posted : Wednesday Apr 11, 2012 6:22:47 EDT



Navy Sonar Technician (Surface) Seaman Douglas Corrigan placed a Skype call to his wife March 25, 2011, from Rota, Spain, shortly after taking his first dose of the antimalaria medication mefloquine.

Preparing for a mission to a malaria-endemic region, his unit watched a video on the illness, and corpsmen dispensed two drugs: daily-dose doxycycline, and mefloquine, taken weekly.

Corrigan doesn’t remember getting a choice. He received a blister pack of mefloquine and was told it could cause nightmares.

“He told me he didn’t feel good,” recalled Nicki Corrigan, his wife of three years. “He said, ‘I don’t feel like myself anymore.’ It was a really weird thing for him to say.”

Corrigan’s personality changed radically, she said. The straight-laced husband and father began chewing tobacco, drinking and carousing. He climbed outside a three-story building to see whether he would feel fear.

Months later, at home, he was found tiptoeing around his basement, pursuing imagined intruders. He ranted psychotically and complained of daily headaches.

Medical tests showed no traumatic brain injury, nor did doctors believe he had post-traumatic stress disorder. They began suggesting he had a personality disorder or was a malingerer, faking his problems to get out of the military.

Finally, an ear, nose and throat doctor at National Naval Medical Center Bethesda, Md., offered another diagnosis: “multifocal brain stem injury” — brain damage — likely caused by mefloquine.

“He has a lesion. On his brain,” said Nicki, a registered nurse.

Back in the spotlight

Mefloquine has drawn attention since the Army’s former top psychiatrist, retired Col. Elspeth Cameron Ritchie, wrote a column in Time magazine listing it among several drugs that may have induced psychoses in Army Staff Sgt. Robert Bales, charged in the shootings deaths of 17 Afghan civilians March 11.

But Defense Department concerns about mefloquine date back further — and some close to the issue say the most recent bout of scrutiny, which began with a meeting last Aug. 24-25 of DoD’s Joint Prevention Medicine Group to discuss mefloquine policy, stems from the Corrigan case.

“You have a sailor with permanent brain damage,” said an Army doctor familiar with the debate. “It’s very serious.”

The Navy would not confirm a link between Corrigan and the current DoD review, citing privacy laws. But on Jan. 17, two months before Bales’ alleged spree, the Pentagon’s top doctor, Jonathan Woodson, directed the Army, Navy and Air Force and the commander of Joint Task Force National Capital Region Medical to give him all data and policies related to mefloquine.

DoD “wants to ensure each service conducts proper screening, patient education and medical documentation,” said Cynthia Smith, a Pentagon spokeswoman.

Mefloquine was developed under the Army’s malaria drug discovery program, which ran from 1963 to 1976. The Food and Drug Administration approved it for preventive use in 1989 and it was marketed under the brand name Lariam.

But no safety and efficacy reviews were ever done on a normal civilian population. The Army performed tests on prisoners in Illinois and Maryland in 1975 and 1976.

Shortly after commercial use began, anecdotes surfaced about side effects including hallucinations, delirium and psychoses.

According to the FDA, the most common side effects are nausea and vomiting, seen in less than 3 percent of users. Side effects occurring in less than 1 percent include emotional disturbances, seizures, hair loss, headache, tinnitus, pain and fatigue.

A 2004 Veterans Affairs Department memo urged doctors to refrain from prescribing mefloquine, citing individual cases of hallucinations, paranoia, suicidal thoughts, psychoses and more.

That same year, then-Assistant Defense Secretary for Health Affairs Dr. William Winkenwerder ordered a study to assess the rate of adverse side effects associated with antimalaria medications.

He ordered the study after questions arose over its possible role in several murder-suicides at Fort Bragg, N.C., in 2002 and suicides in Iraq among deployed troops.

The Army in 2009 issued a policy listing mefloquine as a third choice behind doxycycline and another antimalarial, chloroquine. DoD followed with a memo later that year stating that doxycylcine and mefloquine may be used in areas where malaria is resistant to chloroquine, but doxycycline is the preferred choice.

The Air Force and the Navy have similar policies, officials said.

The DoD memo says troops given mefloquine must be counseled on its possible effects and must not be suspected of having any mental health concerns.

In 2011, U.S. Central Command and U.S. Africa Command issued memos barring mefloquine use except when doxycycline or another preventive drug called Malarone cannot be taken.

