Malaria Pills and Side Effects?
 

I'm going to India, and my doc prescribes Mefloquine (Lariam) that you take once a week. Has anyone used this, and what side effects did you experience?

I've read that it can cause nightmares, hallucinations, depression, anxiety, psychotic fits. Yikes! As if India won't be giving me those symptoms already! ;) Some even develop extremely itchy rashes on their skin.

Anything that you can do to alleviate those side effects? Please share your experience. Thanks!

I would ask your doctor about the alternatives: Malarone and doxyclycline. Neither has the side effects you listed and both are commonly prescribed for malaria prevention in India.

I think such side effects only apply to certain people (though that does not help if you are one of them). I took malaria tablets on and off for decades without any problems, as did untold millions of others.

PJG posted the following on the wrong thread. I am reposting it here:

"I agree with Craig, that Larium sometimes causes hallucinations,I used it in Africa 3 years ago and it did, I just now came back from another trip to Africa and used Malarone... just gave me a bit of dizziness when getting up at night.. other than that all was fine..."

Of course it all depends on the individual.

Having said that I used to take Larium and the only side effect was vivid (and interesting) dreams and wonderful restful overall sleeps.

The last two times I used Malarone which was quite boring in comparison, with no effects at all.

I tried Lariam and gave up after one pill. It gave me nightmares and paranoia. While people react differently, no reason to risk Lariam when you could take Malarone instead.

Larium is the anti-malarial most likely to cause side effects. Approximately one-third of people who take larium develop some kind of psychological side effect, most commonly vivid, bizarre or frightening dreams, but more severe psychological side effects (paranoia, severe, anxiety, and rarely, psychotic episodes) are sometimes seen. Almost two thirds of people taking larium do not experience troublesome side effects. The side effects are the reason physicians recommend people take several test doses before traveling, so if you do develop side effects, you can be switched to another anti-malarial. In excess of 90% of the side effects will appear within the first three doses. Larium has the advantage of once a week dosing, which many people like.

If you do not want to take Larium, talk with your doctor about other options. As Craig mentioned, doxycycline and malarone are your other two options.

Take a look at www.cdc.gov/travel for info on malaria and anti-malarials. Also, make sure you've has the appropriate immunizations for travel to India.

Personally I will not take Larium. I've been on Malarone twice...two years in a row... to Ghana, West Africa. I had some stomach problems with it and always felt just a bit out of it, but kept on going. Happy Travels!

Thanks, all, for sharing your experiences. I'd better ask my doc for malarone as well.

As for Lariam (mefloquine), how long do those side effects (nightmares, psychotic fits, etc.) last after you take the pill? 1 or 2 days or the entire week?

My body doesn't take drugs very well, so I'm quite wary about all they I hear.

thanks again!


P.S. Craig, which malaria drug did you take for your India trip? And how you reacted to it? Thanks.

Everyone is different. Many people report they only have symptoms for a day or two after taking the larium, others report non-stop problems. If you have a history of adverse drug reactions, I'd suggest a different drug.

I've taken Malarone for several weeks for my last half dozen trips. I've never had any side effects.

JC - I started with Malerone and had to switch to doxycycline early in the trip due to stomach problems. Fortunately, my wife was taking doxy and had extra so I didn't have to get a new prescription until I returned. The only side effect of doxy is sensitivity to the sun so if you go that route, take precautions.

On the assumption that having a number of us chime in, here is our experience.

My family of 4 took a course of malarone last summer and also the summer before. I was not keen on experimenting with Lariam because I know people who had overly vivid dreams when taking it. The Malarone was expensive but sounded like a much better drug for us. It was recommended for the areas that we were traveling in SEA.

All of us had mild GI complaints both times. It was an annoyance rather than an impediment to having a good trip. To the extent that the medecine provided substantial (not total) protection against malaria, it seemed worth it as you may surmise from our decision to take the drug again that second summer. It would be wrong to say that we felt no effects at all though. ("We" are a middle-aged couple and 2 older teens generally in good health.)

The one part of the experience that profoundly upset me happened here in the US and was a fluke that is unlikely to happen to any of you. When I went to our (respectable) clinic to pick up our travel meds for the second summer, the young dispensing agent said "Here is your malaria medicine." She showed me a prescription that differed in appearance from what I remembered us taking the previous year. It was mefloquine, not malarone, but she insisted that they were functional equivalents which they indeed are not. If I had been rushing and not remembered that the malaria meds from the previous year looked different, I might have unwittingly accepted the Mefloquine/Lariam, packed off to Asia, and later found myself at Siem Reap with a drug that I didn't want to take. I tell this ridculous tale so that anyone hurriedly preparing for a first trip look carefully at everything they pick up at the clinic before departure.

marya, That is a really frightening experience.

Thanks, Kathie.

Have a great trip, by the way!

Thanks, marya, this will be the first trip in years that I don't need an anti-malarial!

Are Marlari pills needed for Thailand?

