Author Topic: Malaria drug for Canadian troops called dangerous (mefloquine or Lariam)  (Read 7732 times)

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Malaria drug for Canadian troops called dangerous

Canada's military apparently unconcerned over anti-malarial drug's side-effects
CBC News

Posted: Apr 11, 2012 6:16 PM ET
Last Updated: Apr 11, 2012 10:23 PM ET

An anti-malarial drug that has been withdrawn from routine use by the U.S. military because of concerns about potentially dangerous side-effects continues to be prescribed to Canadian troops serving in malaria-prone regions.

The drug, called mefloquine or Lariam, has been associated with psychiatric and physical side-effects that prompted the U.S. military to withdraw it from general use in 2009, but the Canadian Forces continue to prescribe it to soldiers.

Side-effects can range from anxiety, vivid nightmares and depression, to hallucinations and psychotic episodes, and the drug has also been blamed for suicides and long-term health problems.

Retired corporal Donald Hookey of Conception Bay South, N.L., has been home for six years from Afghanistan, but he remains haunted by his experience there.

"I don't think that I can honestly say that I've felt normal since I've been back."

Until recently, Hookey blamed his rage and nightmares on post-traumatic stress disorder, but now he wonders if the anti-malarial drug mefloquine given to him by the army continues to exert long-lasting effects.

"It really freaks me out … what I've been reading on the side-effects for the drugs."

Mefloquine was developed by U.S. army researchers during the Vietnam War, but concerns about its side-effects eventually prompted a warning in a 2009 memo from the assistant secretary of defence: "Mefloquine may cause psychiatric symptoms … ranging from anxiety, paranoia and depression to hallucinations and psychotic behaviour … long after mefloquine has been stopped."

Hoffman-Laroche manufactured mefloquine under the trade name Lariam, while a generic version called Apo-Mefloquine is produced in Canada by Apotex.
Risk of permanent effects cited

U.S. army doctor Maj. Remington Nevin, who first gained experience with mefloquine during his deployment in Afghanistan in 2007, says that "there are a certain group of users in whom … these symptoms, the anxiety, the difficulty sleeping, the mood changes, these could be an indication, an early warning sign of a developing, more serious brain condition… a toxicity caused by rising levels of the drug.

"The worst-case scenario is that a soldier that suffers toxicity from mefloquine is left with permanent brain-stem injury."

Personality changes in returning soldiers have been noted by their close family members.

"It's been very easy to attribute this personality change to some experience during deployment, perhaps some combat experience," says Nevin, "but when we see this in individuals that deployed but never had any traumatic exposures and who had an otherwise unremarkable time overseas, I think it becomes increasingly clear that it was the drug that's responsible for these effects."

The U.S. Centres for Disease Control recommended this year in its Yellow Book travel advisory that mefloquine not be considered the drug of choice for military deployments, given that "neuropsychiatric side-effects may confound the diagnosis and management of post-traumatic stress disorder and traumatic brain injury."

Alternative treatments include doxycycline and atovaquone-proguanil (Malarone), which Nevin says are effective and more predictable.

The possibility that mefloquine may have been prescribed to U.S. Staff Sgt. Robert Bales, who has been charged with 17 counts of murder in the death of Afghan civilians, has been raised by retired army psychiatrist Elspeth Cameron Ritchie. The U.S. Defence Department has refused to confirm or deny that Bales took mefloquine, citing medical privacy.
'Get ready to go loopy'

Kevin Berry of Vancouver served in Afghanistan in 2003 as a 19-year-old infantryman. Mefloquine was administered once a week and "they made it abundantly clear we would be charged if we weren't taking it."

The side-effects were well-known, he says.

"My section commander had been in Somalia and Rwanda. He said, 'Get ready to go loopy, boys!'

"You wake up shaking, sweating, terrified, you know: what's going on? Am I going crazy? But you look around and — oh, everyone's doing it."

Berry says he quit taking the pills, without telling his superiors, and the side-effects stopped.

Hookey says he wishes he had done the same. "I know guys who didn't take the drugs because they said, 'Screw that, man. I don't know what's in it.' Maybe I should have been one of those guys, huh?"

The Canadian Forces base their use of mefloquine on recommendations of the Public Health Agency of Canada, which says the drug is "generally well tolerated" and that severe reactions such as seizures are rare (reported from one in 6,000 to one in 13,000 users). Long-term neuropsychological effects and reports of suicide ideation or suicide have not be confirmed, the agency says.

But the military’s continuing use of mefloquine "is definitely deviating from the evolving standard of care, or the evolving standard of practices of Western militaries," Nevin says.