Roche, the manufacturer of Lariam, stopped marketing it in the U.S. in 2008, but it is still available in more than 50 countries. The mefloquine now taken by U.S. troops is a generic version.

Other drugs also have issues

Doxycycline is not without its drawbacks. It can make patients photo-sensitive, causing debilitating sunburn; has a poor compliance rate, since it must be taken daily; and has side effects, including nausea and vomiting.

And Malarone costs much more than the other drugs — about $30 a week, compared with $3 a week for mefloquine and less than 25 cents a week for doxycycline.

Navy Cmdr. Bill Manofsky — who was medically retired in 2004 for PTSD and neurological problems, including loss of balance, that he said were documented in his medical records as mefloquine-related — said if cost concerns are an issue, they shouldn’t be.

He said if DoD wants to protect the troops from malaria as well as mefloquine’s potential side effects, it should ban mefloquine and pay the higher cost of Malarone.

“How much does a .50-caliber round cost? They’re worried about $4 a pill and they’re willing to spend $5 for a round?” he said.

There’s no question malaria poses a risk. In 2011, 124 service members contracted the potentially fatal disease — 91 in Afghanistan, 24 in Africa and nine elsewhere. The year before, 113 troops contracted malaria; one died.

But mefloquine continues to be used in part because it is taken weekly while the alternatives must be taken daily, and some physicians believe that troops are more likely to take a weekly dose.

The services have 90 days to respond to Woodson’s order for details of their mefloquine policies.

Nicki Corrigan and others have contacted lawmakers, including Sens. Dianne Feinstein, D-Calif., and Jim Webb, D-Va., to press for congressional hearings.

Douglas Corrigan is currently undergoing a Medical Evaluation Board to determine if he is still fit for military service.

Malarone is much safer.

2010 I was doing helicopter assisted fieldwork inspections of sites in Kalimantan. I took Larium for the first time, previously using Malarone - Larium seemed a low cost and convenient (once-a-week) alternative. I took the reccomended 3 days in a row then one a week later. I had severe effects, incredibly vivid dreams which woke me with a start. And very, very dark thoughts.

At the risk of malaria, I never took another Larium and never will.

I have since found out that the Australian Military trialled Larium but cut short the trial. They use doxycycline, as I now do.

To me it is not worth the risk, even if few people suffer side-effects.

Cheers, Chris

I'm with Ann. Do you suppose that's what's wrong with Walter?

This is not new at all!
Lariam is know to have severe psychotic side effects. I am a doctor and I would never use it.

Good hunting

Dear Saeed:

Thank you for the posting. I'm with Ann, I'll take malarone.

Sincerely,

Chris Bemis

Mefloquine is the same as Larium. Took it once, never again!

We switched to Malarone quite awhile back. The Larium did give us weird dreams which Sadie kind of liked but I found myself unnecessarily anxious. Malarone seems to have no adverse effects.

Mark

I tried Larium on my first African elephant hunt and found my self getting paranoid thoughts. Had this uneasy feeling that the outfitter was screwing me. I didnt act on it, thank goodness as it wasn't true.


Spend anytime with a PH and they will tell you stories of clients that were seemingly unreasonable. I wonder now how many of those took Larium.

465H&H

Thats why I don't take mefloquine. Not a good idea to be walking around Africa with a loaded gun seeing things that aren't really there.

I took Larium one time. I personally did not have a problem. However, my brother became deathly ill. I feared for his life. While a definitive diagnosis was never obtained (long story), the consensus opinion was that it was Larium.

I use Malarone now.

I never had the wild dreams from taking mefloquine, might have been a flashback from days of old though.
In 2006 I was on it from mid October thru mid February. Ever since that time my left ear rings horribly. Right ear is fine. I saw some where that ringing ears is a side effect of the drug.
I'm heading to Zim in July, I will take maleron.

One of the drawbacks/bonuses to taking mefloquine is the weird dreams. Some people deal with it better than others. Everyone I know that ever had a serious "freak out" was combining it with other meds and/or large doses of alcohol.

Our County Health department recommends Mararone, which I have used without any side effects.

Lariam has been known for some time to cause a number of neuropsychiatric side effects. These can range from the mild (sleep disturbance, unusual dreaming) to the severe (paranoia and psychosis) and there are also some physical side effects including the encephalopathy (brain damage) being reported here.

This is not new.

