Mefloquine: A personal perspective
Tuesday, May 21, 2019
I began to worry about having taken mefloquine hydrochloride (aka Lariam) about four years ago when I was listening to an NPR podcast of a show called the "Dinner Party Download." During the podcast, the actress Aubrey Plaza said that she taken Lariam during a two-month-long trip to Ghana.
She said, "I had really bad hallucinogenic, neuro-psychological side effects from this drug." She described having panic attacks, paranoia, and a hallucination that it was raining, when it wasn’t. She said that she had to be hospitalized until the symptoms abated.
If you’ve deployed to Iraq or Afghanistan, especially in the early days of Operation Iraqi Freedom and Operation Enduring Freedom, you were probably prescribed mefloquine. For those of you who are unfamiliar with the drug, it is an anti-malarial with some odd and obvious side effects.
The drug, a white pill, was to be ingested every Monday morning for the duration of the deployment, followed by a two-week-long daily dose of primaquine.
I experienced two side effects. First, often, shortly after taking mefloquine, I would feel an unexplained feeling of anger, which might last all day, or a few hours. The second side effect included intense and vivid dreams that would occur on Monday nights. These dreams felt like reality, which could be enjoyable if it was a nice dream. However, oftentimes, they were just bizarre.
My OEF deployment was not my first time to be ordered to take a pill for my “own good.” During Operation Desert Shield, we were given Pyridostigmine Bromide (PB) pills as a pre-treatment for nerve agent exposure. Shortly before redeploying to Fort Campbell, one of our medics told us that they had been ordered to scrub our medical records of any mention of PB pills, and he recommended that we save our blister packs, in case we needed to prove that we’d taken them.
Flash forward 12 years, and sure enough, my prescription for mefloquine was nowhere to be found in my medical file. I did save the blister packs, though. They’re sitting in a box right next to my PB pills.
In the early weeks of my OEF deployment, I wasn’t sure if I should follow orders and take the mefloquine. I based my decision to take them on three things. First, I didn’t think that the PBs had caused any permanent damage. Second, I remembered the unnecessary uproar over mandatory anthrax vaccinations given in the late 1990s.
Finally, while participating in Operation Warrior Sweep, a mortar platoon leader, and a PFC mortarman were afflicted with symptoms of malaria. From my point of view, it looked like they were suffering from the worst hangover imaginable. The platoon leader had been an SF medic (18D) prior to getting his commission. He said that he was more afraid of the mefloquine than of malaria. That should have been a red flag, but I didn’t heed it.
Prior to 1946, the primary treatment for malaria was quinine, taken in powder form and mixed into a liquid, or in the form of tonic water. In fact, the cocktail known as the gin and tonic was invented by British soldiers serving in India, as a more palatable way to ingest the bitter tasting quinine.
In 1946, the drug primaquine was developed and is considered an essential medicine by the World Health Organization. People with the sickle cell trait should not take primaquine.
According to the National Institutes of health, mefloquine was developed at the Walter Reed Army Institute of Research in 1975. Clinical studies of the drug were conducted on inmates in prisons in Illinois and Maryland.
Also according to NIH, patients taking mefloquine began reporting "neuropsychiatric adverse effects" as early as the mid-1990s.
Between the years 2001 and 2003, the World Health Organization performed three clinical studies which confirmed that mefloquine had "potential for causing psychological illness." Furthermore, the studies reported "an excess of neuropsychiatric adverse effects in the mefloquine arm."
In November 2018, the Veterans Administration posted a Public Health Announcement that acknowledged that, "Recent scientific literature has suggested side effects (of mefloquine) including mood changes, bad or vivid dreams, agitation, suicidal thoughts, and suicidal behavior."
In the announcement, the VA reminded interested parties that the agency considers disability claims by veterans who believe their health may have been affected by taking mefloquine.
Earlier this year, the VA established a committee to study the long-term effects of mefloquine toxicity.
It’s good that the VA is taking steps toward, hopefully, a treatment for mefloquine toxicity. However, I’m sure that most vets would rather have not been compelled to take the drug in the first place.
For me, the lesson learned was; if an 18D tells you not to take a pill, then don’t take the pill.
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