De Souza et al.(1717 de Souza JM, Sheth UK, de Oliveira RM, Roulet H, de Souza SD. An open, randomized, phase III clinical trial of mefloquine and of quinine plus sulfadoxine-pyrimethamine in the treatment of symptomatic falciparum malaria in Brazil. Bull World Health Organ. 1985;63(3):603-9. PMid:3899397.) (1985) |
Falciparum malaria |
A 100 mg MQ single dose via oral |
42 days |
_ |
16% participants presented dizziness |
Dizziness was considered a light and transitory side effect, not requiring specific treatment. Thus, MQ was considered highly efficient, safe and well tolerated during the falciparum malaria treatment in adult Brazilian men. The advantages of this medication that can be taken in a single via oral dose to treat multi-resistant falciparum malaria are, therefore, obvious. |
Hessén-Söderman(1919 Hessén-Söderman AC, Bergenius J, Palme IB, Bergqvist Y, Hellgren U. Mefloquine prophylaxis and hearing, postural control, and vestibular functions. J Trav Medic. 1995;2(2):66-9. http://dx.doi.org/10.1111/j.1708-8305.1995.tb00629.x. http://dx.doi.org/10.1111/j.1708-8305.19...
) (1995) |
Prophylaxis |
250 mg MQ via oral once a week |
6 weeks |
A patient presented alteration, which was not specified. |
A patient presented non-specific, light and constant dizziness. |
Results showed that MQ was well tolerated and no general effect of the drug was noticed in the postural system. |
Davis et al.(1818 Davis TM, Dembo LG, Kaye-Eddie SA, Hewitt BJ, Hislop RG, Batty KT. Neurological, cardiovascular and metabolic effects of mefloquine in healthy volunteers: a double-blind, placebo-controlled trial. Br J Clin Pharmacol. 1996;42(4):415-21. http://dx.doi.org/10.1111/j.1365-2125.1996.tb00003.x. PMid:8904612. http://dx.doi.org/10.1111/j.1365-2125.19...
) (1996) |
Prophylaxis |
1 pill a week: 250 mg MQ or 250 mg placebo |
4 weeks |
Tinnitus present in under 10% of the individuals and significant absence of HL at 6 KHz |
Dizziness present in under 10% of the individuals |
Despite evidence of the quinine acute auditory toxicity in healthy individuals, no HL provoked by the MQ use was observed. |
Van Riemsdijk et al.(2121 Van Riemsdijk MM, van der Klauw MM, van Heest JAC, Reedeker FR, Ligthelm RJ, Herings RMC, et al. Neuro-psychiatric effects of antimalarials. Eur J Clin Pharmacol. 1997;52(1):1-6. http://dx.doi.org/10.1007/s002280050240. PMid:9143859. http://dx.doi.org/10.1007/s002280050240...
) (1997) |
Prophylasis |
-- |
3 months |
_ |
Vertigo, dizziness, inpaired sight and ataxia |
Unfavorable reactions to the MQ use were observed. Great part of the drug users presented insomnia, dizziness, sickness, diarrhea, anxiety, depression, palpitation and vertigo. The results pointed out that despite being a drug that presents several side effects, MQ can still be considered a useful medication for the malaria treatment. |
Fusetti et al.(2525 Fusetti M, Eibenstein A, Corridore V, Hueck S, Chiti-Batelli S. Mefloquine and ototoxicity: a report of 3 cases. La Clinica Terapeutica. 1999 Sep-Oct;150(5):379-82.) (1999) |
Falciparum Malaria |
_ |
_ |
Tinnitus and high frequency sensorineural HL. |
_ |
One patient presented HL partial remission after MQ discontinuation. No patient reported tinnitus improvement. Routine audiological evlauation during the MQ prophylactic use is suggested to monitor possible auditory deficit. |
Kollaritsch et al.(2222 Kollaritsch H, Karbwang J, Wiedermann G, Mikolasek A, Na-Bangchang K, Wernsdorfer W H. Mefloquine concentration profiles during prophylactic dose regimens. Wien Klin Wochenschr. 2000;112(10):441‐7. PMID: 10890135.) (2000) |
Prophylaxis |
Six 250 mg MQ doses |
28 days |
_ |
Vertigo |
Adverse reactions were more frequent in women. Headaches, insomnia and vertigo were the most common side effects. MQ lower tolerability in women might be due to the higher concentration of drugs in that group, indicating the need for a proper adjustment of the MQ dose in women. |
Rendi-Wagner et al.(2020 Rendi-Wagner P, Noedl H, Wernsdorfer WH, Wiedermann G, Mikolasek A, Kollaritsch H. Unexpected frequency, duration and spectrum of adverse events after therapeutic dose of mefloquine in healthy adults. Acta Trop. 2002;81(2):167-73. http://dx.doi.org/10.1016/S0001-706X(01)00210-8. PMid:11801224. http://dx.doi.org/10.1016/S0001-706X(01)...
