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How does Lariam work

Malaria is caused by a parasite which is passed from one person to another by mosquito bites. Lariam works by stopping the malaria parasite from growing in your red blood cells.

Lariam is effective in preventing malaria and is recommended in certain parts of the world. Recommendations for which anti-malaria prevention is recommended in different countries can be found at the Travel Health Pro website.

No malaria tablet gives complete protection. You should also take steps to avoid mosquito bites.

Lariam can also be used to treat malaria, but this should only be done under medical supervision after a confirmed diagnosis.

How to take Lariam

For malaria prevention:

• Adults over 45kg should take one tablet once a week.
• Take your tablet on the same day each week.
• Start at least 10 days before entering a malaria area.
• If you have not taken Lariam before, it is often best to start 2–3 weeks before travel in case you need to change treatment.
• Continue taking it weekly during your trip and for 4 weeks after leaving the area.
• The minimum course is 6 weeks.

Swallow tablets whole with plenty of water, preferably after food. Do not chew or suck the tablets.

Lariam is licensed for up to 12 months of continuous use but there is no evidence of harm when it is used for up to 3 years.

Lariam can be used in children and babies over 3 months or over 5kg on prescription from some GPs, travel clinics, or prescribing pharmacists. Dr Fox can only prescribe for people 18 years and over. See more information about malaria tablets for children for more information.

When not to take Lariam

Lariam should not be taken if any of the following apply:

• Allergy to mefloquine, quinidine, or quinine.
• Have lactose intolerance (tablets contain lactose).
• You have - or have had in the past - any mental health problems including depression, anxiety, psychosis, suicidal thoughts or attempts, self-harming, schizophrenia.
• A history of fits or seizures (Lariam may increase the risk of fits and also reduces the effectiveness of antiseizure medications).
• Severe liver problems.
• Previous Blackwater fever (a complication of malaria that affects the blood and kidneys).
• A known heart conduction condition, e.g. heart block, long QT syndrome.
• You are taking amlodipine (often prescribed for hypertension or angina).
• You are taking medication which slows the heart rate, or fluconazole, itraconazole, or ketoconazole tablets.
• A traumatic brain injury - an alternative antimalarial prophylaxis to Lariam should usually be considered.
• Scuba divers planning to dive during their trip should not take Lariam as it can lower seizure threshold and also affect decompression symptoms.
• The UK Civil Aviation Authority advises against pilots using Lariam.

Lariam cautions

In a very few people Lariam can cause serious psychiatric symptoms.

Stop taking Lariam immediately, consult a doctor, and use a different antimalarial, if you experience any of the following symptoms:

• Severe anxiety.
• Paranoia (feelings of mistrust towards others).
• Depression.
• Hallucinations (seeing or hearing things that are not there).
• Insomnia.
• Abnormal dreams/nightmares.
• Feeling restless.
• Confusion or other unusual behaviour.
• Suicidal thoughts.
• Self-harming.

Also stop Lariam, swap to a different antimalarial, and consult a doctor, if any of these other problems develop:

• Changes to your vision.
• Burning sensation.
• Tingling.
• Numbness.
• Muscle weakness.
• Breathlessness.
• Dry cough.

Checks for suitability are carried out online as part of Dr Fox consultations.

Alternatives to Lariam tablets for malaria prevention are available through Dr Fox.

Lariam can be taken by many people, although it is not suitable for everyone. Travel is often stressful and Lariam may exacerbate stress related symptoms.

Lariam and other medicines

You should not take Lariam if:

• You are taking amlodipine (often prescribed for hypertension or angina).
• You are taking any medication which slows the heart rate e.g. beta blockers.
• You are taking the antifungal medications fluconazole, itraconazole, or ketoconazole (possible dangerous increase in the blood level of mefloquine)

There is a very rare theoretical risk of abnormal heart rhythm if Lariam (mefloquine) is taken at the same time as some other medications - please check this list.

Halofantrine (to treat active malaria) should not be used within 15 weeks of taking Lariam as the combination may slow the heartbeat to a dangerous level.

Possible side effects of Lariam

Most people can take Lariam without significant side effects. The most common side effects of Lariam include:

• Depression and anxiety.
• Sleeping problems.
• Nausea (feeling sick).
• Vomiting.
• Dizziness.
• Headache.
• Problems with vision.
• Loss of balance (vertigo).
• Diarrhoea.
• Stomach ache (abdominal pain).
• Itching.

Other side effects are listed in the Lariam patient information leaflet supplied with medicine.

In a few people, depression, dizziness, or vertigo may continue for several months after stopping Lariam.

Occasionally Lariam can affect fine coordination or the ability to visually assess distance which may impact driving, piloting an aircraft, or operating machinery. Special care should be taken when doing any of these tasks.

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