From the Guidelines
The recommended dose of mefloquine for weekly prophylaxis against malaria is 250 mg taken once per week. This dose is based on the most recent and highest quality study available, although the provided studies are from 1990 and 1992, with the latter being more relevant to the general concept of prophylaxis in endemic areas 1. The regimen should begin 1-2 weeks before entering a malaria-endemic area, continue throughout the stay, and for 4 weeks after leaving the area.
Key Considerations
- Mefloquine should be taken with food and plenty of water on the same day each week to maintain consistent blood levels.
- The medication works by killing the malaria parasite in the blood, preventing the development of clinical disease.
- Some patients experience side effects including nausea, dizziness, sleep disturbances, and rarely, neuropsychiatric effects, so it's essential to start the medication before travel to ensure tolerability.
- Mefloquine is contraindicated in people with certain psychiatric conditions, seizure disorders, or cardiac conduction abnormalities, and in those taking medications that may interact with it.
Dosing for Specific Populations
- For children, the dose is adjusted by weight, but since the most recent and highest quality evidence provided does not specify these details, it's crucial to consult up-to-date guidelines or a healthcare professional for precise dosing.
- It's also important to note that mefloquine is not recommended for everyone, especially those with a history of certain medical conditions or taking specific medications, highlighting the need for individual assessment before starting prophylaxis 1.
From the FDA Drug Label
Malaria Prophylaxis: One 250 mg mefloquine hydrochloride tablet once weekly. The recommended dose of mefloquine (Lariam) for weekly prophylaxis against malaria is one 250 mg tablet once weekly.
- Prophylactic drug administration should begin 1 week before arrival in an endemic area.
- Subsequent weekly doses should be taken regularly, always on the same day of each week, preferably after the main meal.
- To reduce the risk of malaria after leaving an endemic area, prophylaxis must be continued for 4 additional weeks to ensure suppressive blood levels of the drug when merozoites emerge from the liver 2.
From the Research
Mefloquine Dosage for Weekly Prophylaxis
The recommended dose of mefloquine for weekly prophylaxis against malaria is:
Key Points to Consider
- Steady-state pharmacokinetics of weekly prophylaxis in long-term travelers have shown that toxic accumulation does not occur and that weekly dosing is associated with protective levels of the drug 3, 4
- A loading dose strategy of 250 mg mefloquine daily for 3 days followed thereafter by weekly mefloquine dosage can attain steady-state levels of mefloquine in a reduced time frame of 4 days, but is associated with a higher incidence of adverse events 3
- Mefloquine has a high protective efficacy (>91%) in nonimmune travelers to areas of chloroquine-resistant Plasmodium falciparum, except for clearly defined regions of multi-drug resistance 3
- Common adverse events associated with mefloquine include dizziness, sleep disturbances, anorexia, ataxia, and fatigue, while more serious adverse reactions such as panic attacks, convulsions, and acute psychosis are rare 7
Special Considerations
- Mefloquine is not appreciably removed by hemodialysis 3
- There is limited data regarding the use of mefloquine in pregnancy, but cumulative evidence has led the World Health Organization and the Centers for Disease Control and Prevention to sanction its use in pregnant women during the second and third trimesters 3
- Patients with a personal or family history of psychiatric disorders may be at increased risk of neuropsychiatric side effects from mefloquine 7