Dermatological adverse effects with the antimalarial drug mefloquine: a review of 74 published case reports

Abstract

Mefloquine is a relatively new antimalarial drug which has been associated with a wide variety of adverse effects, including skin reactions. In order to evaluate the range and frequency of mefloquine's dermatological effects, we searched the scientific literature for published case reports of such effects. We found 74 case reports, published between the years 1983 and 1997. Pruritus and maculopapular rash are the dermatological effects most commonly associated with mefloquine: their approximate frequency is 4-10% for pruritus, and up to 30% for nonspecific maculopapular rash. Adverse effects associated less commonly with mefloquine include urticaria, facial lesions and cutaneous vasculitis. One case of Stevens-Johnson syndrome and one fatal case of toxic epidermal necrolysis occurred. Appropriate primary studies of mefloquine use should be carried out to elucidate the epidemiology and aetiology of dermatological and other adverse effects of the drug.

Adverse effects of the antimalaria drug, mefloquine: due to primary liver damage with secondary thyroid involvement?

“…[55,56] These nested studies would allow for rigorous testing of the aetiological mechanisms which we have proposed for mefloquine's adverse effects. The studies should also resolve those prescribing issues on which experts' opinions differ (eg, Is mefloquine safe in pregnancy?…”

“…For example, mefloquine has been associated with a wide variety of dermatological adverse effects, and most of these can be linked with effects on the liver or thyroid. [41,55] Convulsions and dizziness are other reported effects of mefloquine which can be related to liver or thyroid disturbance. [2,41]…”

Adverse Cutaneous Reactions to Antimicrobials in Patients with Human Immunodeficiency Virus Infection

“…Many drugs in this class have been associated with significant side effect profiles in the general population. Reports have identified cases of SJS secondary to the use of albendazole, 122 atovaquone-proguanil, 123 mebendazole, 124 mefloquine, 125 and thiabendazole. 126 Mefloquine, metronidazole, 127 and thiabendazole 128 have been identified as causative agents in cases of TEN.…”

Extracts from "Clinical Evidence": Malaria: prevention in travellers

“…Retrospective questionnaire surveys in tourists and business travellers found that sleep disturbance and psychosis were common. 45 46 One review of 74 dermatological case reports found that up to 30% of mefloquine users developed a maculopapular rash and 4-10% had pruritus 47. Seven observational studies in tourists found that women tolerated mefloquine less well than men.…”