"This will be a cost borne not by the militaries but by the various Veterans Affairs Departments," he says.

The Canadian military declined to comment to CBC News about its use of mefloquine.
With files from the CBC's Nancy Wood

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Drug's lasting impact sees violence follow veteran home (mefloquine) AFG
« Reply #1 on: February 25, 2013, 09:36:17 PM »
Drug's lasting impact sees violence follow veteran home (mefloquine)

CBC News
Posted: Apr 13, 2012 6:50 AM NT
Last Updated: Apr 13, 2012 8:36 AM NT

A Newfoundland veteran of the war in Afghanistan says the Canadian military knowingly gave him drugs with psychotic side-effects.

Donald Hookey of Conception Bay South has been suffering from violent episodes since returning from Afghanistan six years ago.

He thought it was caused by post-traumatic stress, until he was contacted by CBC.

The drug in question is called mefloquine — an anti-malaria drug commonly prescribed by the Canadian Forces to soldiers in Afghanistan.

Most soldiers never have a problem with it — but a growing number, like Hookey, do.

    'At any consequences, stay away from the drug. Don't take it.'
    —Donald Hookey

While Hookey knew that he would find violence when he went to war in Afghanistan, he never dreamed the violence would follow him home.

"I chased a guy down in Edmonton, in my wife's car,” Hookey recalled.

“It was like I had blinders on, and that was my target. That was the enemy. I had to take him out or he was going to take me out."
Plagued by rage

Hookey has been plagued by rage, hyper-aggression, flashbacks and nightmares since he returned from Afghanistan six years ago.

He assumed it was post-traumatic stress, and never dreamed it could be caused by an anti-malaria drug that he was ordered to take.

"I didn't hear about these side-effects until recently, when a team from CBC did contact me and they did give me information."

Mefloquine was developed by the U.S. Army during the Vietnam War. Its potentially psychotic side-effects have always been known, but were never shared with Hookey or his fellow soldiers.

Hookey says when they started taking the drugs, violent behaviours started too. "Some of them would slam their arms in doors, trying to break their arms to try to get home."
Side-effects continued

When Hookey got home, the side-effects continued. In the worst incidents, he says he unconsciously hurt his wife.

"She's had to wake me out of a sleep because I've been leaning over her with my hands around her throat,” he said. “I was choking her."

Stories like Hookey's have become so common that the U.S. military stopped prescribing mefloquine in 2009.

Today, Hookey feels “extremely pissed off” and “betrayed." He is seeing a counsellor, and doing his best to put the war in Afghanistan behind him.

But he wants to warn young soldiers about a danger that doesn't lurk on the battlefield.

"At any consequences, stay away from the drug. Don't take it."

The Department of National Defence declined comment.


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Top Doctor For U.S. Special Forces Tells Troops To Stop Taking Mefloquine
« Reply #2 on: September 19, 2013, 10:28:32 PM »
Top Doctor For U.S. Special Forces Tells Troops To Immediately Stop Taking Mefloquine

Report from Associated Press:

WASHINGTON (AP) — The top doctor for Green Berets and other elite Army commandos has told troops to immediately stop taking mefloquine, an anti-malaria drug found to cause permanent brain damage in rare cases.

The ban among special operations forces is the latest development in a long-running controversy over mefloquine. The drug was developed by the Army in the 1970s and has been taken by millions of travelers and people in the military over the years. As alternatives were developed, it fell out of favor as the front-line defense against malaria, a mosquito-borne disease that international health officials say kills roughly 600,000 people a year.

The new prohibition among special operations forces follows a July 29 safety announcement by the Food and Drug Administration that it had strengthened warnings about neurologic side effects associated with the drug. The FDA added a boxed warning to the drug label, the most serious kind of warning, saying neurologic side effects like dizziness, loss of balance and ringing in the ears may become permanent.

The drug’s other side effects include anxiety, depression and hallucinations – conditions that some military families over the years believe prompted psychotic behavior in their loved ones, including killings and suicides.

Source: Top Doctor For U.S. Special Forces Tells Troops To Immediately Stop Taking Mefloquine


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EXCLUSIVE: War hero issues alert over controversial antimalarial drug
« Reply #3 on: July 20, 2014, 04:47:40 PM »
EXCLUSIVE: War hero issues alert over controversial antimalarial drug

A RETIRED British general has called for a rethink on a controversial antimalarial drug given to troops despite fears over its psychological risks.

By: Marco Giannangeli
Published: Sun, July 20, 2014

Major-General Julian Thompson said he and his wife suffered hallucinations after taking Lariam.

