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3. Eyelids or conjunctiva

a.Urticaria

b.Rash

c.Pruritus

4. Visual hallucinations

Possible

1. Eyelids of conjunctiva

a.Stevens-Johnson syndrome

b.Erythema multiforme

c.Exfoliative dermatitis

d.Toxic epidermal necrolysis

Clinical significance

This agent was developed for resistant malaria but has become a favorite for malaria prevention. It does not cause deposits in the cornea, retina, etc., which are seen with other commonly used antimalarial agents. Palmer et al (1993) point out that at least 20% of patients taking this drug complain of diplopia. This figure is much higher than reported by others. Around 1% of patients taking prophylactic dosages have had visual hallucinations lasting a few seconds or up to 1 hour. This occurs after each dosage. There does not appear to be a relationship between total dosage of mefloquine and the onset of neuropsychiatric side effects.

References and Further Reading

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Croft AMJ, World MJ. Neuropsychiatric reactions with mefloquine chemoprophylaxis. Lancet 347: 326, 1996.

Lobel HO, Bernard KW, Williams SL, et al. Effectiveness and tolerance of long-term malaria prophylaxis with mefloquine. JAMA 3: 361–364, 1991.

Palmer KJ, Holliday SM, Brogden RN. Mefloquine: a review of its anti­ malarial activity pharmacokinetic properties and therapeutic efficacy. Drugs 45(3): 430–475, 1993.

Shlim DR. Severe facial rash associated with mefloquine. Correspondence. JAMA 13: 2560, 1991.

Suriyamongkol V, Timsaad S, Shanks GD. Mefloquine chemoprophylaxis of soldiers on the Thai-Cambodian border. Southeast Asian J Trop Med Pub Health 22: 515–518, 1991.

Van den Enden E, Van Gompel A, Colebunders R, Van den Ende J. Meflo- quine-induced Stevens-Johnson syndrome (letter). Lancet 337(8742): 683, 1991.

Weinke T, Trautmann M, Held T, et al. Neuropsychiatric effects after the use of mefloquine. Am J Trop Med Hyg 45: 86–91, 1991.