Uses of Mef-Q: - Malaria Malaria Hypersensitivity to related compounds (e.g. quinine and quinidine); history of blackwater fever;, prophylactic use in patients w/ history of psychiatric (including depression) or convulsive disorders; retreatment w/ mefloquine. Severe hepatic impairment. Concomitant use w/ halofantrine.

How to use Mefloquine: Take this medicine in the dose and duration as advised by your doctor. Swallow it as a whole. Do not chew, crush or break it. Mefloquine is to be taken with food. Administration: Should be taken with food. Best taken w/ meals & a full glass of water. Should be taken on the same day of each week. Adult Dose: Oral Acute Malaria Adult: 5 tablets (Total 1250 mg) as a single oral dose. OR 750 mg orally as initial dose, followed by 500 mg orally 6 to 12 hours after initial dose. Total dose 1,250 mg. Malaria prophylaxis 250 mg once weekly, taken 1-3 wk before exposure and continuing for 4 wk after leaving the endemic area. Dosing Considerations If a full-treatment course does not lead to improvement within 48-72 hr, mefloquine should not be used for retreatment; an alternative therapy should be used Similarly, if previous prophylaxis with mefloquine failed, mefloquine should not be used for curative treatment Child Dose: Oral Acute Malaria <6 months old: Safety and efficacy not established Child: >6 months: 20-25 mg/kg PO as single dose. Maximum total dose: 1250 mg. OR 15 mg/kg as initial dose, followed by 10 mg/kg po given 6-12 hours after initial dose. Total dose= 25 mg/kg Malaria prophylaxis Child: 5 to <10 kg: 31.25 mg (1/8 tablet) PO qWeek 10 to <20 kg: 62.5 mg (1/4 tablet) PO qWeek 20 to <30 kg: 125 mg (1/2 tablet) PO qWeek 30-45 kg: 187.5 mg (3/4 tablet) PO qWeek >45 kg: 250 mg (1 tablet) PO qWeek Start 1-2 weeks before arrival in endemic area; continue 4 weeks after leaving endemic area

Increased risk of ECG abnormalities w/ quinine or chloroquine, antihistamines, TCAs and phenothiazines. May increase risk of seizure w/ quinidine or quinine. Concomitant use w/ valproic acid, phenobarbital, carbamazepine and phenytoin may cause loss of seizure control and lower plasma levels of anticonvulsants. Increased risk of QT prolongation and arrhythmia w/ ketoconazole. Concomitant use w/ digoxin, Ca-channel blockers, antiarrhythmics and ?-blockers may increase the risk of cardiotoxicity. Increased risk of ventricular arrhythmias w/ amiodarone. Concomitant use w/ TCAs, SSRIs, buprion, antipsychotic, tramadol may increase the risk of convulsions. Increased plasma levels w/ metoclopromide. May compromise adequate immunisation by live typhoid vaccine. Vaccinations w/ attenuated live bacteria should be completed at least 3 days prior the 1st dose of mefloquine. Potentially Fatal: Avoid concomitant use w/ halofantrine as potentially fatal cardiac arrhythmias may occur.

Hypersensitivity to related compounds (e.g. quinine and quinidine); history of blackwater fever;, prophylactic use in patients w/ history of psychiatric (including depression) or convulsive disorders; retreatment w/ mefloquine. Severe hepatic impairment. Concomitant use w/ halofantrine.

Common - Abdominal pain - Abnormal dreams - Anxiety - Chills - Depression - Diarrhea - Dizziness - Fever - Headache - Atrial arrhythmias (altered heart rate) - Insomnia (difficulty in sleeping) - Itching - Loss of appetite - Muscle pain - Nausea - Rash - Ringing in ear - Vertigo - Visual impairment - Vomiting - Fatigue 1-10% Anxiety,Difficulty concentrating,Headache,Insomnia,Lightheadedness,Vertigo,Vomiting,Diarrhea,Stomach pain,Nausea,Visual disturbances,Tinnitus Frequency Not Defined Suicidal depression,Psychiatric Sx,Pneumonitis,Seizure,Abnormal ECG Potentially Fatal: Seizures, thrombocytopenia, leucopenia, AV block, encephalopathy.

Precaution: Epilepsy; delay admin until at least 12 hr after the last dose of quinine/quinine-related compounds (monitoring of cardiac and neurological functions is warranted). Avoid driving or operating machines during and up to 3 wk after mefloquine use. Pregnancy, lactation; cardiac conduction disturbances; children <3 mth or 5 kg. Lactation: Minimally excreted in human breast milk; based on a study in a few subjects, low concentrations (3% to 4%) excreted; caution advised

In cases of overdosage with Mefloquine, the symptoms may be more pronounced. The following procedure is recommended in case of overdosage: Induce vomiting or perform gastric lavage, as appropriate. Monitor cardiac function (if possible by ECG), neurologic and psychiatric status for at least 24 hours. Provide Symptomatic and intensive supportive treatment as required, particularly of cardiovascular disturbance. Treat vomiting or diarrhoea with standard fluid therapy.

Store in a cool dry place. Protect from light.

Anti-malarial drugs

Mefloquine is a 4-methanolquinine antimalarial agent and a blood schizontocide which acts by interfering w/ the parasite's ability to metabolise and utilise erythrocyte Hb. It is active against most Plasmodium sp and is used for prophylaxis and treatment against malaria.

Use in Pregnancy: There is no adequate and well-controlled study in pregnant women. However, clinical experience with Mefloquine has not revealed an embrytoxic or teratogenic effect. Mefloquine should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus.Use in Nursing Mothers: Mefloquine is excreted in breast milk in small amounts. the activity of which is unknown. Because of the potential for serious adverse reactions in nursing infants form Mefloquine. a decision should be made whether to discontinue the drug taking into account the importance of the drug to the mother.