While not everyone gets the side effects, and they are generally stopped by discontinuing the drug, it is a known risk.

The only real reason IMO to get Lariam as a prophylactic is the convenience of once a week dosing, which causes it to be cheaper than malarone. Treatment is another story, but there the side effects risk profile are generally better than the disease.

I had stomach cramps with Malarone although they were not severe.

i went to la la land with larium, but malarone did a similar although not as severe a reaction. now it's just doxy and cloroquine

I had no side effects the first couple of times I used Malarone, but the last two times, I too had stomach issues; the last time not as bad as the time before. Nevertheless, I stop taking the stuff before the flight back, so I question how much good it does. Might have to try doxy next time.

I took Larium on my first trip to Zim and never had any problems. After reading about the nasty side effects, I switched to Malarone and found that I couldn't get to sleep while on that drug unless I took a sleeping pill. At first I thought it was the time change, but after three days of having problems sleeping I stopped taking it and the sleeping problems went away. This happened even though I took the Malarone in the morning. I guess I'll go with doxy on my next trip.

In the old days we always used chloroquine and doxycycline. Chloroquine always gave most of the guys the shits. Then the resistant strains of malaria started showing up. Larium was the next great wonder drug. Nightmares and some psychotic episodes reported. Mostly overblown and selectivley edited by the media. Especially in relation to the suicides/murders. Considering other motives, stress factors such as infidelity, and ptsd or combinations thereof the drug became a convenient defence. So the bad press hit and the next wonder drug hit. Malarone came along, supposedly with less side effects. Major difference was in dosing schedules, daily versus weekly. Now we are told it is equally bad. Based on what? How many clinical cases out of how many sailors,soldiers,airmen,and marines? I will bet the number is not clinically significant. I am not saying there is not a down side. I am saying again it is entirely overblown. I have used all of them without significant problems over the last 30 years or so. Believe what you want and do what you think best but you can ignore the spin until there are real hard numbers.

I would suggest ignoring most info on the internet and talk to a real doctor, one who is familiar with malaria meds and other drug interactions.

If you take anything else besides a malaria med, you need to get the real info on drug interaction before you take this stuff.

All malaria meds are potent and affect people differently.

I have seen a very high percentage of people have problems with Lariam over the years, in particular extremely vivid nightmares and some paranoia etc. I would not recommend anyone take it. Interestingly it seems to affect ladies a lot more, probably because they are given the same size dose disregarding their lower body weight.

For those people who get affected, LARIAM (Mefloquine) seems to produce different effects on different people; from fever, nausea, double vision to hallucinations.
I personally don't touch the stuff nor do I even carry it around. I don't take any prophylactic and haven't had malaria in 30 years.
I always carry a box of Malaria Self-Test and COARTEM in my First Aid in the event someone gets a bout and have administered it once to a client who tested positive - was back on his feet and hunting within 12 hours.

quote:

And Malarone costs much more than the other drugs — about $30 a week, compared with $3 a week for mefloquine and less than 25 cents a week for doxycycline.

I think my sanity and health is well worth $30 a week.

quote:

Originally posted by Aspen Hill Adventures:
Malarone is much safer.

For sure

Look at the CDC website. CDC continues to recommend Lariam. I have taken Lariam on eight trips without any side affects.

Look folks, I was a pharmacist before I had to retire for other health reasons. That being my short term memory went to shit. My point that I was trying to make was this. It dosnt matter what my or your personal experiences have been. I know that sounds silly but hear me out. we put all of our belief in this based on our or a friends experience. Makes perfect sense, except that it may not be accurate. As I said we need to see actual cold hard numbers for each drug. Then you can make some type of informed comparison not just something based on anectdotal evidence. Personally I believe there is truth in all of what we are hearing. the question is how much. At this point it is a matter of belief or faith if you will and not based on fact. You need a llarge statistical sample for that.

Can one of you guys who is a doc or a statistical person help me out here? I know what I am trying to say but dont think I am being very clear. Maybe I am, I dont know, it has been one of those days.

Well, a doctor did chime in above and said he would never use it.

A number of us have been using it every year since 1993, and none of us reported any side effects.

This includes Walter, who is on a large coctail of all sort of daily medicine.

Thanks for the timely post. I just checked my prescription for my May-June trip and it is for Malarone.

Guess I better get it filled and packed.

