Mefloquine Indinavir

Anti-infective drugs Ciprofloxacin can greatly increase the risk of seizure induction in patients taking anticonvulsants. Erythromycin produces a rapid 100-200% rise in carbamazepine levels. There is a possibility of reduced plasma levels of the protease inhibitors indinavir and saquinavir with carbamazepine. Isoniazid increases carbamazepine serum levels, and leads to the possible emergence of toxicity (disorientation and aggression). Mefloquine may antagonize the anticonvulsant effect of carbamazepine. Ritonavir, a protease inhibitor, may cause toxicity by raising carbamazepine plasma levels. 

Data from individual patients surest there is no pharmacokinetic interaction between mefloquine and indinavir or nelfinavir. In pharmacokinetic studies in healthy subjects, ritonavir did not alter mefloquine pharmacokinetics, but mefloquine modestly decreased steady-state ritonavir levels. 

Two HIV-positive patients using HAART, one taking indinavir 800 mg three times daily, the other taking nelfinavir 1.25 g twice daily were given mefloquine 250 mg weekly, before a trip to Africa. Mefloquine achieved therapeutic levels, and its half-life was similar to that found in healthy subjects. In addition, no consistent changes in the plasma levels of the protease inhibitors were found. ... 

Schippers EF, Hugen PWH, den Hartigh J, Burger DM, Hoetelmans RMW, Visser LG, Kroon FP, No drug-drug interaction between nelfinavir or indinavir and mefloquine in HIV-1 infected patients, AIDS (2000) 14,2794-5,... 

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