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Severe Psychiatric Side Effects Observed During Prophylaxis and Treatment With Mefloquine

Severe Psychiatric Side Effects Observed During Prophylaxis and Treatment With Mefloquine Abstract Mefloquine hydrochloride is now one of the major antimalarial drugs used both in prophylactic and therapeutic regimens. Large-scale studies have shown that it is efficacious and relatively well tolerated. However, some severe side effects, particularly neuropsychiatric reactions, have been described. We describe two young men with no previous medical history who experienced severe psychiatric reactions during prophylactic and curative mefloquine therapy. In both cases, full recovery was rapid after cessation of the therapy. There is no explanation for these reactions. Serum levels of mefloquine were within the normal range. The absence of contraindications and minor side effects during an initial course of mefloquine should be confirmed before another course is prescribed. (Arch Intern Med. 1994;154:2360-2362) References 1. Steffen R, Heuser R, Machler R, et al. Malaria chemoprophylaxis among European tourists in tropical Africa: use, adverse reactions, and efficacy . Bull World Health Organ. 1990;68:313-322. 2. Kozarsky P, Eaton M. Use of mefloquine for malarial chemoprophylaxis in its first year of availability in the United States . Clin Infect Dis. 1993;16:185-186.Crossref 3. Sturchler D, Handschin J, Kaiser D, et al. Neuropsychiatric side effects of mefloquine . N Engl J Med. 1990;322:1752-1753. 4. Bem JL, Kerr L, Stuerchler D. Mefloquine prophylaxis: an overview of spontaneous reports of severe psychiatric reactions and convulsions . J Trop Med Hyg. 1992;95:167-179. 5. Weincke T, Trautmann M, Held T, et al. Neuropsychiatric side effects after the use of mefloquine . Am J Trop Med Hyg. 1991;45:86-91. 6. Rouveix B, Bricaire F, Michon C, Franssen G, Lebras J, Bernard J. Mefloquine and an acute brain syndrome . Ann Intern Med. 1989;110:577-578.Crossref 7. Bjorkman A. Acute psychosis following mefloquine prophylaxis . Lancet 1989; 2:865.Crossref 8. De Gennes C, Colas C, Nollet D, et al. Attaque de panique au décours d'un traitement curatif par la méfloquine . Ann Med Intern. 1992;142:631. 9. Stuiver PC, Lightelm RJ, Goud TJLM. Acute psychosis after mefloquine . Lancet . 1989;2:282.Crossref 10. Lapras J, Vighetto A, Trillet M, Garin JP. Trouble transitoire de la mémoire au décours d'un accès palustre: responsabilité de méfloquine? Presse Med. 1989; 18:776. 11. Lobel HO, Bernard KW, Williams SL, Hightower AW, Patchen LC, Campbell CC. Effectiveness and tolerance of long-term malaria prophylaxis with mefloquine: need for a better dosing regimen . JAMA. 1991;265:361-364.Crossref 12. Masson C, Cheron F, Gautier MS, Cambier J. Psychose aiguë après prise de chloroquine . Presse Med. 1990;19:334. 13. Luxemburger C, Nosten F, Ter Kuile F, et al. Mefloquine for multidrug-resistant malaria . Lancet. 1991;338:1268.Crossref 14. Bjorkman A, Steffen R, Armengaud M, Picot N, Piccoli S. Malaria chemoprophylaxis with mefloquine . Lancet. 1991;337:1479-1480.Crossref 15. Centers for Disease Control. Recommendations for the prevention of malaria among travellers . MMWR Morb Mortal Wkly Rep. 1990;39:1-10. 16. Bourgeade A, Tonin V, Keudjian F, Levy PY, Faugere B. Intoxication accidentelle à la méfloquine . Presse Med. 1990;19:1903. 17. Arthur JD, Shanks GD, Echeverria P. Mefloquine prophylaxis . Lancet. 1990; 335:972.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

Severe Psychiatric Side Effects Observed During Prophylaxis and Treatment With Mefloquine

