LARIAM: THE STORY IN THE UK

Lariam (also known as mefloquine) was licensed for use in the UK in 1990. In 1993, it became the main prophylaxis (ie. preventive drug) for people travelling to areas known to be resistant to chloroquine, including parts of Africa. Since then, the guidelines on its use have been revised several times (see below).

Why isn’t there a Lariam Action in the UK?

Since the mid-1990s there has been public concern in the UK about the possible side effects of the drug. A self-help support group, Lariam Action, was set up in 1995, but is now disbanded.

After television publicity on the BBC consumer programme ‘Watchdog’ on 6th November 1995, and subsequent press reports, nearly 1000 people contacted the Bristol-based solicitors Lawrence Tucketts thinking they had a case against Roche. Some of them were actively involved in Lariam Action.

Some had lost jobs, some were sectioned under the Mental Health Act, others were unable to work for years or more because of the physical and medical legacy, which they believe was a side effect of taking the drug.

Of the 1000 cases, lawyers decided 200 looked convincing enough to use in a court case against Roche. 70 of them were funded publicly through Legal Aid. When, in 1998 and after lengthy legal arguments (see below), Legal Aid was withdrawn, the legal action collapsed. Private clients, who were footing their own bills, had no choice but to pull out.

Roche didn’t actually win, as such, but it did strike a deal preventing those who had pursued the case from taking any further action against the company. Providing they did not pursue any further publicity against Roche, the company would not pursue the applicants for the costs of the case.

Lariam Action UK – led by Lorraine Traer-Clarke and Lance Cole – disbanded the same year, feeling they had taken the case as far as they could.

Why did the Legal Aid Board withdraw funding?

Lawyers had advised the Legal Aid Board, who decided on funding, that the chances of success were slim. The claimants would have had to show that Roche had failed to reveal all the information it had about the drug’s safety, that patients would not have taken the drug had they known of the side effects, and to prove the side effects were higher than those claimed by Roche.

What has happened since then?

Following the adverse publicity, UK experts have revised the advice on malaria prophylaxis several times, in 1997, 2001 and 2003.

In September 1997, the government’s Malaria Advisory Committee issued complex 16 page guidelines, fine-tuning Lariam’s use to certain parts of affected countries at particular times of year.

The gist of the changes was that travellers to East Africa for two-week package holidays, who were at a lower risk, should use chloroquine and proguanil.

Those travelling to West Africa, where the risk was considerably higher, should still use Lariam in June to December, when the transmission risk was at its peak. The rest of the year they could use chloroquine and proguanil.

Since then, the guidelines have been updated and revised again, once in 2001, and again in 2003. (Current guidelines)

The guidelines acknowledge that neuro-psychological effects are more likely in women than men.

They also spell out the alternative drug options currently available for malaria prophylaxis in the UK. These are doxycycline, Maloprim, and Malarone, as well as the more traditional chloroquine and proguanil. The guidelines are complicated: you are advised to seek the advice of a qualified doctor if you are in any doubt as to which is appropriate for your particular journey.

I think I suffered adverse reactions from Lariam, what can I do?

If you have suffered an adverse reaction which you think is due to taking Lariam, then please inform your doctor and ask them to fill in a Yellow Card reporting your fears to the Committee on Safety of Medicines. Only by doing this will your concerns be registered with the authorities who monitor drug safety.

You can find out more about the scheme look up ‘Yellow Card’ in the search engine at Medicines and Healthcare products Regulatory Agency.

Can I pursue legal action despite the collapse of the previous case?

The chances of getting public funding for a case against Roche are slim. But you may wish to check with AVMA for further advice about what you might do.