Lariam: Comprehensive Malaria Prophylaxis for High-Risk Regions
| 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 to areas with known chloroquine-resistant strains. As a long-acting chemoprophylactic agent, it offers robust protection against one of the world’s most dangerous parasitic infections. Its weekly dosing regimen provides significant convenience for long-term travelers, military personnel, and expatriates residing in endemic regions. Medical professionals recommend initiating prophylaxis prior to exposure and continuing post-return to ensure complete protection throughout the transmission period.
Features
- Active ingredient: Mefloquine hydrochloride (250 mg base per tablet)
- Formulation: Film-coated oral tablet
- Dosing schedule: Weekly administration
- Half-life: Approximately 2-4 weeks, allowing sustained protection
- Manufacturer: Original formulation developed by Hoffmann-La Roche
- Packaging: Available in blister packs of 8 tablets
- Regulatory status: FDA-approved since 1989 for malaria prophylaxis
- Spectrum: Effective against chloroquine-resistant P. falciparum
Benefits
- Provides reliable weekly dosing convenience versus daily alternatives
- Offers protection in regions with multidrug-resistant malaria strains
- Maintains efficacy throughout extended stays in endemic areas
- Reduces malaria-related morbidity and mortality in non-immune travelers
- Demonstrates proven effectiveness in clinical use for over three decades
- Eliminates need for daily remembering of medication schedules
Common use
Lariam is primarily prescribed for malaria prophylaxis in adults and children weighing over 5 kg who are traveling to or residing in areas with chloroquine-resistant malaria transmission. It is particularly valuable for long-term travelers, peacekeeping forces, and humanitarian workers spending extended periods in sub-Saharan Africa, Southeast Asia, and the Amazon Basin where resistant strains predominate. The medication is also used off-label for treatment of acute malaria infections under strict medical supervision, though this application requires different dosing protocols and closer monitoring.
Dosage and direction
Prophylaxis in adults: 250 mg (one tablet) orally once weekly. Begin administration 1-3 weeks before travel to endemic areas to establish therapeutic levels and assess tolerance. Continue weekly doses during exposure and for 4 weeks after leaving the malarious area.
Pediatric dosing: 5 mg/kg body weight once weekly. Not recommended for children weighing less than 5 kg. Maximum pediatric dose should not exceed 250 mg.
Administration guidelines: Swallow tablet whole with at least 8 ounces of water, preferably following a meal to minimize gastrointestinal discomfort. Maintain consistent weekly dosing day (e.g., every Monday) to ensure protection. Do not crush or chew tablets.
Precautions
- Complete medical history assessment required before prescription, with emphasis on psychiatric history
- Regular monitoring for neuropsychiatric symptoms throughout prophylaxis period
- Caution advised when operating machinery or driving until response to medication is established
- Not recommended for persons with cardiac conduction abnormalities or severe hepatic impairment
- Pregnancy Category C: Use during pregnancy only if potential benefit justifies potential risk to fetus
- Breastfeeding considerations: Mefloquine excreted in breast milk; infant risk assessment necessary
- Regular ophthalmologic examinations recommended during prolonged use
Contraindications
- History of psychiatric disorders including depression, anxiety disorders, psychosis, or suicide attempts
- Known hypersensitivity to mefloquine or related compounds (quinine, quinidine)
- Active or recent history of convulsive disorders
- Severe hepatic impairment
- Concurrent administration with halofantrine or drugs that prolong QT interval
- Use in persons with cardiac conduction defects or arrhythmias
Possible side effects
Common (≥1%):
- Dizziness, vertigo, loss of balance
- Headache, migraine
- Nausea, vomiting, diarrhea
- Sleep disorders (insomnia, abnormal dreams)
- Visual disturbances
Less common (<1%):
- Neuropsychiatric reactions (anxiety, depression, confusion)
- Tinnitus, hearing impairment
- Skin rash, pruritus
- Hair loss, changes in hair texture
- Muscle weakness, fatigue
Rare but serious:
- Convulsions, seizures
- Acute encephalopathy
- Sinus bradycardia, arrhythmias
- Severe dermatological reactions
- Hepatitis, elevated liver enzymes
Drug interaction
- Contraindicated combinations: Halofantrine (increased risk of QT prolongation)
- Significant interactions: Anticonvulsants (reduced seizure threshold), antiretroviral drugs (metabolic competition), other antimalarials
- QT-prolonging agents: Increased risk of cardiac arrhythmias with antiarrhythmics, antipsychotics, antidepressants
- Vaccines: Limited data suggest possible reduced antibody response to live typhoid vaccine
- Ketoconazole: May increase mefloquine concentrations through CYP3A4 inhibition
- Chloroquine: Cross-resistance and increased adverse effect risk
Missed dose
If a weekly dose is missed, take the missed dose as soon as possible, then resume the regular weekly schedule. However, if the next scheduled dose is within 2 days, skip the missed dose and continue with normal dosing schedule. Never double the dose to make up for a missed administration. If two or more consecutive doses are missed, consult healthcare provider regarding need for additional protective measures.
Overdose
Mefloquine overdose may produce exaggerated adverse effects including severe nausea, vomiting, dizziness, and cardiac conduction abnormalities. Neurological symptoms may include convulsions, encephalopathy, and coma. Cardiac manifestations may include bradycardia, ventricular arrhythmias, and QT prolongation. Management is supportive with gastric lavage if presented early, ECG monitoring, and symptomatic treatment. There is no specific antidote; hemodialysis is not effective due to high protein binding.
Storage
Store at controlled room temperature (20-25°C or 68-77°F) in original packaging. Protect from light and moisture. Keep blister strips intact until time of administration. Do not store in bathroom or other humid environments. Keep out of reach of children and pets. Do not use after expiration date printed on packaging.
Disclaimer
This information is for educational purposes only and does not constitute medical advice. Lariam is a prescription medication that requires thorough medical evaluation before use. Healthcare providers must assess individual risk factors, travel itinerary, and medical history before prescribing. Patients must report any adverse effects immediately to their prescribing physician. Malaria prophylaxis should be part of a comprehensive protection strategy including mosquito avoidance measures.
Reviews
“After 18 months working in Central Africa, Lariam provided reliable protection without daily dosing hassle. The weekly schedule proved invaluable for field work where daily medication compliance would have been challenging.” - Epidemiologist, MSF
“While effective for malaria prevention, I discontinued use due to vivid dreams and mild anxiety. My colleague tolerated it perfectly throughout our two-year assignment. emphasizes the need for individual assessment.” - NGO Worker, DRC
“As an infectious disease specialist, I reserve Lariam for specific high-risk regions where weekly dosing advantage outweighs potential neuropsychiatric risks. Patient selection and education are paramount.” - MD, Travel Medicine