MEFLOQUINE

Antimalarial medicine

Dosage Forms

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Tablet

250 mg

Uses

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  • Prophylaxis of P. falciparum malaria of multiple resistance

Dose and Duration

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Prophylaxis of P. falciparum malaria

Prophylaxis should start 1–3 weeks before travelling to a malaria-endemic area and continue for 4 weeks after leaving the area.
Maximum recommended duration of treatment is 12 months.

Adult over 45 kg: 250 mg once a week

Child over 5 kg: 5 mg/kg once a week

Taken on the same day each week

Dose Table

Weight (kg) Dose per week
5–19 ¼ tablet
20–30 ½ tablet
31–45 ¾ tablet
Adult and child >45 1 tablet

Contraindications

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  • Hypersensitivity to quinine
  • History of neuropsychiatric disorders including depression or convulsions
  • Severe hepatic impairment
  • History of blackwater fever

Side Effects

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  • Nausea, vomiting, diarrhoea, abdominal pain, anorexia
  • Headache, dizziness, vertigo, insomnia, abnormal dreams
  • Anxiety, depression, suicidal ideation
  • Visual impairment
  • Pruritus, Stevens-Johnson syndrome
  • Encephalopathy
  • Atrioventricular block

Interactions

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  • Amiodarone: (increased risk of ventricular arrhythmias)
  • Artemether + Lumefantrine: (avoid concomitant use)
  • Carbamazepine: (antagonism of anticonvulsant effect)
  • Chloroquine: (increased risk of convulsions)
  • Citalopram: (risk of ventricular arrhythmias)
  • Ethosuximide: (antagonism of anticonvulsant effect)
  • Haloperidol: (increased risk of ventricular arrhythmias)
  • Phenytoin: (antagonism of anticonvulsant effect)
  • Quinine: (increased risk of convulsions)
  • Rifampicin: (reduced concentration of mefloquine)
  • Valproic acid: (antagonism of anticonvulsant effect)

Patient Instructions

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  • Dizziness may impair ability to perform skilled tasks for up to 3 weeks after treatment
  • Stop use and seek medical advice if symptoms such as anxiety, paranoia, depression, hallucinations, suicidal thoughts and psychosis occur

Pregnancy

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  • Do not use

Breast-feeding

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  • Can be used

⚠️ Caution

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  • Intravenous quinine can still be given in severe malaria regardless of the interaction
  • Avoid pregnancy during and for 3 months after use
  • Avoid use in epilepsy and cardiac conduction disorders
  • Stop therapy if patient experiences signs of neuropathy
  • Use with caution in renal impairment
  • Vaccinations with oral attenuated live bacteria should be completed at least 3 days before the first dose of mefloquine