Dizziness mefloquine

The success of quinine inspired the search for other antimalarials. The greatest impetus for the development of synthetic dmgs came this century when the two World Wars intermpted the supply of cinchona bark to the combatants. A stmcturally related 4-quinolinemethanol is mefloquine (65, Lariam [51773-92-3]) which now serves as an effective alternative agent for chloroquine-resistant P. falciparum. This is a potent substance that requires less than one-tenth the dose of quinine to effect cures. There are some untoward side effects associated with this dmg such as gastrointestinal upset and dizziness, but they tend to be transient. Mefloquine is not recommended for use by those using beta-blockers, those whose job requires fine coordination and spatial discrimination, or those with a history of epilepsy or psychiatric disorders. A combination of mefloquine with Fansidar (a mixture of pyrimethamine and sulfadoxine) is known as Fansimef but its use is not recommended. Resistance to mefloquine has been reported even though the compound has not been in wide use. 

Patients taking mefloquine as prophylaxis against malaria should be advised to take the medication regularly and to avoid mosquito bites. Dizziness may be caused by mefloquine and patients should be informed about this side-effect. 

Adverse reactions include nausea, vomiting, dizziness, diarrhoea, abdominal pain, anxiety disorder, sinus bradycardia, ataxia. It is reported that mefloquine is teratogenic in nature so should not be given in first trimester of pregnancy. 

Weekly dosing with mefloquine for chemoprophylaxis may cause nausea, vomiting, dizziness, sleep and behavioral disturbances, epigastric pain, diarrhea, abdominal pain, headache, rash, and dizziness. Neuropsychiatric toxicities have received a good deal of publicity, but despite frequent anecdotal reports of seizures and psychosis, a number of controlled studies have found the frequency of serious adverse effects from mefloquine to be no higher than that with other common antimalarial chemoprophylactic regimens. Leukocytosis, thrombocytopenia, and aminotransferase elevations have been reported. 

Adverse effects include nausea, dizziness, disturbance of balance, vomiting, abdominal pain, diarrhoea and loss of appetite. More rarely, hallucinations, seizures and psychoses occur. Mefloquine should be avoided in patients taking (i-adrenoceptor and calcium channel antagonists for it causes sinus bradycardia quinine can potentiate these and other... 

Lumefantrine was inferior to artesunate + mefloquine in an open, randomized comparison in 617 patients in Thailand with uncomplicated multidrug-resistant malaria tropica, but produced two to four times fewer adverse effects, such as nausea, vomiting, dizziness, sleep disorders, or other neurological symptoms (4). 

The chemotherapeutic response of Plasmodium berghei to various combinations of mefloquine with other drugs (sulfadoxine + pyrimethamine, primaquine, floxacrine) have shown that the desired effects are purely additive (SEDA-13, 809), so the adverse effects too are probably only those of the individual compounds. Adverse reactions occurred in 46% of 400 patients treated with Fanimef (mefloquine + pyrimethamine + sulfadoxine) (SEDA-12, 693). Of note were dizziness (29%), nausea (9.5%), vomiting (7.3%), weakness/lassitude (5.8%), abdominal discomfort or pain (5.5%), diarrhea (3.8%), pruritus (3.0%), insomnia (2.0%), and headache (2.0%). 

Mefloquine NVD, dizziness, syncope, extrasystoles, CNS effects (rare) Avoid in seizures, psychiatric disorders, and cardiac conduction defects... 

Toxicity Mefloquine is less toxic than quinine its adverse effects include gastrointestinal distress, skin rash, headache, and dizziness. At high doses, mefloquine may cause neurologic symptoms and seizures. 

The incidence of side effects with mefloquine is considered to be high. The effects are classified as neuropsychiatric, Gl, dermatologic, and cardiovascular. The neuropsychiatric effects may be serious (e.g., suicidal tendencies or seizures) or minor (e.g., dizziness, vertigo, ataxia, and headaches). Gastrointestinal side effects included nausea, vomiting, and diarrhea, whereas the dermatologic effects include rash, pruritus, and urticaria. Finally, cardiovascular side effects may include bradycardia, arrhythmias, and extrasystoles. 

E. Mefloquine in therapeutic use or overdose may cause dizziness, vertigo, hal-... 

Nervous system The literature on mefloquine neurotoxicity has been reviewed [9 ]. Nausea, dizziness, sleep disturbances, anxiety, and psychosis have been reported. Female patients and patients with a low body mass index are at greater risk. 

A single-dose study of this potentially very useful new antimalarial compound in volunteers (14 ) reported only transient dizziness and nausea at relatively high dosage. It is as yet, however, too early to make an accurate assessment of the potential of mefloquine for causing adverse effects, particularly as phototoxicity has been the major adverse effect caused by closely related drugs. 

---