Reported Side Effects to Chloroquine, Chloroquine plus Proguanil, and Mefloquine as Chemoprophylaxis against Malaria in Danish Travelers

Petersen, Eskild; Rønne, T; Rønn, Anita M.; Bygbjerg, Ib Christian; Larsen, Severin Olesen

doi:10.2310/7060.2000.00026

Cited by 50 publications

(34 citation statements)

References 11 publications

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“…If medication is stopped sooner than prescribed, a substantial risk of acquiring clinical malaria exists. Mefloquine, now available as a generic, is relatively inexpensive and convenient, but due to neuropsychiatric adverse effects, [64][65][66] it is not recommended for those with depression, anxiety, or posttraumatic stress disorder, 21,22 all of which are common in VFR travelers. 67 Newly required warning sheets from dispensing pharmacies may discourage some from taking mefloquine, unless specifically reassured.…”

Section: Food and Waterborne Illnessesmentioning

confidence: 99%

Travel Medicine Considerations for North American Immigrants Visiting Friends and Relatives

Bacaner¹

2004

JAMA

212

119

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RAVEL MEDICINE TRADITIONally focuses on assisting tourist and business travelers avoid travel-related illnesses. It is now clear that immigrants returning to their home countries, termed visiting friends and relatives (VFRs), are at particularly high risk and that traditional travel services are inadequate for protecting this population. This article will review existing data concerning the increased risk and discuss practical recommendations that may assist the primary care and travel clinicians.International migration has risen from 120 million in 1990 to 175 million in 2002. 1,2 In 2002 more than 1 million persons legally immigrated to the United States from more than 220 countries. 3 Twenty percent of the US population are first-generation immigrants or their children are. 4 In spite of being a minority of the population, VFRs comprised approximately 40% of US international air travelers in 2002. 5 Similarly, in the United Kingdom, VFRs made 40% of the 2 million visitors to Africa in 2000. 6,7 Although no VFR demographics exist, it is assumed that national statistics pertaining to immigration patterns reflect subsequent travel patterns for immigrants. There have been major shifts in

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Section: Food and Waterborne Illnessesmentioning

confidence: 99%

Travel Medicine Considerations for North American Immigrants Visiting Friends and Relatives

Bacaner¹

2004

JAMA

212

119

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“…This is also confirmed by a Danish study which showed that malaria cases in those who took chloroquine/proguanil were not due to poor compliance, as it was the case for those taking mefloquine, but were more probably due to the presence of drug resistance [52]. This drug combination can induce gastrointestinal side effects, epigastric pain, vomiting, oral ulcerations and blurred vision in long-term travellers above all [44]. In a 2003 multicentre, randomised, double blind, four arm study on a total of 623 non-immune individuals, the highest incidence of side effects and the highest incidence of moderate to severe skin problems and withdrawal was reported in the combined chloroquine-proguanil arm in comparison with mefloquine, atovaquone-proguanil and doxycyxline arms [53].…”

Section: Chemoprophylaxismentioning

confidence: 61%

“…Chloroquine chemoprophylactic regimen in adults is 300 mg base/week (5 mg base/Kg/die in children) starting one week before the trip up to four weeks after return [43] (Table 3). It can induce several side effects, usually mild [44], including insomnia, nausea, headache, dizziness, blurred vision and itching. A cumulative dose of 100g may result in retinal toxicity, generally after 5-6 years of weekly intake [45].…”

Section: Chemoprophylaxismentioning

confidence: 99%

“…In these cases an alternative regimen (atovaquone/proguanil or doxycycline) should be used [74,75]. Travellers may have a better adherence to mefloquine prophylactic regimen in comparison with chloroquine/proguanil, probably due to its weekly administration [44]. Conversely, a better adherence to atovaquone/proguanil regimen in comparison to mefloquine has also been reported by other studies, probably because of its shorter duration of administration after return [66,76].…”

Section: Chemoprophylaxismentioning

confidence: 99%

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Malaria Prophylaxis: A Comprehensive Review

et al. 2010

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The flow of international travellers to and from malaria-endemic areas, especially Africa, has increased in recent years. Apart from the very high morbidity and mortality burden imposed on malaria-endemic areas, imported malaria is the main cause of fever possibly causing severe disease and death in travellers coming from tropical and subtropical areas, particularly Sub-Saharan Africa. The importance of behavioural preventive measures (bed nets, repellents, etc.), adequate chemoprophylaxis and, in selected circumstances, stand-by emergency treatment may not be overemphasized. However, no prophylactic regimen may offer complete protection. Expert advice is needed to tailor prophylactic advice according to traveller (age, baseline clinical conditions, etc.) and travel (destination, season, etc.) characteristics in order to reduce malaria risk.

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“…Cohort studies have indicated that the use of mefloquine is associated with an increased risk of depression [20–23], central nervous system symptoms [21], and insomnia [24]. One study found that females reported adverse events more frequently than males [20].…”

Section: Introductionmentioning

confidence: 99%

Severe Neuropsychiatric Reaction in a Deployed Military Member after Prophylactic Mefloquine

Peterson

Seegmiller²,

Schindler³

2011

Case Reports in Psychiatry

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Recent studies of military personnel who have deployed to Iraq and Afghanistan have reported a number of combat-related psychiatric disorders such as posttraumatic stress disorder, depression, and traumatic brain injury. This case report involves a 27-year-old male active-duty US military service member who developed severe depression, psychotic hallucinations, and neuropsychological sequelae following the prophylactic use of the antimalarial medication mefloquine hydrochloride. The patient had a recent history of depression and was taking antidepressant medications at the time of his deployment to the Middle East. Psychiatrists and other health care providers should be aware of the possible neuropsychiatric side effects of mefloquine in deployed military personnel and should consider the use of other medications for malaria prophylaxis in those individuals who may be at increased risk for side effects.

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Reported Side Effects to Chloroquine, Chloroquine plus Proguanil, and Mefloquine as Chemoprophylaxis against Malaria in Danish Travelers

Cited by 50 publications

References 11 publications

Travel Medicine Considerations for North American Immigrants Visiting Friends and Relatives

Travel Medicine Considerations for North American Immigrants Visiting Friends and Relatives

Malaria Prophylaxis: A Comprehensive Review

Severe Neuropsychiatric Reaction in a Deployed Military Member after Prophylactic Mefloquine

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