) (2002) |
Prophylaxis |
1250 mg MQ in five 250mg pills, starting with three pills and six hours later the other two. |
21 days |
_ |
Vertigo present in 96% of the individuals, which was severe in 73% |
Vertigo was described as dizziness associated to fast movements, causing problems of coordination, severe sickness and vomiting, starting within 24 hours and reaching a peak on the first day. These findings represent the first investigation with therapeutical doses, allowing the identification of adverse reactions associated to MQ, regardless of any malaria symptoms. |
Mizuno et al.(2323 Mizuno Y, Kudo K, Kano S. Chemoprophylaxis according to the guidelines on malaria prevention for Japanese overseas travelers. Southeast Asian J Trop Med Public Health. 2006;37(Suppl 3):11-4. PMid:17547042.) (2006) |
Prophylaxis |
_ |
2 weeks |
Tinnitues |
Dizziness |
The importance of knowing the toxicity profile and adverse effects of the MQ prolongued use is pointed out. |
Wise and Toovey(2626 Wise M, Toovey S. Reversible hearing loss in temporal association with chemoprophylactic mefloquine use. Travel Med Infect Dis. 2007;5(6):385-8. http://dx.doi.org/10.1016/j.tmaid.2007.08.006. PMid:17983978. http://dx.doi.org/10.1016/j.tmaid.2007.0...
) (2007) |
Prophylaxis |
Three 250mg MQ doses (one dose a week) |
21 dias |
Tinnitus and sensorineural HL at 90 dB in 1 kHz and at 70 dB in 4 kHz |
_ |
The case might provide a lesson regarding counterindication to the MQ use, and it seems wise to avoid the drug use in individuals with hearing impairment. |
Nevin(1313 Nevin RL. Investigating channel blockers for the treatment of multiple sclerosis: considerations with mefloquine and carbenoxolone. J Neuroim. 2012;243(1-2):106-7. http://dx.doi.org/10.1016/j.jneuroim.2011.12.016. http://dx.doi.org/10.1016/j.jneuroim.201...
) (2012) |
Falciparum Malaria |
Three MQ doses |
15 days |
Tinnitus |
Vertigo and unbalance |
MQ caused balance alterations. |
Livezey et al.(2828 Livezey J, Oliver T, Cantilena L. Prolonged neuropsychiatric symptoms in a military service member exposed to mefloquine. Drug Safety - Case Reports. 2016 Jun;3(1):1-6. http://dx.doi.org/10.1007/s40800-016-0030-z. http://dx.doi.org/10.1007/s40800-016-003...
) (2016) |
Prophylaxis |
250 mg a week |
6 months |
_ |
Dizziness, unbalance and vertigo |
The study reports the potential appearance of neuropsychiatric side effects induced by MQ, varying from central vestibulopathy to significant behavioral alterations, also presenting sleep disorders. |
Nevin and Leoutsakos(2424 Nevin RL, Leoutsakos J-M. Identification of a syndrome class of neuropsychiatric adverse reactions to mefloquine from latent class modeling of FDA adverse event reporting system data. Drugs R D. 2017;17(1):199-210. http://dx.doi.org/10.1007/s40268-016-0167-3. PMid:28063022. http://dx.doi.org/10.1007/s40268-016-016...
) (2017) |
Prophylaxis |
_ |
_ |
_ |
Vertigo and dizziness |
The appearance of neurological symptoms such as dizziness, vertigo and paresthesia might help to improve the findings of MQ case studies on the drug severe adverse reactions. Whenever these symptoms appear, the drug use should be discontinued. |