Lariam: Comprehensive Malaria Prophylaxis for High-Risk Regions
| 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 a once-weekly dosing regimen, making it a practical choice for extended travel. Its mechanism of action involves the destruction of the erythrocytic stage of malaria parasites. Healthcare providers must carefully evaluate patient suitability due to its specific neuropsychiatric risk profile and contraindications.
Features
- Active ingredient: Mefloquine hydrochloride (250 mg per tablet)
- Formulation: Film-coated oral tablet
- Dosing schedule: Once weekly administration
- Onset of prophylactic action: Begins immediately upon starting regimen
- Duration of protection: Continues for 4 weeks after last dose
- FDA-approved since 1989 with extensive clinical documentation
- Manufactured under strict GMP standards ensuring batch consistency
Benefits
- Provides reliable protection against chloroquine-resistant malaria strains in endemic regions
- Weekly dosing regimen enhances adherence compared to daily alternatives
- Maintains protective blood concentrations throughout exposure period and for four weeks post-administration
- Extensive clinical experience supporting efficacy in diverse geographical settings
- Suitable for long-term travelers requiring months of continuous prophylaxis
- Comprehensive protection against both P. falciparum and P. vivax malaria species
Common use
Lariam is primarily prescribed for malaria prophylaxis in non-immune travelers aged ≥18 years visiting areas with chloroquine-resistant malaria transmission. Typical indications include military personnel, long-term expatriates, adventure travelers, and researchers working in rural endemic zones. The medication is particularly valuable for travel to sub-Saharan Africa, Southeast Asia, and the Amazon Basin where resistant strains predominate. Medical practitioners often recommend Lariam when weekly dosing is preferable to daily regimens and when contraindications to alternative prophylactics exist.
Dosage and direction
Prophylaxis in adults: One 250 mg tablet once weekly. Begin administration exactly one week before entering endemic area. Continue weekly doses during stay and for four consecutive weeks after leaving malaria-risk area.
Administration guidelines: Swallow tablet whole with at least 8 ounces of water, preferably following a meal to minimize gastrointestinal discomfort. Maintain consistent dosing day each week. If vomiting occurs within 30 minutes of ingestion, administer a repeat dose. For vomiting occurring 30-60 minutes post-dose, administer half dose.
Pediatric dosing: Not recommended for children weighing less than 5 kg. For children ≥5 kg: 5 mg/kg once weekly. Maximum pediatric dose: 250 mg weekly.
Precautions
- Conduct thorough medical history assessment focusing on psychiatric disorders, seizure history, and cardiac conditions
- Perform baseline neurological examination before initiation
- Monitor for emergence of anxiety, depression, nightmares, or unusual behavior throughout prophylaxis
- Use with extreme caution in patients with history of depression, generalized anxiety disorder, or other psychiatric conditions
- Regular cardiac monitoring advised in patients with conduction abnormalities
- Avoid concomitant administration with drugs that prolong QT interval
- Not recommended for persons with occupational requirements for fine motor coordination (e.g., pilots, precision machine operators)
- Pregnancy Category C: Use only if potential benefit justifies potential risk to fetus
- Breastfeeding considerations: Mefloquine excreted in milk; infant risk assessment required
Contraindications
- History of epilepsy or seizure disorders
- Known hypersensitivity to mefloquine or related compounds (quinine, quinidine)
- Active or recent history of depression, generalized anxiety disorder, psychosis, or other major psychiatric disorders
- History of suicidal ideation or suicide attempt
- Pre-existing cardiac conduction abnormalities including arrhythmias
- Severe hepatic impairment (Child-Pugh Class C)
- Concurrent administration with halofantrine or ketoconazole
- Use in patients with blackwater fever history
Possible side effects
Common (≥1% incidence):
- Dizziness (15-25%)
- Gastrointestinal disturbances including nausea, vomiting, diarrhea (10-20%)
- Headache (10-15%)
- Sleep disorders including insomnia and vivid dreams (5-10%)
- Visual disturbances (3-5%)
Less common (0.1-1% incidence):
- Anxiety, depression, restlessness
- Tinnitus, vertigo
- Skin rash, pruritus
- Hair loss
- Bradycardia
Rare (<0.1% incidence but serious):
- Acute anxiety reactions, paranoia, hallucinations
- Convulsions, encephalopathy
- Stevens-Johnson syndrome
- Cardiomyopathy, myocarditis
- Blood dyscrasias including leukopenia and thrombocytopenia
- Vestibular damage with permanent ataxia
Drug interaction
- Contraindicated combinations: Halofantrine (increased risk of fatal cardiotoxicity), ketoconazole (increased mefloquine concentrations)
- QT-prolonging agents: Increased risk of torsades de pointes with antiarrhythmics, antipsychotics, certain antibiotics
- Anticonvulsants: May reduce seizure threshold; monitor anticonvulsant levels
- Beta-blockers: Potential additive bradycardic effect
- Vaccines: Limited data suggest possible reduced antibody response to live typhoid vaccine
- Anticoagulants: Theoretical interaction with warfarin; monitor INR
- Chloroquine: Cross-resistance may reduce efficacy
Missed dose
If a weekly dose is missed, administer as soon as possible. If remembered within 48 hours of scheduled time, take immediately and resume regular weekly schedule. If more than 48 hours have passed, skip missed dose and resume regular schedule. Never double dose to compensate for missed administration. Maintain continuous weekly dosing for four weeks after leaving endemic area regardless of missed doses. Consult healthcare provider if multiple doses missed.
Overdose
Mefloquine overdose may produce exaggerated adverse effects including severe neuropsychiatric reactions, cardiotoxicity, and convulsions. Symptoms may include nausea, vomiting, dizziness, sinus bradycardia, syncope, and acute anxiety. No specific antidote exists. Management involves immediate gastric lavage if presentation within 1-2 hours, followed by activated charcoal administration. Cardiac monitoring for at least 24 hours essential due to risk of QT prolongation. Symptomatic and supportive care including benzodiazepines for anxiety/convulsions. Hemodialysis 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 blister strips intact until administration. Do not transfer to alternative containers. Keep securely closed and out of reach of children. Discard any tablets showing signs of deterioration or expiration. Do not flush medications or pour down drain.
Disclaimer
This information does not constitute medical advice. Lariam is a prescription medication requiring professional medical supervision. Healthcare providers must assess individual risk-benefit ratio before prescription. Patients must disclose complete medical history and current medications. Malaria prophylaxis requires comprehensive approach including mosquito avoidance measures. No antimalarial provides 100% protection. Seek immediate medical attention if fever develops during or after travel to malaria-endemic areas.
Reviews
“After extensive clinical use across multiple deployments, Lariam remains a valuable tool in malaria prophylaxis despite its side effect profile. The weekly dosing significantly improves compliance in long-term scenarios where daily alternatives often prove challenging.” - Travel Medicine Specialist, 15 years experience
“Our tropical medicine clinic reserves Lariam for specific scenarios where weekly dosing is advantageous and contraindications to other agents exist. Careful patient selection and thorough counseling about neuropsychiatric symptoms are absolutely essential.” - Infectious Disease Physician
“While effective, the medication requires meticulous patient education. We’ve implemented a standardized screening protocol that has significantly reduced adverse event reporting through appropriate patient selection.” - Public Health Researcher