Former soldiers, families face military officials In Townsville over anti-malaria drug side effects

10 May 2016

Article by Jesse Dorsett

The military’s top brass has come face to face with former soldiers and their families suffering depression and anxiety after being given controversial anti-malaria drugs
on deployment.
Key points:-
 2,000 ADF personnel given anti-malaria drug in East Timor over five years.
 Drug side effects include mood swings and suicidal thoughts.
 ADF says they did not know drugs would produce chronic problems.

 A forum has been held in Townsville, in north Queensland, to give former soldiers, ex-service organisations and health professional the chance to discuss the effects of anti-malaria medication Mefloquine, as well as the drug Tafenoquine. 

Nearly 2,000 Australian Defence Force (ADF) personnel were prescribed Mefloquine, also known as Lariam, primarily in East Timor, between July 2000 and June 2015.
The drug is known to cause agitation, mood swings, panic attacks, confusion, hallucinations,aggression, psychosis and suicidal thoughts in a small number of patients.
Another 492 took Tafenoquine as part of a trial in 2000 and 2001
Lavina Salter, the organiser of the Townsville forum, fought back tears as she recounted her husband’s mental health ssues after taking Mefloquine in the early 2000s.
“The man I married died a long time ago,” MsSalter said.”There is no sign on his head saying ‘I’m depressed’. Some ights I cried myself to sleep not knowing what to do.
“I would go to the hospital every day to see him. I’d cry so much on the way home I’d have to pull over because I couldn’t see the road through my tears.
“Our kids can’t sneak up behind him. I dread the day they find out he’s attempted suicide more times than I can count on my hand.” “The man I married ded a long time ago.”

Lavinia 1

‘It’s always a balancing act when we’re looking at drug like this’ Surgeon General of the ADF, Air Vice-Marshal Tracy Smart, said 63 members contracted malaria between the time the Army entered East Timor in 1999 and when the trials started. “The drugs we were using weren’t working,” she said. (Air ViceMarshal Tracy Smart ) She acknowledged the military knew the medication could cause side effects but assumed they would not be chronic. “Back when we were doing the trial in Timor there was an nderstanding that some people may have side effects, people were told about those side effects and told to stop the medication if they were getting those side effects,” she said. “It’s always a balancing act when we’re looking at drug like this because first and foremost we want to protect our people from alaria. That’s a disease that kills people around the world very day.”

AVM Smart

 But Dr Remington Nevin, a leading expert on Mefloquine and Tafenoquine, told the audience via Skype that the side effects were “trivialised” and “minimised” when soldiers signed up for the trial.

“As time has gone by there has been more evidence that there has been long time effects,” Air Vice-Marshal Smart said. “What we’re trying to do is be as transparent as possible, put all of our cards on the table.”

The American point of view.On Mefloquine

Mefloquine, sold under the brand names Lariam among others, is a medication used to prevent or treat malaria When used for prevention it is taken once a week and should be begun one or two weeks before potential exposure and continued for four weeks after potential exposure. It can be used to treat mild or moderate malaria but should not be used to treat severe malaria. It is taken by mouth.

Serious side effects include potentially long term mental health problems such as depression and anxiety and neurological side effects such as poor balance, seizures, and ringing in the ears. It is therefore not recommended in people with a history of mental health problems or epilepsy. Common side effects include vomiting, diarrhoea, headaches, and a rash. It is not recommended in pregnancy unless other options are not available. It should not be used during breast feeding.

Mefloquine was developed by the United States Army in the 1970s and came into use in the mid-1980s. It is on the World Health Organization’s List of Essential Medicines, the most important medications needed in a basic health system. It is available as a generic medication.    

Adverse effects

Mefloquine is contraindicated in those with a previous history of seizures or a recent history of psychiatric disorders severe side effects requiring hospitalization are rare. Compared to other malaria prophylaxis regimens, mefloqinone may produce more side effects in non-pregnant travellers. In pregnant travellers, it appears to pose
minimal risk to the fetus.

Neurologic and psychiatric

In 2013 the United States Food and Drug Administration added a boxed warning to the U.S. label of mefloquine regarding the potential for neuropsychiatric side effects that may persist even after discontinuing administration of the drug. Psychiatric effects include nightmares,visual and auditory hallucinations, anxiety, depression, unusual behaviour, and suicidal ideations, among others.

Neurologic effects include dizziness, loss of balance, and tinnitus. The label warns that ild symptoms may presage more serious ones, and that the drug should be discontinued at the first sign of symptoms.

Mefloquine should not be used in people with a history of psychiatric problems. Central nervous system events requiring hospitalization occur in about one in 10,000 people taking mefloquine for malaria prevention, with milder events (e.g., dizziness, headache, insomnia, and vivid dreams) in up to 25%. When some measure of subjective severity is applied to the rating of adverse events, about 11-17% of travellers are incapacitated to some degree.

Mefloquine may cause abnormalities with heart rhythms that are visible on electrocardiograms. Combining mefloquine with other drugs that cause similar effects, such as quinine or quinidine, can increase these effects. Combining mefloquine with halofantrine can cause significant increases in QTc intervals.

Mefloquine is contraindicated in those with a previous history of seizures or a recent history of psychiatric disorders. Women should not become pregnant and should use effective birth control while taking mefloquine.

Pregnancy and Breastfeeding
A retrospective analysis of outcomes in more than 2,500 women found no evidence that mefloquine was associated with an increased risk of birth defects or miscarriages. The drug may be used during breastfeeding, though it appears in breast milk in low concentrations. The World Health Organization gives approval for the use of mefloquine in the second and third trimesters of pregnancy and use in the first trimester does not mandate termination of pregnancy. Please check it out on the internet ..The Australian Government, Dept f Health have a different focus of disorders including cataract, retinal disorders and damage to the optic nerve.