The Daily Telegraph
(c) Telegraph Group Limited, London, 2002
Saturday, October 26, 2002

Travel - Suicide warning added to malaria drug notes
Lance Cole reports on new controversy over Lariam, ...
By Lance Cole.

Travel - Suicide warning added to malaria drug notes Lance Cole reports on new controversy over Lariam, but Dr Richard Dawood argues that the drug is still vital.

There have been "rare cases" of suicide among travellers taking the antimalarial drug Lariam, the drug's manufacturer, Roche, has stated in new notes on prescription sent to doctors in the United States.

The revision of the notes will fuel controversy over the drug, which has been associated in the past five years with an increasing number of reports of suicide and suicide ideation (thinking about suicide).

In a letter to every doctor in the United States, which comes with a US Food and Drug Administration warning on the envelope, Roche has expanded the list of side effects associated with the drug and the contraindications against its use.

The company now says that while "no relationship to the drug has been confirmed ... rare cases of suicide have been reported". Current British and previous US warnings refer only to suicidal ideation.

Two months ago Vanessa Brunt, a 22-year-old Cambridge student, died in an apparent suicide. This was after a long-term depression, possibly a reaction to Lariam taken during a gap year spent in China and South-East Asia.

In May this year, Roche reached a settlement without admitting liability with a widow from Bethel, Ohio, who had alleged that Lariam triggered the suicide of her husband.

The FDA, meanwhile, says there were 11 suicides and 12 suicide attempts associated with Lariam between 1997 and 2001. In contrast, there have been only seven deaths from malaria in the US since 1992.

In its revised notes on side effects, Roche says that problems may persist "long after" use of Lariam has stopped (previous warnings referred to "several weeks"). The company also recommends that Lariam should not be given to anyone with a recent history of depression, or generalised anxiety disorder.

All these changes to notes on the use of the drug are being issued in the United States only. A spokesman for Roche, speaking to Swiss television from the company's Basle headquarters, said there were "no plans" to write to doctors in Europe, adding that different rules in different countries affected what information was included in packets.

Dr Peter Barrett of MASTA (Medical Advisory Services for Travellers Abroad), who published a paper in the British Medical Journal on the effects of Lariam, said it was bizarre for American doctors to be given information on side effects which differed from that available to their European counterparts.

Dr Barrett said British users of the drug had a right to know about the revisions, adding that MASTA would consider posting the new information on its UK website (www.masta.org).

A spokesman for the Department of Health said a warning of "suicidal ideation" was already on the UK packet and that the Department would review further developments.

In Britain, between eight and 15 deaths result from malaria each year, reflecting the fact that British travellers venture further afield than Americans.