Dean Kendall was telling me about a Chinese made drug that he swears by. He said it could be taken profalacitcally, but they don't use it that way. They keep it on hand and then if they feel a bout of malaria coming on they take it and it significantally lessens the length and severity of the illness. Does anyone know anything about it?

I have taken Malarone without any side effects for several years. My wife, however, had rather severe psychotic symptoms (intense anxiety and vivid nightmares) and has never taken them since. Since she routinely seriously shields hereself from the sun, doxcy has been no problem for her on subsequent trips and a much safer alternative in her case. All these drugs are powerful and have the potential to cause serious side effects.

Bwana,
Artemisinin is the active drug derived from the herb sweet wormwood.
It is effective.

http://en.wikipedia.org/wiki/Artemisinin

I am an M.D., but no tropical medicine expert. I have taken Malarone twice in the past, over a month duration each time, no ill effects.
My personal research pointed to it as the best choice.
It comes in pediatric dosage form too.

Regarding Lariam/mefloquine psychiatric effects:

People are different.
Some are damaged goods who should not take Lariam.
Others are psychiatrically sound and have no problems from the drug.
This does not explain Walter's tolerance for the drug.

Duration of exposure might also have something to do with it, as in prolonged, continuous use.

Science has a tough time whenever human psychiatry is involved.

Bwana
I think the Chinese take deer penis or some other penis to stop marlaria. The way I understand it it keeps the mosquitos from biting in the first place.

quote:

Originally posted by Bwanna:
Dean Kendall was telling me about a Chinese made drug that he swears by. He said it could be taken profalacitcally, but they don't use it that way. They keep it on hand and then if they feel a bout of malaria coming on they take it and it significantally lessens the length and severity of the illness. Does anyone know anything about it?

I am not a physician but I have stayed at a Holiday Inn. I would not take medicine for Malaria or anything else for that matter that the Chinese made. They can't even get dog treats right. I have used Malarone with no problems.

Believe this, from Wikipedia, is the Chinese anti-malaria at question. Have not used it myself.

Regards, Tim

Artemisinin ( /ɑrtɨˈmɪsɨnɨn/), also known as Qinghaosu (Chinese: 青蒿素), and its derivatives are a group of drugs that possess the most rapid action of all current drugs against Plasmodium falciparum malaria.[1] Treatments containing an artemisinin derivative (artemisinin-combination therapies, ACTs) are now standard treatment worldwide for P. falciparum malaria. The starting compound artemisinin is isolated from the plant Artemisia annua, sweet wormwood, an herb employed in Chinese traditional medicine.

Chemically, artemisinin is a sesquiterpene lactone containing an unusual peroxide bridge. This peroxide is believed to be responsible for the drug's mechanism of action. Few other natural compounds with such a peroxide bridge are known.[2] (Ascaridole is another.)

Use of the drug by itself as a monotherapy is explicitly discouraged by the World Health Organization, as there have been signs that malarial parasites are developing resistance to the drug. Therapies that combine artemisinin with some other antimalarial drug are the preferred treatment for malaria and are both effective and well tolerated in patients. The drug is also increasingly being used in Plasmodium vivax malaria,[3] as well as being a topic of research in cancer treatment.

I would never ever take Lariam again. It makes me upset over silly trifling things ...

quote:

Originally posted by Aspen Hill Adventures:
Malarone is much safer.

I fully agree! I have used Malarone many times without any side-effects.
Cheers, Hans

A semisynthetic Artemisin (Arthemeter) is marketed in combination with Lumefantrin by Novartis. It is not suitable for prophylaxis but works very well in acute infection. Adverse effects are mainly cardiologic, palpitations are frequent.
Stae of the art prophylaxis is Malarone, Doxycyclin often does not prevent infection and phototoxicity is a concern in sunny countries.

quote:

Originally posted by EB:
I have taken Malarone without any side effects for several years. My wife, however, had rather severe psychotic symptoms (intense anxiety and vivid nightmares)...

I've taken Malarone on all of my African trips and never had a problem, until my 6th trip last year. I've taken this drug for weeks at a time without any noticable side effects but about half way through my hunt in Zambia last year I took it one morning without eating much and had the exact symptoms above, which lasted for few days. I switched to taking it at night after dinner but the symptoms never fully stopped and I ended up puking my guts out my last night in camp.

I don't know why all of a sudden I had a problem with Malarone. I am sure I have taken it in the past without eating much, but I will never do it again.