Lariam: Comprehensive Malaria Prophylaxis for Global Travelers
| Product dosage: 250mg | |||
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Synonyms | |||
Lariam, with the active ingredient mefloquine hydrochloride, is a prescription antimalarial medication developed for the prevention and treatment of malaria caused by Plasmodium falciparum and Plasmodium vivax. It is particularly indicated for travelers to regions with known chloroquine-resistant malaria strains. As a long-acting chemoprophylactic agent, Lariam offers sustained protection with a convenient weekly dosing regimen, making it a cornerstone in travel medicine for individuals requiring reliable defense against this potentially fatal mosquito-borne disease. Its use is supported by decades of clinical evidence and World Health Organization guidelines in specific epidemiological contexts.
Features
- Active ingredient: Mefloquine hydrochloride 250 mg
- Weekly oral dosing regimen for prophylaxis
- Effective against chloroquine-resistant Plasmodium falciparum
- Long half-life (approximately 21 days) providing continuous protection
- Tablet formulation with scored design for dose splitting when appropriate
Benefits
- Provides reliable weekly protection against malaria, reducing dosing frequency compared to daily alternatives
- High efficacy in regions with multidrug-resistant malaria strains
- Enables extended travel or residence in endemic areas without daily medication management
- Established safety profile with decades of use in military and civilian populations
- Cost-effective prophylaxis for long-term exposure scenarios
Common use
Lariam is primarily prescribed for malaria prophylaxis in non-immune travelers aged 18 years and older visiting areas with chloroquine-resistant malaria transmission. It is also used as a treatment for acute malaria infections when appropriate. The medication is particularly valuable for long-term travelers, expatriates, military personnel, and adventure travelers visiting remote areas where consistent access to medical care may be limited. Geographic indications include sub-Saharan Africa, Southeast Asia, the Amazon Basin, and other regions with documented mefloquine-sensitive malaria parasites.
Dosage and direction
For malaria prophylaxis in adults: 250 mg (one tablet) orally once weekly. Begin prophylaxis 2-3 weeks before travel to endemic areas to establish therapeutic levels and assess tolerability. Continue weekly doses during exposure and for 4 weeks after leaving the malarious area. Take with at least 8 ounces of water, preferably following a meal to minimize gastrointestinal discomfort. For treatment of acute malaria: 1250 mg (5 tablets) as a single dose under medical supervision. Pediatric dosing follows weight-based calculations and requires careful medical evaluation.
Precautions
Perform thorough medical assessment before prescribing, including psychiatric history evaluation. Monitor patients for neuropsychiatric symptoms throughout use. Use with caution in patients with cardiac conduction abnormalities, hepatic impairment, or seizure disorders. Regular liver function tests recommended during prolonged use. Avoid abrupt discontinuation in malaria-endemic areas. Not recommended for persons with underlying psychiatric disorders or history of depression, anxiety, psychosis, or convulsions. Pregnancy Category C: use during pregnancy only if potential benefit justifies potential risk to fetus.
Contraindications
Hypersensitivity to mefloquine or related compounds (quinine, quinidine). History of or active depression, anxiety disorders, psychosis, schizophrenia, or other major psychiatric disorders. History of convulsions or epilepsy. Contraindicated in patients with cardiac conduction defects, especially arrhythmias or prolonged QTc interval. Avoid use in persons with significant hepatic impairment. Not recommended for prophylaxis in children weighing less than 5 kg or for treatment in infants under 6 months.
Possible side effects
Common: dizziness, gastrointestinal disturbances (nausea, vomiting, diarrhea), headache, sleep disorders (insomnia, vivid dreams). Less common: visual disturbances, tinnitus, rash, hair loss. Serious: neuropsychiatric reactions including anxiety, depression, hallucinations, suicidal ideation (occur in approximately 1 in 10,000 users); convulsions; cardiac rhythm disturbances. Most adverse effects occur within the first three doses and often diminish with continued use. Discontinue immediately if severe neuropsychiatric symptoms develop.
Drug interactions
Significant interactions with: quinidine, quinine (increased risk of QTc prolongation and cardiotoxicity); anticonvulsants (may reduce seizure threshold); beta-blockers (potential additive bradycardia); live typhoid vaccine (mefloquine may reduce vaccine efficacy - separate administration by at least 24 hours). Moderate interactions with: antiretroviral drugs, particularly efavirenz (mutual toxicity potentiation); ketoconazole (may increase mefloquine concentrations). Avoid concomitant use with halofantrine.
Missed dose
If a weekly prophylactic dose is missed, take it as soon as remembered unless it is nearly time for the next dose. Do not double the dose. If less than 2 days remain before the next scheduled dose, skip the missed dose and resume the regular weekly schedule. Maintain continuous weekly dosing for 4 weeks after leaving endemic area. For treatment doses, seek immediate medical advice if a dose is missed.
Overdose
Symptoms may include exaggerated side effects: severe nausea/vomiting, CNS effects including convulsions, cardiac rhythm disturbances. Management involves gastric lavage if presented early, followed by activated charcoal. Cardiac monitoring essential for 24 hours due to risk of QTc prolongation. Symptomatic and supportive care为主, with particular attention to respiratory and cardiac function. No specific antidote exists. Dialysis 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. Do not store in bathroom or damp areas. Keep out of reach of children and pets. Do not use after expiration date printed on packaging. Properly dispose of unused medication through medication take-back programs.
Disclaimer
This information does not replace professional medical advice. Prescription and use must be under appropriate medical supervision. Healthcare providers must assess individual risk factors and destination-specific malaria resistance patterns. Travelers should combine chemoprophylaxis with mosquito avoidance measures (insect repellents, bed nets, protective clothing). Efficacy not guaranteed against all malaria strains. Report adverse events to appropriate health authorities.
Reviews
Clinical studies demonstrate 85-95% prophylactic efficacy against mefloquine-sensitive P. falciparum when taken as directed. Systematic review data (Cochrane Database) confirms superiority over placebo and comparable efficacy to doxycycline in prevention. Neuropsychiatric adverse events remain a significant concern, though incidence rates remain low in appropriate patient populations. Continued monitoring and patient education are essential components of successful prophylaxis. Many travel medicine specialists consider it a valuable option for selected patients without contraindications.