Mefloquine contraindications

Mefloquine (oral) 228 mg (base) (250 mg salt) weekly Less than or equal to 15 kg 4.6 mg/kg base (5 mg/kg salt) once weekly 1 5-19 kg 1/4 tablet 20-30 kg 1/f tablet 31-45 kg 3A tablet Greater than or equal to 45 kg 1 tablet Start 1 -2 wk before departure and continue for 4 wk after leaving endemic area may start 3—4 wk earlier to assess tolerance Contraindications History of seizure, psychiatric disorders (including depression and anxiety), or arrhythmias... 

VLa.2,6. Other antimalarials. Doxycydine (see Section ILb) is a useful and effective short-term prophylactic agent for travellers to chloroquine-resistant areas and can be used as an alternative when mefloquine or proguanil is unavailable or mefloquine is contraindicated. In combination with quinine also tetracycline is used as an antimalarial. 

Contraindications Cardiacabnormalities, severe psychiatric disorders, epilepsy, history of hypersensitivity to mefloquine... 

The use of proguanil plus atovaquone has been reviewed (14). Neuropsychiatric adverse events were more frequent with mefloquine, whereas other adverse events occurred with similar frequencies as with chloroquine plus proguanil and mefloquine. Proguanil plus atovaquone is contraindicated in severe renal insufficiency. Co-administration of proguanil plus atovaquone with rifampicin is not recommended because of reductions in plasma atovaquone concentrations. 

A woman whose epilepsy was controlled with sodium vaiproate developed convulsions when she took mefloquine. Note that mefloquine is normally contraindicated in epilepsy. 

It has been hypothesized that the mechanisms whereby mefloquine increases the risk of seizures in patients with a history of seizures, which may be via altered neuronal calcium homeostasis, altered gap-junction functioning, and neuronal cell death, are particularly associated with a mutation in EPMl, a gene that is associated with progressive myoclonic epilepsy type 1, and hence altered GABA activity [10 ]. The author proposed that mefloquine should be contraindicated in people with the EPMl mutation and in those with a history of myoclonus or ataxia, or a family history of degenerative neurological disorders that are consistent with the presence of the EPMl mutation. 

---