The San Francisco Chronicle
Copyright 2002

Sunday, September 15, 2002

TRAVEL MEDICINE

Tricky anti-malaria drug still travelers' first choice
Ulysses Torassa
E-mail Ulysses Torassa at utorassa@sfchronicle.com.

The controversial anti-malaria drug Lariam is back in the news, with speculation that it might be connected to the recent rash of murders and suicides at Fort Bragg, N.C. Three soldiers, each of whom had reportedly been given Lariam (mefloquine) during their tour of duty in Afghanistan, killed their wives this year. Two of them took their own lives as well.

Lariam's manufacturer, Roche Pharmaceuticals, said it was alerting doctors that a small number of people have committed suicide after taking it. (The label already lists suicidal thoughts and other psychiatric problems as potential risks). And last month, the U.S. Food and Drug Administration approved labeling Malarone (atovaquone/proguanil) to say that it has fewer side effects than Lariam.

Both medications are proven to prevent cases of malaria, a sometimes deadly mosquito-borne disease endemic in much of Africa, parts of Asia and South America. Chloroquine was once the drug of choice, but resistant strains of malaria have spread to most of the world. Another preventive treatment, doxycycline, has unpleasant side effects and must be taken daily. Lariam needs to be taken only weekly and has become public health officials' first choice.

But the drug has been dogged by reports that it triggers neurological disturbances, vivid dreams and even psychosis in some who have taken it. A former congressman blamed Lariam for a series of bad business deals that culminated in multiple fraud charges.

Lariam has its defenders. It is cheaper than Malarone -- $10 versus $33 for a week's worth -- and taking it weekly instead of daily means less chance of missing a dose. And officials cite studies that found a relatively low incidence of adverse episodes. Millions of people -- myself included -- have taken it without any problems.

Tom Skinner, a spokesman for the Centers for Disease Control and Prevention, said the agency is reviewing its recommendations for malaria prevention and expects to issue an update early next year. Meanwhile, the CDC stands by its recommendation of Lariam as the first choice for travelers to areas where malaria has become chloroquine resistant. It also lists Malarone, doxycycline and others as useful alternatives.

Army investigators have said they are "pretty sure" Lariam did not play a role in the Fort Bragg killings.

But anti-Lariam activists such as Jeanne Lese of San Rafael want patients to sign an explicit consent form detailing the risks before the drug is prescribed.

"People are . . . not being warned, because the doctors aren't aware there is a problem," said Lese, co-director of Lariam Action USA.