Only small parts of Thailand are malarial risk: The border areas with Burma, Laos and Cambodia (including Koh Chang) are highest risk.

take a look at www.cdc.gov/travel

The three of us have taken Lariam for three different trips to India with not even a twinge of a side effect. It does depend on the person. You won't know until you take one. Good luck. :-)

I would not recommend Lariam to my worst enemy. I ended up suicidal and parnoid for 2 years after taking 8 tablets.

Pardon me but med side effects go away after the cessation of the particular drug, depending of how long it takes for the particular drug to be metabolized and excreted. Lariam or any other drug for that matter doesn't stay in your body for anywhere near that length of time. The half life is long. 3 weeks but if you were so effected for 2 yrs. its not the drug. Its gone about 6 weeks after injestion of the last dose.

Actually, if only it were so simple that "med side effects go away after the cessation of the particular drug, depending of how long it takes for the particular drug to be metabolized and excreted." I don't know jsp, but there have been a number of well-documented cases of persistent after-effects of larium. A number of drugs can produce long-lasting after-effects.

It sounds like an awful experience, jsp.

Here's an update based on our personal experience. We recently came back from India, and we'd asked the doc to change our meds to malarone. We took it with food and had no problem. No side effects whatsoever.

Thanks all for the warnings about lariam!

I just double checked with one of the PharmD's at work (Phd. in pharmacology) and he said that drug is long gone in a few weeks time. Two yrs. is way too long to consider. At that point its not the drug.

Jacketwatch, the drug is gone, but there can be lingering effects from a drug long after it is gone from the body. Talk with your PharmD about drugs that have long-term or permanent effects long after all of the drug has been metabolized and excreted. There are many examples.

take doxy or malarone. doxy is veyr effective and much cheaper than malarone but i've heard of people having bad side effects from larium also.

Kathie: I did talk to him most specifically about this and thats the answer I got. and I aggree to. I suppose we will just disagree aboutt this. I still say two yrs. is way beyond belief inre to drug side effects. It makes no sense. JM2C.

Whatever you do - DON'T take larium.

I chose the prospect of malaria over the awful, awful nightmares I experienced. What is worse, these dreams stay with you - I could tell you now, in vivid detail, what I experienced four years ago in Africa - arghhh - I'm feeling disturbed just thinking about it.
Just don't. Please.

just finished 19 days of malerone for my trip in india with zero side affects

jacketwatch, ask your ParmD about tardive dyskensia, a permanent side effect of anti-psycotic medication. Just one example of how a drug can long-term or permanently alter someone's functioning.

Kathie: That is a PHYSICAL SE of long term usage of anti-psychotic medication and is more common in the elderly. Lariam is not in that class of drug, is taken short term and there are no such reported SE's. There are also no reported long term (i.e. two yrs.) mental SE's either, esp. for two yrs. In a matter of weeks the drug has been excreted. You can't compare TD with a supposed 2 yr. schizo episode. Its like compare apples to oranges. I feel for this poster but if these mental effects lasted two yrs. is can't be the drug.

jacketwatch, perhaps we really have wandered off topic (but I do love these kinds of discussions). I used TD as an example as it appeared to me that you were maintaining that a SE couldn't last beyond the life of the drug in the body. TD is a well-known example of a side effect that lasts permanently. It has been documented in some cases after a very short time on the drugs. It is a physical side effect apparently due to changes in dopamine metabolism in the brain. As you know, changes in the concentrations and metabolism of neurotransmitters in the brain are the physical manifestation of psychological/psychiatric illnesses.

There have been published studies of long-term side effects of larium, including paranoid psychotic episodes and episodes of psychotic depression lasting several years. It's a rare effect, but it does occur. A number of years ago, Consumer Reports published an article about larium. It was nicely done, accessible to the general reader. They cited stats on side effects and gave brief synopses of some case studies of long-term psychiatric effects of larium. I think you can still access the article at their website.

There are other drugs that are well-known for long-term psychiatric effects, mostly drugs of abuse. IV Amphetimine abuse is well-known for inducing psychotic episodes, including psychotic episodes that are years in duration (obviously long after the drug and its metabolites have been excreted).

Perhaps I should also mention that cortisone can induce psychotic symptoms with higher doses or longer use. I remember a young womna with rhumatiod arthritis who became paranoid enough that she had to be hospitalized. She improved with the withdrawal of the cortisone, but had some lingering symptoms for one to two years afterwards.

Kathie: I do agree that symptoms can linger with long term use. I did ask another PhamrD today and his answer was the same as his colleauge's about this. Perhaps someone can report such symptoms but anything can happen once. I looked into it too and really can't find anything to substantiate this. So based on that and what two teaching professors at the college of pharmacy here told me and my own experience as a critical care RN for 28 yrs. I can only conclude what I have previously stated inre to effects of short term lariam use. If such effects lingered for two yrs. I think there has to be other reasons of factors. I am just plain skeptical about that. it seems too far out there to me but of course that is my opinion only. BTW I do recall having a pt. who became severly depressed after we began a lidocaine drip but she was fine once we stopped it. This was many yrs. ago. Lido. is not in vogue anymore. Cheers, Larry

Kathie: Do you have a link to that site or article? Thank you.

