Sweet Dreams, Mefloquine!

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Ghana is one of the many in countries in Africa infested with malaria-carrying mosquitoes.  If caught quickly, malaria can easily be treated with a three-day course of antibiotics. Other cases can be more serious and even deadly. Obviously, I want to avoid getting malaria, so I use bug spray laced with DEET and take an anti-malarial prophylaxis. Due to different drug resistances, the main two anti-malarials taken by travelers to Ghana are doxycycline and mefloquine. Doxy is a daily prescription and mefloquine is taken weekly. I take mefloquine.

Mefloquine Structural Formula. Coutesy of Wikipedia (I know)

Mefloquine Structural Formula. Courtesy of Wikipedia

Mefloquine, also known as Larium, was created as a response to the thousands of malaria infections experienced in the Vietnam War. The U.S. Army developed the drug in 1971 after strains of malaria became resistant to chloroquine. It was cheap to make, effective, and only needed to be taken weekly. It entered the commercial market in 1989, and is currently the third most prescribed anti-malarial. Only generic versions can be purchased, as the brand-name manufacturer, Roche, no longer sells Larium in the U.S.

Several years after being commercially sold, doctors began to notice some problematic symptoms among those taking the drug. According to the FDA, the neurological side effects can include dizziness, loss of balance, or ringing in the ears. The psychiatric side effects can include feeling anxious, mistrustful, depressed, or having hallucinations. In addition to those, mefloquine can cause hair loss, chronic insomnia, diarrhea, and migraine headaches; the drug has also been attributed to numerous psychotic episodes. These symptoms generally disappear after stopping the drug, but in some cases may be permanent.

Roche claims that serious psychological side effects only occur in one in 10,000 people. However, Dr. Paul Clarke, an infectious disease specialist from Great Britain, organized his own study after witnessing side effects in a greater frequency. According to Clark’s study, the actual frequency of disabling effects is closer to one in 140 people. This dramatic difference is mostly due to Roche’s qualification of “serious” versus Clark’s “disabling.” The drug company only considers a case serious if it causes death, hospitalization, or a long-term disability. Between 1997 and 2001, the FDA recorded eleven suicides and twelve suicide attempts that were linked with mefloquine.

So innocent looking, yet so dangerous.

So innocent looking, yet so dangerous.

On June 29th, 2013, the FDA released an announcement that strengthened the warnings about the neurological side effects. Then in September, the Surgeon General’s Office of the Army Special Operations Command ordered a halt in prescribing mefloquine for the approximately 25,000 Green Berets, Rangers, Civil Affairs and Psychological Operations soldiers. Furthermore, the Pentagon has been reviewing the potential neurological side effects on service members, as the side effects can often mimic other issues, such as PTSD. The review is expected to be completed this January.

So if mefloquine has all of these worrying side effects, why did my doctor prescribe it? As a proud member of the pasty people population, I didn’t have much of a choice. I’ve taken doxy before and experience sun sensitivity–not exactly ideal for traveling to a country so near the equator. Plus my doctor was hesitant to give me doxy for such a long period of time. I would have to take it every single day for almost six months. Lastly, buying that many pills can get pretty pricy.

So I’ve been taking mefloquine for about three and a half months now. So far, I haven’t had any of the scary side effects, like hallucinations, but I do have some of the more mild ones. I suffer from insomnia, especially on the days I take my dose. Even when I’m super tired, I have trouble falling asleep and wake up several times a night. Secondly, I’m frequently dizzy. It’s usually not too bothersome, but the vertigo has gotten so bad once or twice that I had to lie down or risk falling over. Lastly, I’ve experienced very vivid and occasionally lucid dreams. Since I never used to remember my dreams, this is an entirely new and often pleasurable experience. I even woken myself up several times laughing hysterically for no reason. I realize that taking mefloquine is not ideal and can be very harmful for people with history of mental illnesses. If I start experiencing any of the serious side affects, I plan to stop taking it immediately.

For more information, read this super scary article by CBS News, and one by The Guardian:

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