Formulary
Mefloquine: Indications, Dosing, Side Effects and Interactions
Mefloquine clinical drug profile including indications, dosing, side effects, cautions and interactions.
MedNext Academy | 4 min read
Mefloquine: Indications, Dosing, Side Effects and Interactions
Mefloquine clinical drug profile including indications, dosing, side effects, cautions and interactions.
Indications and dose
**Treatment of malaria**
- **Adult** (By Mouth): (consult product literature).
**Prophylaxis of malaria**
- **Child** (By Mouth): (body-weight 45 kg and above) 250 mg once weekly, dose to be started 2-3 weeks before entering endemic area and continued for 4 weeks after leaving.
- **Adult** (By Mouth): (body-weight 45 kg and above) 250 mg once weekly, dose to be started 2-3 weeks before entering endemic area and continued for 4 weeks after leaving.
**Treatment of malaria for mefloquine**
- **Child** (By mouth): (consult product literature).
**Prophylaxis of malaria for mefloquine**
- **Child (body-weight 5-15 kg)** (By mouth): 62.5 mg once weekly, dose to be started 2-3 weeks before entering endemic area and continued for 4 weeks after leaving.
- **Child (body-weight 16-24 kg)** (By mouth): 125 mg once weekly, dose to be started 2-3 weeks before entering endemic area and continued for 4 weeks after leaving.
- **Child (body-weight 25-44 kg)** (By mouth): 187.5 mg once weekly, dose to be started 2-3 weeks before entering endemic area and continued for 4 weeks after leaving.
- **Child (body-weight 45 kg and above)** (By mouth): 250 mg once weekly, dose to be started 2-3 weeks before entering endemic area and continued for 4 weeks after leaving.
Cautions
Cardiac conduction disorders; epilepsy (avoid for prophylaxis); infants less than 3 months (limited experience) (in children); not recommended in infants under 5 kg (in children); traumatic brain injury Cautions, further information Neuropsychiatric reactions Mefloquine is associated with potentially serious neuropsychiatric reactions. Abnormal dreams, insomnia, anxiety, and depression occur commonly. Psychosis, suicidal ideation, and suicide have also been reported. Psychiatric symptoms such as insomnia, nightmares, acute anxiety, depression, restlessness, or confusion should be regarded as potentially prodromal for a more serious event. Adverse reactions may occur and persist up to several months after discontinuation because mefloquine has a long half-life. For a prescribing checklist, and further information on side-effects, particularly neuropsychiatric side-effects, which may be associated with the use of mefloquine for malaria prophylaxis, see the Guide for Healthcare Professionals provided by the manufacturer.
Contraindications
Avoid for prophylaxis if history of psychiatric disorders (including depression) or convulsions; avoid for standby treatment if history of convulsions; history of blackwater fever
Side effects
Common or very common Anxiety; depression; diarrhoea; dizziness; gastrointestinal discomfort; headache; nausea; skin reactions; sleep disorders; vision disorders; vomiting Frequency not known Acute kidney injury; agranulocytosis; alopecia; aplastic anaemia; appetite decreased; arrhythmias; arthralgia; asthenia; behaviour abnormal; cardiac conduction disorders; cataract; chest pain; chills; concentration impaired; confusion; cranial nerve paralysis; delusional disorder; depersonalisation; drowsiness; dyspnoea; encephalopathy; eye disorder; fever; flushing; gait abnormal; hallucination; hearing impairment; hepatic disorders; hyperacusia; hyperhidrosis; hypertension; hypotension; leucocytosis; leucopenia; malaise; memory loss; mood altered; movement disorders; muscle complaints; muscle weakness; nephritis; nerve disorders; oedema; palpitations; pancreatitis; paraesthesia; pneumonia; pneumonitis; psychosis; seizure; self-endangering behaviour; speech disorder; Stevens-Johnson syndrome; suicidal behaviours; syncope; thrombocytopenia; tinnitus; tremor; vertigo
Interactions
**Severe interactions:**
- Halofantrine: There is evidence that the use of halofantrine during mefloquine chemoprophylaxis or treatment of malaria, or within 15 weeks after the last dose of mefloquine, causes a significant...
- Clinically significant QTc prolongation has not been found with mefloquine alone.
**Other interactions (8):**
- Other drugs that prolong the QTc interval: Concomitant administration of other drugs known to alter cardiac conduction (e.g.
- Anticonvulsants and drugs lowering the epileptogenic threshold: Patients taking mefloquine while on concomitant treatment with anticonvulsants (e.g.
- Concomitant administration of mefloquine and drugs known to lower the epileptogenic threshold (antidepressants such as tricyclic or selective serotonin reuptake inhibitors (SSRIs); bupropion;...
- Other Interactions/ Inhibitors and Inducers of CYP3A4: Mefloquine does not inhibit or induce the cytochrome P450 enzyme system.
- However, inducers (rifampicin, carbamazepine, phenytoin, efavirenz) or inhibitors of the isoenzyme CYP3A4 may modify the pharmacokinetics/metabolism of mefloquine, leading to an increase or decrease...
- Interaction with vaccines: When mefloquine is taken concurrently with oral live typhoid vaccines, attenuation of immunisation cannot be excluded.
Pregnancy
When used for Treatment of malaria: Not known to be harmful, M but see also Pregnancy in Malaria, treatment . When used for Prophylaxis of malaria: UKHSA advises that use may be considered if travelling to high-risk areas or there is resistance to other drugs. See also Pregnancy in Malaria, prophylaxis .
Breast feeding
Specialist sources indicate present in milk but amount probably too small to be harmful.
Hepatic impairment
Manufacturer advises avoid in severe impairment-elimination may be prolonged.
Renal impairment
Manufacturer advises caution.
Medicinal forms
Clinical governance
**Author:** MedNext Clinical Team. **Clinical reviewer:** Dr Shameer Deen, MBBS, MS, MRCS. **Sources:** BNF, Indian Pharmacopoeia, CIMS India. **Correction:** Report errors at support@mednext.academy.
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