Mefloquine

Dosing

P. vivax or uncomplicated mefloquine-susceptible P. falciparum malaria treatmentP. falciparum prophylaxis- BW 45-60 kg: 3 tab PO at 0h, then 2 tab PO at 6-8h

  • BW >60 kg: 3 tab PO at 0h, then 2 tab PO at 6-8h, then 1 tab PO at 12-16hBW >45 kg: 1 tab PO q1w from 1 week before entering endemic area to 4w after returnMefloquine 1 tab = Mefloquine hydrochloride 250 mg = Mefloquine base 228 mgNo renal dose adjustment

Safety and efficacy in pediatric patients <3m of age have not been established

Mefloquine 1 tab = Mefloquine hydrochloride 250 mg = Mefloquine base 228 mg- BW 2.5-3 kg: 0.25 tab PO 1 dose

  • BW 10-12 kg: 1 tab PO 1 dose

  • BW 20-30 kg: 2 tab PO at 0h, then 0-1 tab PO at 6-8h

  • BW 30-45 kg: 2 tab PO at 0h, then 1-2 tab at 6-8h

  • BW 45-60 kg: 3 tab PO at 0h, then 2 tab PO at 6-8h

  • BW >60 kg: 3 tab PO at 0h, then 2 tab PO 6-8h, then 1 tab PO at 12-16h

  • BW <20 kg: 0.25 tab PO q1w

  • BW 20-30 kg: 0.5 tab PO q1w

  • BW 30-45 kg: 0.75 tab PO q1w

  • BW >45 kg: 1 tab PO q1w

No renal dose adjustment

General Information

Treatment for malaria.

Black Box Warning: Mefloquine should not be prescribed for prophylaxis in patients with major psychiatric disorders. During prophylactic use, if psychiatric or neurologic symptoms occur, the drug should be discontinued and an alternative medication should be substituted.

Clinical improvement of malaria should occur within 48-72 hours following a full course of mefloquine treatment.

Long-term treatment (>1year): periodically assess liver function test, psychiatric and neurologic adverse reaction, and ophthalmic exams.

Common

  • Bradyarrhythmia

  • Abdominal pain

  • Diarrhea

  • Nausea

  • Vomiting

  • Anxiety

  • Dizziness

  • Headache

  • Insomnia

  • Vertigo

Serious

  • Seizure

  • Prolonged QT interval

  • At risk for suicide

  • Pneumonitis

Multiple drug-drug interactions

Contrainidications:

  • QT interval prolonging drugs

  • Ketoconazole

  • Posaconazole

  • Fluconazole

  • Isradipine

  • Levomethadyl

  • Aurothioglucose

  • Nelfinavir

Antimicrobial class: Antimalarial agent, Quinoline

Pregnancy category: B

Average serum half life: 3 weeks

Precautions:

  • An IV antimalarial drug should be used prior to oral treatment for life-threatening, serious or overwhelming malaria infections due to Plasmodium falciparum.

  • Monitor for neurological symptoms and discontinue if symptoms occur.

  • Refer to ophthalmologist if symptoms occur and discontinuation may be necessary.

  • Psychiatric symptoms may occur and symptoms have been reported months or years after treatment has been discontinued; monitoring recommended, especially non-verbal children and use caution in patients with history of depression.

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