Idiosyncratic quinoline central nervous system toxicity: Historical insights into the chronic neurological sequelae of mefloquine

Nevin, Remington L.

doi:10.1016/j.ijpddr.2014.03.002

Cited by 45 publications

(57 citation statements)

References 104 publications

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“…In addition, such a mechanism does not readily explain the reported dizziness or diplopia, and neither does it explain the unilateral nature of the observed CSCR. In contrast, recent insights into the toxic effects of mefloquine on the CNS [1] may provide an alternative and more plausible explanation for these visual and non-visual effects.…”

Section: Discussionmentioning

confidence: 99%

“…We propose that CSCR should therefore be considered a potential sign of mefloquine intoxication [1] and more generally of quinoline CNS toxicity, and should prompt a careful clinical evaluation for other evidence of neuropsychiatric toxicity. In our case, insight into a possible CNS etiology came too late to inform clinical application, but fortunately our patient appears to have been spared the chronic cognitive sequelae, including cognitive dysfunction, which may affect a sizable minority of those reporting neuropsychiatric adverse effects from the drug [2].…”

Section: Discussionmentioning

confidence: 99%

“…Recently its popularity has declined as awareness has grown of the drug’s focal central nervous system (CNS) toxicity, which is associated with a wide range of acute and chronic neurological sequelae including vertigo, loss of balance, and symptoms of polyneuropathy which may be irreversible [1], as well as certain neuropsychiatric effects including cognitive impairment which may last years after use [2]. Although not widely recognized in the literature [3, 4], certain visual effects associated with mefloquine use including blurred vision or accommodative dysfunction may also be plausibly attributable to focal CNS toxicity [1, 5]. …”

Section: Introductionmentioning

confidence: 99%

“…While dizziness [1], diplopia [6], and maculopathy [7] have been previously reported separately with mefloquine use, these conditions have not previously been reported together, and confirmation of central serous chorioretinopathy (CSCR) has not been previously reported. Identification of a common mechanism of CNS toxicity plausibly underlying both these visual and non-visual effects would have implications for better understanding of the acute and chronic neuropsychiatric effects of intoxication with mefloquine and other quinoline antimalarial drugs.…”

Section: Introductionmentioning

confidence: 99%

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Mefloquine-associated dizziness, diplopia, and central serous chorioretinopathy: a case report

2016

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BackgroundMany acute and chronic neurological sequelae from the quinoline derivative antimalarial drug mefloquine, including dizziness and effects on the visual system such as diplopia and blurred vision, may be attributable to focal central nervous system toxicity. Maculopathy has also been reported with use of mefloquine, although the mechanism of this effect has remained unclear. Identification of a common mechanism of toxicity plausibly underlying these visual and non-visual effects may provide broader insights into the acute and chronic neuropsychiatric effects of this and other quinoline antimalarial drugs.Case presentationThis case report describes a 30-year-old man of Pakistani descent with sudden onset of dizziness and diplopia following the administration of mefloquine who developed macular changes diagnosed as acute central serous chorioretinopathy by angiography and optical coherence tomography. Similarities between the visual conditions observed in this case and those observed following administration of related quinoline derivative antimalarial drugs including quinine are considered, and plausible mechanisms for the observed drug-induced toxicity are discussed.ConclusionsIt is proposed that central serous chorioretinopathy be considered a potential ophthalmological sign of mefloquine central nervous system toxicity, and for this effect to potentially indicate susceptibility to other neuropsychiatric effects of mefloquine intoxication. Treating physicians should be aware of the potential for acute and chronic ocular effects resulting from administration of mefloquine and other quinoline antimalarial drugs.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Mefloquine-associated dizziness, diplopia, and central serous chorioretinopathy: a case report

2016

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“…The neurotoxicity of the 8-aminoquinolines [29] [30] is characteristic for these substances. In most of described neuropsychiatric disturbances after malaria prophylaxis were notified with use of mefloquine, plasmocid, clioquinol, plasmochine and rhodoquine [31]- [58]. However, already in 1951 appears that primaquine can exhibit the similar effects in animal models [53] Despite very broad use of primaquine in curative medicine, more than several hundred million cases per year, the description of neurotoxicity of this drug is very poor presented in literature.…”

Section: Toxicity and Neurotoxicity Of Primaquine And 8-aminoquinolinesmentioning

confidence: 99%

Review: Can Toxic Substances Initiate Psychotic Behavior? Part I. Antimalarial Drugs

Brondz¹

2014

OJPM

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During and after every military conflict or war, there appears to be rapports about military crimes which were done by military and civil personal of conflicting sides. The basis of these offences is different; however the common to these is psychological and psychical background. The psychological background is an indoctrination of troopers that all what they are doing is right, well for country, nation or defends religion, or ideology. The life and property of enemy (opponent) are less worth than their oven. But most important in this indoctrination is the direct or indirect insurances about the absence of responsibility and promises about free for punishment for these actions. These aspects are well known and well-studied. The psychical background is less studied and more diverse; however in all cases the components of stress are present. The stress can be physical, psychical or toxic. The physical and psychical stress of engaged in military conflict personal is well studied, its action both during the war and as postwar syndrome have sufficient explanations. The action of intoxication especially by contaminants in medical forms, or toxins to induce the criminal behavior of military personal is nearly unstudied. The exceptions are alcohol, psychogenic substances as narcotics, LSD and special doping agents. This paper presented the evidences of additional toxic stress by contaminates in medical forms and intoxication by toxins of military personal engaged in different conflicts during last decades. The hypothesis about the influences of the additional toxic stress by medication with low quality pharmaceutical forms and some toxins on inducing the crimes generally and war crimes by military personal is launched in the paper. In this part the investigation will be concentrated on antimalarial drugs, especially on contaminated primaquine. Primaquine has a special position in preventing malaria infection in areas of conflict on the territories of endemic malaria. The possibility of induction of psychotic cases which lead to uncontrolled by person its-self actions and which are of criminal nature will be discussed, together with juridical responsibilities for these actions.

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Prolonged neuropsychiatric effects following management of chloroquine intoxication with psychotropic polypharmacy

Maxwell

Nevin

Stahl

et al. 2015

Clinical Case Reports

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Key Clinical MessageSusceptibility to quinoline antimalarial intoxication may reflect individual genetic and drug-induced variation in neuropharmacokinetics. In this report, we describe a case of chloroquine intoxication that appeared to be prolonged by subsequent use of multiple psychotropic medications. This case highlights important new considerations for the management of quinoline antimalarial intoxication.

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Idiosyncratic quinoline central nervous system toxicity: Historical insights into the chronic neurological sequelae of mefloquine

Abstract: Graphical abstract

Cited by 45 publications

References 104 publications

Mefloquine-associated dizziness, diplopia, and central serous chorioretinopathy: a case report

Mefloquine-associated dizziness, diplopia, and central serous chorioretinopathy: a case report

Review: Can Toxic Substances Initiate Psychotic Behavior? Part I. Antimalarial Drugs

Prolonged neuropsychiatric effects following management of chloroquine intoxication with psychotropic polypharmacy

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