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Publisher
American Medical Association
Copyright
Copyright © 1994 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.1994.00420200116012
Publisher site
See Article on Publisher Site

Abstract

Abstract Mefloquine hydrochloride is now one of the major antimalarial drugs used both in prophylactic and therapeutic regimens. Large-scale studies have shown that it is efficacious and relatively well tolerated. However, some severe side effects, particularly neuropsychiatric reactions, have been described. We describe two young men with no previous medical history who experienced severe psychiatric reactions during prophylactic and curative mefloquine therapy. In both cases, full recovery was rapid after cessation of the therapy. There is no explanation for these reactions. Serum levels of mefloquine were within the normal range. The absence of contraindications and minor side effects during an initial course of mefloquine should be confirmed before another course is prescribed. (Arch Intern Med. 1994;154:2360-2362) References 1. Steffen R, Heuser R, Machler R, et al. Malaria chemoprophylaxis among European tourists in tropical Africa: use, adverse reactions, and efficacy . Bull World Health Organ. 1990;68:313-322. 2. Kozarsky P, Eaton M. Use of mefloquine for malarial chemoprophylaxis in its first year of availability in the United States . Clin Infect Dis. 1993;16:185-186.Crossref 3. Sturchler D, Handschin J, Kaiser D, et al. Neuropsychiatric side effects of mefloquine . N Engl J Med. 1990;322:1752-1753. 4. Bem JL, Kerr L, Stuerchler D. Mefloquine prophylaxis: an overview of spontaneous reports of severe psychiatric reactions and convulsions . J Trop Med Hyg. 1992;95:167-179. 5. Weincke T, Trautmann M, Held T, et al. Neuropsychiatric side effects after the use of mefloquine . Am J Trop Med Hyg. 1991;45:86-91. 6. Rouveix B, Bricaire F, Michon C, Franssen G, Lebras J, Bernard J. Mefloquine and an acute brain syndrome . Ann Intern Med. 1989;110:577-578.Crossref 7. Bjorkman A. Acute psychosis following mefloquine prophylaxis . Lancet 1989; 2:865.Crossref 8. De Gennes C, Colas C, Nollet D, et al. Attaque de panique au décours d'un traitement curatif par la méfloquine . Ann Med Intern. 1992;142:631. 9. Stuiver PC, Lightelm RJ, Goud TJLM. Acute psychosis after mefloquine . Lancet . 1989;2:282.Crossref 10. Lapras J, Vighetto A, Trillet M, Garin JP. Trouble transitoire de la mémoire au décours d'un accès palustre: responsabilité de méfloquine? Presse Med. 1989; 18:776. 11. Lobel HO, Bernard KW, Williams SL, Hightower AW, Patchen LC, Campbell CC. Effectiveness and tolerance of long-term malaria prophylaxis with mefloquine: need for a better dosing regimen . JAMA. 1991;265:361-364.Crossref 12. Masson C, Cheron F, Gautier MS, Cambier J. Psychose aiguë après prise de chloroquine . Presse Med. 1990;19:334. 13. Luxemburger C, Nosten F, Ter Kuile F, et al. Mefloquine for multidrug-resistant malaria . Lancet. 1991;338:1268.Crossref 14. Bjorkman A, Steffen R, Armengaud M, Picot N, Piccoli S. Malaria chemoprophylaxis with mefloquine . Lancet. 1991;337:1479-1480.Crossref 15. Centers for Disease Control. Recommendations for the prevention of malaria among travellers . MMWR Morb Mortal Wkly Rep. 1990;39:1-10. 16. Bourgeade A, Tonin V, Keudjian F, Levy PY, Faugere B. Intoxication accidentelle à la méfloquine . Presse Med. 1990;19:1903. 17. Arthur JD, Shanks GD, Echeverria P. Mefloquine prophylaxis . Lancet. 1990; 335:972.Crossref

Journal

Archives of Internal MedicineAmerican Medical Association

Published: Oct 24, 1994

References