As a last-year neurology resident, we are often asked to determine if certain behaviors are caused by meds. As Kathie mentioned, antipsychotics can cause permanent movement disorders/rigidity, called tardive dyskinesias. As for the steroids, the psychiatric symptoms usually go away within a few weeks after the treatment stopped... the more pressing question for both that and any other med is whether the person has any other predisposition to mental illness (family background, or unnoted seizures that were maybe mistaken as staring spells), or is it truely the medication. Many street drugs, most notable PCP and LSD, as well as nameles others can permanently alter the structure of the brain. That said, it seems that Larium has had enough people report psychiatric side effects to make the number statistically significant... once we use our PET scans on a more routine basis, we'll know for sure.
Personally, I would just stick to Malarone. :)

Given that Lariam is a highly specific drug, there is no reason for someone who doesnt't work with it often or study it to be well versed in the possible side effects and reported side effects. With the number of drugs on the market today, a thorough understanding of each and every one of them by the average pharmacist is simply unreasonable. I'm sure the people jacketwatch asked about Lariam are well educated and respected professionals. But, I doubt they are "Lariam specialists." The general consensus is that Lariam is safe for everybody and easy to take...and that is so for many, but not for all.

Here are some links to government information. The US Gov't used Lariam for troops long before it was approved for the general public. They warn of persistent side effects and even include it as a special topic for VA care.

"Symptoms may continue long after mefloquine use has been stopped." from http://deploymenthealthlibrary.fhp.o...m)%20(160).pdf

" The most severe and persistent adverse effects appear in “case reports.” In those
instances, consistent with the nature of a case report, the relevant signs and symptoms began
while mefloquine was being taken, and persisted in some reports for weeks, months or even
years after the drug was stopped. NOTE: Mefloquine has a long half-life in humans of 15 to 30
days. Adverse effects that are reported to persist for significant periods after the drug is stopped,
or that could be associated with long-term health effects, include the following which lists in
decreasing frequency the cases; NOTE: The reported number of individual cases and the
number of published reports for that health effect are shown in parenthesis; i.e., 16/12 means
that there were sixteen reported cases and twelve published reports." from http://www1.va.gov/environagents/doc...0-2004-007.pdf

Severe and persistent side effects:
"(1) Anxiety, paranoia, hallucinations, depression, suicidal ideation, cognitive and other (1) Anxiety, paranoia, hallucinations, depression, suicidal ideation, cognitive and other
neuropsychiatric symptoms (16/12),

(2) Acute and paranoid psychosis (10/9),

(3) Convulsions, grand mal seizures, coma and abnormal electroencephalography (EEG)
(9/4),

(4) High frequency sensorineural hearing loss and tinnitus, with partial or no remission (3/1),

(5) Acute lung injury with diffuse alveolar damage (2/1),

(6) Elevated liver function tests or fatty liver (2/2),

(7) Multifocal myoclonus (1/1),

(8) Fatal toxic epidermal necrolysis (1/1),

(9) Trigeminal sensory neuropathy (1/1),

(10) Atrial flutter (1/1), and

(11) Mefloquine overdose induced encephalopathy (1/1). "

http://www.indiana.edu/~primate/larrefs.html
for a bibliography of reliable sources of information including info about persistent side effects.

http://www.vva.org/TheVeteran/2005_1...ure_Lariam.htm

http://psy.psychiatryonline.org/cgi/...t/44/4/339.pdf

http://transcripts.cnn.com/TRANSCRIP...07/pzn.00.html

For more, just google "lariam persistent side effects."

jacketwatch and others (Larry, I'm amazed we still have people reading our rather arcane discussion), I checked teh consumer reports website today and they do not have their report on Larium available on the website any longer. They say it was published in the March 2002 issue, so it should be something you can locate at your library.

Junejuly and Kim, thanks for your additions to this discussion.

Kathie: We disagree here but I think you are so cool. :D Larry

Thanks, Larry. I know I tend to "lecture" about medical topics and hope that I don't alienate people by doing so.

Not me hun. :D :D

Getting back to the topic it is clear there are cases, though very few of incredibly long term mental discomforts after taking this drug. I tend to agree with Junejuly here inre to previous psych issues and/or familial predispositions as a mitigating factor or one worthy of investigation. I disagree about the notion of Lariam "specialists." I think that is too narrow a focus of study. Those who have advanced knowledge of the fundamentals of pharmacology have a solid basis to opine on this matter. I've seen these two gentleman practice for 10-15 yrs. and IMHO they are very intelligent and have achieved positions as tenured professors through research and clinical excellence. I've learned to respect their opinions too. They are nearly always right. JM2C. Larry.