The disclosure comes just days after a Member of Parliament once again challenged the Government over its decision to continue to supply troops with the drug, officially known as mefloquine hydrochloride, following an increasing number of serious complaints about the its side effects.

More than 2,500 British troops are issued with the anti-malarial remedy every year, usually before deployment to danger countries such as Sierra Leone, Kenya and Borneo, and areas of Latin America and South East Asia.

Lariam has long been associated with mental health risks and suicide claims, and was linked by the US Department of Defense to the massacre by Staff Sergeant Robert Bales, the US soldier who killed 16 Afghan civilians in March 2012.

Its stated side effects include ringing in the ears, depression, loss of memory and hallucinations. The Medications and Healthcare Products Regulatory Agency has received more than 2,300 accounts of adverse reactions.

Speaking last night, General Thompson, who commanded 3 Commando brigade during the Falklands War, described how he and his wife had been forced to stop taking Lariam for personal visits to Batswana when they began to suffer from “unpleasant side effects.”

"We go to Botswana quite a lot and, of course, you have to take anti-malaria stuff there. At first we took Lariam, ignoring warnings we’d heard – my wife, being a thoroughly practical nurse, said people were just imagining things.

"But on our second trip we started to get hallucinations and began feeling so odd that we decided enough was enough. My wife, says we are not to go near it at any price.

“Of course, we only took it for short periods, and the side effects ended shortly after we stopped.

"We now use Malarone which is more expensive, but has none of the nasty side effects."

"I’m not a medical person but I’d say that, if there’s an alternative to Lariam - which clearly there is - then we should be using that instead.”

He added: “Though it may only be issued to relatively small numbers of troops at the moment, we never know what’s going to happen round the corner, and we could end up with much larger number of British troops in the jungle with a pill that isn’t a good idea.”

One Army medic told the Sunday Express that soldiers often played “Russian roulette” when gambling on whether to take Lariam or risk Malaria.

"Where Lariam is particularly dangerous is in cases where a soldier may already be suffering from issues, resulting from his time in combat, such as depression, anger, or ptsd. Lariam emphasis these symptoms. I know many soldiers just do not want to take it. But when you’re in Sierra Leone, for instance, there isn’t a lot of choice.”

    We took Lariam, ignoring warnings, but started to get hallucinations and began feeling so odd

    Major General Julian Thompson

Last year, the US Food and Drugs Administration (FDA) riled that the makers had to carry the agency’s strongest warning on the drug’s potential newrological and psychiatric effects.

The so-called “black box” warning is designed to inform patients of potentially dangerous and permanent side effects.

After an extensive review, the FDA found that neurologic side effects such as dizziness, loss of balance or tinnitus can “persist or become permanent” as a result of taking the medication

“Neurologic side effects can occur at any time during drug use, and can last for months to years after the drug is stopped or can be permanent,” said an FDA spokesman.

The decision caused the US military to abandon the use of Lariam, in favour of the more expensive except in cases of last resort, where other antimalarial were not effective. It now favours the more expensive Malarone.

"We estimate that around one in three of US military personnel who have ever taken Mefloquine have experienced adverse reactions - and many of those were just normal guys with no pre-existing issues," said David Haines, a former Somalia veteran and co-founder of the US-based Veterans Against Lariam group.

In the UK, however, Pubic Health England has allowed the MoD to continue issuing Lariam, and it remains the default antimalarial remedy.

Last night one Whitehall source confirmed: “While it is officially sanctioned, and considerably cheaper than Malarone, the MoD sees no reason why it should change its position.”

Sir Alan Meale, MP for Mansfield, said he had raised the question in parliament after three of his constituents, all former members of the Armed forces, reported suffering from serious side effects after taking Lariam.

"I think the Army is being typically bureaucratic on this issue. It took the decision to take Lariam years and years ago, and will continue to do so, despite the increasing and overwhelming evidence that it is dangerous, until someone actually tells them to stop. Cost is also probably a major factor.

"In the meantime I have three constituents, all former members of the armed Forces, who are in a very bad way because of Lariam.

"I would not be surprised if it resulted in legal action against the MoD.”

An MoD spokesperson said: “All our medical advice is based on the current guidelines set out by Public Health England. Based on this expert advice, the MoD continues to prescribe Mefloquine (Lariam) as part of the range of malaria prevention treatments recommended, which help us to protect our personnel from this disease.

Mefloquine is used across the UK, not just by the military, and is only ever prescribed after an individual risk assessment.”

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