Senator questions malaria drug?s safety

[thedrifter]

November 19, 2003

Senator questions malaria drug?s safety

By Deborah Funk
Times staff writer


A California senator is asking the Defense Department to rethink its use of a particular malaria prevention drug because of reports of psychological problems in some users.
Democratic Sen. Dianne Feinstein wrote to Defense Secretary Donald Rumsfeld asking him to ?consider revising the department?s policies? on prescription of Lariam, also known as mefloquine, based on complaints from constituents and ?growing evidence? about its ?dangerous side effects.?

In the short term, Feinstein wants other anti-malarial drugs, such as Doxycycline and Malarone, given to service members, and wants them to be told of Lariam?s possible side effects. She also asked that troops who receive Lariam be more closely monitored.

Feinstein?s office has heard recently from several troops and federal civilians overseas who have taken Lariam as protection against malaria and say they ?suffered significant side effects,? she wrote.

Pentagon officials did not respond to a request for comment on the letter, and referred questions on the use of anti-malarial drugs to the individual services.

Decisions by military commanders on when to use an anti-malarial drug and which to choose depend largely on the threat of malaria in a particular region, and whether the drug is still effective in that area.

In the Navy, combatant commanders and medical staff, weighing the risks and benefits in each case, make decisions.

?All of the anti-malaria drug regimens have minor side effects,? said Navy Lt. John Schofield, a spokesman for Navy medicine. ?Considering the effects of malaria, minor side effects are certainly the best of the two options.?

If someone has significant adverse side effects, a different medicine can be used, he said.

Air Force doctors rely on a variety of sources, including the World Health Organization, Centers for Disease Control and Prevention and military medical intelligence, to determine the threat of malaria and the best drug to use for each airman to prevent the disease. Treatment is individualized and a doctor dispenses anti-malarial drugs, the Air Force?s preventive medicine chief said through a spokesman.

The Army also uses a risk-benefit analysis to determine which drug to use to prevent malaria. It has not routinely used Lariam in Iraq, and ?very, very few? soldiers are using it there, said Virginia Stephanakis, spokeswoman for the Army Surgeon General. But it is still one of the drugs of choice in areas where falciparum malaria is resistant to chloroquine, another anti-malarial drug. Nausea, vomiting, abdominal pain, headache, insomnia and vivid dreams are the most common side effects of mefloquine, according to Lariam maker Hoffman-LaRoche.

But in an update of its warning label in late 2002, the company advised doctors not to prescribe it to patients with a history of convulsions, depression, or other major psychiatric disorders.

?Rare cases of suicidal ideation and suicide have been reported, though no relationship to drug administration has been confirmed,? the company advised doctors.

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Sempers,

Roger