If you are planning to travel to a part of the world where malaria is a potential risk to your health then there is a good chance that you will be prescribed with a course of anti-malarial drugs. In Britain traditionally travellers were prescribed Chloroquine and, for those travelling to higher risk areas, a supplementary treatment, typically a variant of Chloroquine would also be prescribed. However in recent years travellers planning on going to high risk areas have been prescribed Lariam, which has the following structure:

Mefloquine Hydrochloride (aka Lariam or Mephaquine) is a relatively new anti-malarial drug, developed by Hoffman LaRoche of Switzerland. It is especially good at preventing the onset of one particularly lethal strain of malaria known as falciparum. This strain is becoming a problem in certain parts of the world as it has become resistant to many forms of treatment, especially in Central Afirca

Sped up by the Vietnam War, the Walter Reed Army Institute of Research started sampling compounds in 1963 to search for new anti-malarial drugs for use by US servicemen. Over a quarter of a million compounds were sampled. During the sampling process mefloquine appeared to be one of the more successful potential drugs. A Swiss company, Hoffman LaRoche, who eventually released mefloquine (Lariam) to the public during the mid-1980s, then developed the drug further for the mass market. Mefloquine is also marketed under the name Mephaquine by Mepha.

A study was published in the British Medical Journal (31 August 1996, 313:13) and found that "About 0.7% (1 in 140) travellers taking Mefloquine can expect to have a neuropsychiatric adverse event unpleasant enough to temporarily prevent them from carrying out theirday to day activities, compared with 0.009% (1 in1100) taking Chloroquine and Progunil. This indicated that perhaps there needed to be a rethink of the procedure of how Lariam was prescribed to prospective travellers, after an alarming number of individuals experienced severe symptoms of 'mefloquine toxicity'. It is interesting to note that the manufacturers claimed that the frequency of severe side effects are 1 in 10000.

Mefloquine toxicity affects the nervous system and can cause much distress to the individual. Anecdotally many people have reported serious side-affects. These can simply be intense of particularly vivid dreams. However more serious side effects such as panic attacks, convulsions (not dissimilar to epileptic fits), convulsions, headaches, visual and auditory hallucinations, etc. In certain case these symptoms have persisted several months after the last dose was taken, which was thoroughly debilitating for the individuals concerned. The result is that several support groups in the U.K., the U.S.A., New Zealand, Canada and Ireland have been set up. In addition to this several lawsuits have been filed against the manufacturer.

Lariam should definitely not be taken by sufferers of epilepsy, people with kidney or liver complaints, or those with weak hearts.

It is also not recommended that anyone who intends to operate machinery that requires a high degree of dexterity and coordination should take mefloquine (pilots of many airlines are not allowed to take Lariam and surgeons are often not allowed to practise when taking a course of Lariam), since it can affect a users sense of balance and precision.

Other groups of people who should not take mefloquine are pregnant women, or women are planning on becoming pregnant. It is often also not recommended for divers as it may interact with the raised levels of nitrogen in the blood stream.

The current centre of the "Lariam Controversy" is here in the U.K. So you are unlikely to be prescribed a course of Lariam by a British doctor. After an 18 month enquiry, on the 19^th of September 1997 the U.K. Malria Advisory Committee published their revised "Guidelines for the prevention of malaria travellers from the United Kingdom"

The results of which are that the use of Mefloquine is now no longer recommended for travellers going to low risk areas for periods of less than two weeks. So the general advice would be don’t take Lariam unless you really need to.

If however you are prescribed a course of Lariam, don’t panic- the findings of the U.K. Malaria Advisory Committee state that adverse side affects are only encountered in approxiamately 50 in 10,000 travellers. And for the rest of us all the only side affects are vivid and intense dreams! The most important thing is that, should you experience serious side affects whilst taking Lariam, be sure to get your hands on another form of treatment to replace it. And, consult your doctor on what form of Malaria prevention you should take before going travelling as he will be able to advise you on what you need for the area you are planning on visiting.