Lariam: Comprehensive Malaria Prophylaxis for High-Risk Regions
Lariam
| Product dosage: 250mg | |||
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Synonyms | |||
Lariam (mefloquine hydrochloride) is a prescription antimalarial medication indicated for the prophylaxis of Plasmodium falciparum and Plasmodium vivax malaria in travelers to areas with known chloroquine-resistant strains. As a long-acting chemoprophylactic agent, it offers robust protection against one of the world’s most dangerous parasitic infections. Its weekly dosing regimen provides significant convenience for long-term travelers, military personnel, and expatriates residing in endemic zones. Medical professionals prescribe Lariam following a thorough risk-benefit assessment tailored to the patient’s itinerary, medical history, and individual susceptibility to potential neuropsychiatric adverse effects.
Features
- Active ingredient: Mefloquine hydrochloride 250 mg
- Pharmacological class: 4-Methanolquinoline antimalarial
- Administration: Oral tablet
- Dosing schedule: Weekly prophylaxis
- Half-life: Approximately 2-4 weeks, allowing consistent blood concentration
- FDA-approved since 1989 for malaria prevention
- Effective against chloroquine-resistant P. falciparum
Benefits
- Provides high-grade protection in multidrug-resistant malaria regions
- Weekly dosing enhances adherence compared to daily alternatives
- Established efficacy profile with decades of clinical use data
- Suitable for prolonged stays in endemic areas without frequent dosing
- Systemic tissue distribution offers protection beyond blood-stage parasites
- Cost-effective for long-term travel when compared to some newer agents
Common use
Lariam is primarily prescribed for malaria prophylaxis in non-immune individuals traveling to or residing in areas with chloroquine-resistant malaria transmission. These regions include parts of Sub-Saharan Africa, Southeast Asia, and the Amazon Basin. It is particularly valuable for military deployments, aid workers, and long-term business travelers who require protection for extended periods. The medication is typically started 2-3 weeks before travel to establish therapeutic levels and assess tolerance, continued weekly during exposure, and for 4 weeks after leaving the endemic area to eliminate any potential incubating parasites.
Dosage and direction
Adult Prophylaxis: One 250 mg tablet once weekly. Begin 1-3 weeks before travel to assess tolerance. Continue weekly during exposure and for 4 weeks after leaving endemic area.
Pediatric Prophylaxis:
- ≥45 kg: 250 mg weekly
- 31-45 kg: 187.5 mg weekly
- 20-30 kg: 125 mg weekly
- 5-19 kg: 62.5 mg weekly
Administer with food and at least 8 oz of water to minimize gastrointestinal discomfort. If vomiting occurs within 30 minutes, repeat full dose. If within 30-60 minutes, repeat half dose. Maintain consistent weekly dosing day (e.g., every Monday).
Precautions
Conduct thorough medical and psychiatric history assessment before prescription. Monitor for emergent anxiety, depression, psychosis, or seizures—discontinue if neuropsychiatric symptoms develop. Use caution in patients with cardiac conduction abnormalities, hepatic impairment, or epilepsy. Regular ophthalmologic examinations recommended during prolonged use due to potential retinal changes. Not recommended for persons with underlying psychiatric disorders or history of convulsions. Pregnancy Category C: use only if potential benefit justifies potential risk to fetus.
Contraindications
- Known hypersensitivity to mefloquine or related compounds
- History of epilepsy or convulsive disorders
- Active or recent history of depression, anxiety disorders, psychosis, or other major psychiatric conditions
- History of cardiac arrhythmias or conduction abnormalities
- Concurrent administration with halofantrine or ketoconazole
- Use in patients with severe hepatic impairment
Possible side effects
Common (≥1%): Dizziness, headache, sleep disorders (insomnia, vivid dreams), gastrointestinal disturbances (nausea, vomiting, diarrhea), visual difficulties.
Serious (<1%): Neuropsychiatric reactions including anxiety, depression, hallucinations, suicidal ideation; seizures; sinus bradycardia; QT prolongation; encephalopathy; pneumonitis.
Post-marketing reports: Vestibular disorders, tinnitus, tachycardia, blood dyscrasias, skin reactions including Stevens-Johnson syndrome.
Drug interaction
- Contraindicated: Halofantrine (increased risk of fatal cardiotoxicity)
- Significant interactions: Ketoconazole (increased mefloquine concentrations), anticonvulsants (reduced seizure threshold), quinine/quinidine (increased QT prolongation risk)
- Caution advised: Beta-blockers, calcium channel blockers (potential additive bradycardia), antidepressants (potential neuropsychiatric effect enhancement)
- Vaccines: No known interactions with travel vaccines; may administer concurrently
Missed dose
If remembered within 24 hours of scheduled time, take immediately and resume regular weekly schedule. If more than 24 hours late, take as soon as possible and resume weekly schedule from that day. Never double dose. If missed dose occurs within 2 weeks of entering endemic area, consider additional protective measures (insicide-treated nets, repellents) until next scheduled dose.
Overdose
Symptoms may include exaggerated side effects: severe nausea/vomiting, CNS stimulation followed by depression, cardiac arrhythmias. No specific antidote exists. Management includes gastric lavage if presented early, activated charcoal, and symptomatic/supportive care with continuous ECG monitoring for at least 24 hours. Consider cardiac monitoring for QT prolongation and arrhythmias. Dialysis not effective due to high protein binding.
Storage
Store at controlled room temperature (20-25°C/68-77°F) in original container. Protect from light and moisture. Keep tightly closed and out of reach of children. Do not use after expiration date printed on packaging. Do not transfer to alternative containers as this may affect stability and identification.
Disclaimer
This information does not replace professional medical advice. Prescription and use require physician supervision based on individual risk assessment. Healthcare providers must evaluate destination-specific malaria risk, patient medical history, and current resistance patterns. Patients must report any neurological or psychiatric symptoms immediately. The prescriber should review official prescribing information for complete details.
Reviews
Clinical Infectious Diseases (2018): “Mefloquine remains a valuable option for malaria prophylaxis in appropriate populations, with weekly dosing advantage particularly beneficial for long-term travelers. Neuropsychiatric risk, while real, affects small minority and must be weighed against malaria mortality risk.”
Journal of Travel Medicine (2020): “Despite newer alternatives, mefloquine’s cost-effectiveness and weekly regimen maintain its position in malaria chemoprophylaxis, especially for military and extended-stay travelers to highly endemic regions.”
US FDA (2019): “Continued approval reflects favorable risk-benefit profile when prescribed according to guidelines with appropriate patient selection and monitoring. Boxed warning emphasizes neuropsychiatric risk assessment.”