Pregnancy mefloquine

Mefloquine prophylaxis can be undertaken v/ith caution in cardiac conduction disorders. It should be avoided in epilepsy, during pregnancy and breastfeeding and for 3 months after pregnancy. 

There is very limited evidence available on the effectiveness of the drugs in pregnant women. A possible increase in risk of stillbirth with the use of mefloquine in pregnancy has been reported. Standard adult dose of antimalarial drugs recommended for 2nd and 3rd trimester pregnancy did not cause harm or congenital abnormalities. Evidence on the safety of all recommended antimalarial drugs in the 1st trimester is still unclear. 

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. 

Artemisinin derivatives (artesunate and artemether) for the treatment of multidrug-resistant Plasmodium falciparum malaria have been evaluated in 83 Karen pregnant women in Thailand 55 women were treated for recrudescent infection after quinine or mefloquine, 12 for uncomplicated hyperparasitemic episodes, and 16 had not declared their pregnancy when treated (32). 

A review of the use of mefloquine in pregnancy (47) did not suggest that mefloquine has a worse effect in pregnancy than other antimalarial drugs, such as chloroquine and pyrimethamine + sulfadoxine. 

Phillips-Howard PA, Steffen R, Kerr L, Vanhauwere B, Schildknecht J, Fuchs E, Edwards R. Safety of mefloquine and other antimalarial agents in the first trimester of pregnancy. J Travel Med 1998 5(3) 121-6. 

McGready R, Brockman A, Cho T, Cho D, van Vugt M, Luxemburger C, Chongsuphaj aisiddhi T, White NJ, Nosten F. Randomized comparison of mefloquine-artesunate versus quinine in the treatment of multidrug-resistant falciparum malaria in pregnancy. Trans R Soc Trop Med Hyg 2000 94(6) 689-93. 

Tangkitchot S, Boudreau E, Bunnag D, White NJ. Mefloquine prophylaxis prevents malaria during pregnancy a double-blind, placebo-controlled study. J Infect Dis 1994 169(3) 595-603. 

Nosten F, Vincenti M, Simpson J, Yei P, Thwai KL, de Vries A, Chongsuphaj aisiddhi T, White NJ. The effects of mefloquine treatment in pregnancy. CUn Infect Dis 1999 28(4) 808-15. 

Hemolysis has occurred with primaquine in patients deficient in G6P dehydrogenase Mefloquine is used for prophylaxis in regions where chloroquine resistance occurs Quinine is safe to use in pregnancy... 

Mawson A. Mefloquine use, psychosis, and violence a retinoid toxicity hypothesis. Med Sci Monit Int Med J Exp Chn Res 2013 19 579-83. Nevin RL. Limbic encephalopathy and central vestibulopathy caused by mefloquine a case report. Travel Med Infect Dis 2012 10 144r-51. Nevin RL. Mefloquine gap junction blockade and risk of pregnancy loss. Biol Reprod 2012 87(3) 65,1-9. 

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