Weekly Malaria Prophylaxis Options
Yes, mefloquine (Lariam) is a highly effective weekly malaria prophylaxis option, taken as 250 mg once per week starting 1 week before travel, continuing weekly during travel, and for 4 weeks after departure. 1
Weekly Dosing Regimens
Mefloquine (First-Line Weekly Option)
- Dosing: 250 mg tablet once weekly, always on the same day each week, preferably after the main meal with at least 8 oz of water 1
- Timing: Start 1 week before arrival in endemic area, continue weekly during travel, and for 4 additional weeks after leaving 1
- Efficacy: Provides 100% protection against P. falciparum malaria in clinical trials, equivalent to daily regimens 2
- Compliance advantage: Weekly regimens demonstrate significantly better adherence than daily regimens (P<0.0001) 3
Maloprim (Second-Line Weekly Option)
- Dosing: One tablet weekly (pyrimethamine 12.5 mg + dapsone 100 mg) combined with chloroquine 300 mg base 4
- Geographic use: Now superseded by mefloquine but remains second-line for Oceania when other drugs cannot be used 4
- Critical warning: Adult dose must not exceed one tablet weekly due to agranulocytosis risk 4
Important Contraindications for Mefloquine
Mefloquine should NOT be used in patients with: 4, 1
- History of seizures or epilepsy
- History of psychiatric disorders (depression, anxiety, psychosis)
- Children weighing less than 15 kg (30 lbs)
- Pregnancy (especially first trimester)
- Travelers using beta blockers or cardiac conduction-altering drugs
- Airline pilots or those requiring fine motor coordination
Neuropsychiatric Side Effects
- Frequency: Severe neuropsychiatric effects occur in 0.01% of users, with 70% occurring within the first three doses 4, 5
- Manifestations: Anxiety, depression, sleep disturbances, nightmares, hallucinations, and rarely overt psychotic attacks or convulsions 4
- Timing: Effects usually occur early in drug use, making the pre-travel start important for monitoring tolerability 1
Alternative Daily Regimens (When Weekly Not Suitable)
If mefloquine is contraindicated, daily options include:
- Atovaquone-proguanil: Daily dosing but only requires 7 days post-travel (vs. 4 weeks for mefloquine) 2
- Doxycycline: 100 mg daily, contraindicated in pregnancy and children <8 years, causes photosensitivity 4
Clinical Pitfall to Avoid
Never confuse mefloquine with Fansimef (a fixed combination of mefloquine and Fansidar marketed in some countries)—Fansimef is NOT recommended for prophylaxis due to high agranulocytosis risk 4