Mefloquine, sold under the brand names Lariam among others, is a medication used to prevent or treat malaria. When used for prevention it is taken once a week and should be started one or malaria in pregnancy a literature review pdf weeks before potential exposure and continued for four weeks after potential exposure. Mefloquine was developed by the United States Army in the 1970s and came into use in the mid 1980s.

Mefloquine is used to both prevent and treat certain forms of malaria. Mefloquine is useful for the prevention of malaria in all areas except for those where parasites may have resistance to multiple medications, and is one of several anti-malarial medications recommended by the United States Centers for Disease Control and Prevention for this purpose. Mefloquine is used as a treatment for chloroquine-sensitive or resistant Plasmodium falciparum malaria, and is deemed a reasonable alternative for uncomplicated chloroquine-resistant Plasmodium vivax malaria. Mefloquine is widely used for the treatment of malaria in pregnancy.

Limited data suggests that it is safe for this purpose. Resistance to mefloquine is now common around the west border in Cambodia and other parts of Southeast Asia. The mechanism of resistance is by increase in Pfmdr1 copy number. Mefloquine is contraindicated in those with a previous history of seizures or a recent history of psychiatric disorders. Severe side effects requiring hospitalization are rare.

In 2013 the United States Food and Drug Administration added a boxed warning to the U. Mefloquine may cause abnormalities with heart rhythms that are visible on electrocardiograms. Combining mefloquine with other drugs that cause similar effects, such as quinine or quinidine, can increase these effects. Women should not become pregnant and should use effective birth control while taking mefloquine. A retrospective analysis of outcomes in more than 2,500 women found no evidence that mefloquine was associated with an increased risk of birth defects or miscarriages.

The drug may be used during breastfeeding, though it appears in breast milk in low concentrations. The World Health Organization gives approval for the use of mefloquine in the second and third trimesters of pregnancy and use in the first trimester does not mandate termination of pregnancy. Mefloquine is metabolized primarily through the liver. Its elimination in persons with impaired liver function may be prolonged, resulting in higher plasma levels and an increased risk of adverse reactions. The mean elimination plasma half-life of mefloquine is between two and four weeks.

Liver function tests should be performed during long-term administration of mefloquine. Alcohol use should be avoided during treatment with mefloquine. Mefloquine is a chiral molecule with two asymmetric carbon centres, which means it has four different stereoisomers. 1970s shortly after the end of the Vietnam war. Mefloquine was number 142,490 of a total of 250,000 antimalarial compounds screened during the study. US Department of Defense and a pharmaceutical company.

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