Lariam: Comprehensive Weekly Malaria Prophylaxis
| 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. As a long-acting chemoprophylactic agent, it offers a convenient once-weekly dosing schedule, making it a strategic choice for individuals traveling to regions with known chloroquine-resistant malaria. Its mechanism involves the destruction of the erythrocytic forms of plasmodial parasites. Proper medical screening and adherence to prescribing guidelines are imperative due to its specific safety profile and potential for serious neuropsychiatric adverse reactions.
Features
- Active ingredient: Mefloquine hydrochloride 250 mg
- Formulation: Oral tablet
- Dosing schedule: Once weekly
- Prophylaxis initiation: 1-3 weeks prior to travel
- Prophylaxis continuation: 4 weeks post-travel
- Spectrum: Effective against chloroquine-resistant P. falciparum
Benefits
- Provides reliable weekly dosing convenience for extended travel itineraries
- Offers protection in multidrug-resistant malaria endemic regions
- Maintains efficacy throughout exposure and for four weeks after leaving endemic areas
- Reduces dosing frequency compared to daily alternatives
- Supported by decades of clinical use and epidemiological data
- May be suitable for long-term expatriates or frequent travelers under medical supervision
Common use
Lariam is primarily prescribed for malaria prophylaxis in non-immune travelers aged ≥18 years visiting areas with chloroquine-resistant P. falciparum malaria. It is particularly valuable for travel to sub-Saharan Africa, parts of South America, and Southeast Asia where resistance patterns warrant its use. Medical practitioners consider individual traveler factors—including destination, duration, season, itinerary, and personal medical history—when determining appropriateness. It is not recommended for residents of endemic areas or for treatment of acute malaria.
Dosage and direction
The standard adult prophylactic dosage is 250 mg (one tablet) orally once weekly. Initiate prophylaxis 1-3 weeks before travel to assess tolerability. Take consistently on the same day each week, during a meal and with at least 8 ounces of water. Continue weekly doses throughout exposure in the malarious area and for 4 weeks after leaving. Do not crush or chew tablets. For pediatric use (weight-based dosing), consult specific prescribing information and a tropical medicine specialist.
Precautions
Conduct thorough medical and psychiatric history screening before prescription. Avoid use in patients with active or recent history of depression, anxiety disorders, psychosis, seizures, or other major psychiatric disorders. Monitor for emergent neuropsychiatric symptoms throughout use and for several months post-discontinuation. Use caution in patients with cardiac conduction abnormalities, hepatic impairment, or epilepsy. Not recommended during pregnancy unless potential benefit justifies potential risk; avoid in first trimester. Not recommended for infants under 5 kg.
Contraindications
Absolute contraindications include known hypersensitivity to mefloquine or related compounds (quinine, quinidine). Contraindicated in patients with current or history of psychiatric disorders including depression, generalized anxiety disorder, psychosis, schizophrenia, or suicidal ideation. Do not use in patients with convulsive disorders or known cardiac arrhythmias/conduction disturbances. Contraindicated with concomitant use of halofantrine or ketoconazole.
Possible side effect
Common: dizziness, gastrointestinal disturbances (nausea, vomiting, diarrhea), headache, sleep disorders (insomnia, abnormal dreams). Less common: visual disturbances, tinnitus, rash, hair loss. Serious: neuropsychiatric reactions (anxiety, depression, hallucinations, psychosis, suicidal behavior), seizures, vestibular damage, cardiac rhythm disturbances. Symptoms may persist months after discontinuation. Discontinue immediately if signs of neurologic or psychiatric toxicity emerge.
Drug interaction
Significant interactions occur with:
- Antiarrhythmics (quinidine, amiodarone): increased risk of QT prolongation
- Anticonvulsants (carbamazepine, phenytoin, valproic acid): reduced seizure threshold
- Antipsychotics: potential additive neuropsychiatric effects
- HIV protease inhibitors: altered mefloquine concentrations
- Live typhoid vaccine: reduced immunogenicity
- Beta-blockers: potential bradycardia
- Anticoagulants: possible enhanced effect
Missed dose
If a weekly dose is missed, take it as soon as remembered, then resume the regular weekly schedule. If next dose is due within 3 days, skip missed dose and continue normal schedule. Do not double doses. If two or more consecutive doses are missed, consult healthcare provider regarding need for re-initiation protocol or alternative prophylaxis.
Overdose
Symptoms may include exaggerated adverse effects: severe nausea/vomiting, CNS stimulation (agitation, seizures), cardiac effects (bradycardia, QT prolongation). No specific antidote exists. Management involves gastric lavage if recent ingestion, symptomatic and supportive care, cardiac monitoring, and seizure prophylaxis. Consider activated charcoal if presented early. Dialysis is not effective due to high protein binding.
Storage
Store at controlled room temperature (15-30°C/59-86°F) in original container. Protect from light and moisture. Keep tightly closed and out of reach of children. Do not use after expiration date printed on packaging. Do not transfer to alternative containers as moisture protection may be compromised.
Disclaimer
This information does not replace professional medical advice. Prescription and use require individual risk-benefit assessment by a qualified healthcare provider familiar with travel medicine. Country-specific regulations and resistance patterns may affect appropriateness. Travelers must follow comprehensive mosquito bite prevention measures regardless of chemoprophylaxis.
Reviews
Clinical studies demonstrate Lariam’s efficacy in malaria prophylaxis ranges from 85-95% when taken correctly. Many travelers report satisfactory tolerance and appreciate the weekly convenience. However, significant variability in individual tolerance exists, with approximately 5-10% discontinuing due to adverse effects. Post-marketing surveillance continues to inform safety profiles. Professional medical societies maintain specific guidelines regarding its use in various traveler populations.