Travel Medicine and Infectious Disease
Volume 7, Issue 1 , Pages 2-6, January 2009

Mefloquine neurotoxicity: A literature review

  • Stephen Toovey

      Affiliations

    • Corresponding Author InformationPresent address: Burggartenstrasse 32, 4103 Bottmingen, Switzerland. Tel.: +41 61 421 7872; fax: +41 61 421 7063.

Academic Centre for Travel Medicine and Vaccines, and the WHO Collaborating Centre for Reference, Research and Training in Travel Medicine, University College London Medical School, Royal Free Campus, London, UK

Received 4 December 2008; accepted 10 December 2008. published online 15 January 2009.

Summary 

A literature review revealed that mefloquine neurotoxicity has been demonstrated at both the preclinical and clinical levels, with nausea, dizziness, sleep disturbances, anxiety and psychosis, amongst other adverse neuropsychiatric events, reported in users. Females and individuals of low body mass index (BMI) are at apparent greater risk. Mechanisms of possible neurotoxicity may include binding to neuroreceptors and cholinesterases, inhibition of sarcoendoplasmic reticulum ATPase (SERCA) and interference with cellular Ca2+ homeostasis, accumulation in the CNS, and reductions in CNS efflux in individuals possessing certain MDR1 polymorphisms. It may be prudent to avoid mefloquine in females and low BMI individuals, and in combination with other potentially neurotoxic agents such as the artemisinin antimalarials.

Keywords: Mefloquine, Malaria, Neurotoxicity, Ototoxicity, Neuropsychiatric, Prophylaxis

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PII: S1477-8939(08)00154-3

doi:10.1016/j.tmaid.2008.12.004

Travel Medicine and Infectious Disease
Volume 7, Issue 1 , Pages 2-6, January 2009

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