“Our World” Segment on Lariam

Voice of America, News Now

(AIRED MAY 12 and 16, 2001)

INTRO: American health officials say the anti-malaria drug mefloquine –
trade name Lariam — is extremely effective and that serious side
effects are rare. The drug is used in many parts of the world to prevent
malaria. But some other experts say the rate of severe reactions,
ranging from nausea and dizziness, to convulsions and psychosis, appears
to be far higher than was believed when Lariam was first approved for
use in 1989 in the U.S. VOA’s Carolyn Weaver has the second part of her
report:

TEXT: Early research by the Roche pharmaceutical company, which makes
Lariam, reported severe side effects in only one-in-ten-thousand
travelers on the drug. But a 1996 study published in the British
Medical Journal found severe side effects in one in 140 travelers. And a
study presented last fall at a conference sponsored by the American
Society for Microbiology reported mild to serious neuropsychiatric
adverse effects in 29% of Lariam users.

TAPE: CUT ONE – RAYMOND WOOSLEY :05
“There are some very serious reactions that appear to be happening more
commonly.”

TEXT: Dr. Raymond Woosley is the head of pharmacology at Georgetown
University in Washington, D.C.

TAPE: CUT TWO – WOOSLEY :13
“You look in the package insert, they’re listed there. So they are
real, there is no doubt about that. But the true incidence is something
we don’t understand, and it really doesn’t matter, because they’re such
severe reactions that patients need to be warned about this.”

TEXT: A Roche spokesman declined VOA’s request for an interview, saying
the company saw no advantage in participating. Roche received the rights
to manufacture and market the drug after it was first developed by U.S.
Army scientists and then approved for use in 1989. The American military
and the Peace Corps have relied on Lariam since then, especially in
areas where malaria is resistant to most other drugs. Unlike alternative
drugs, Lariam needs to be taken only once a week – an important
consideration for organizations with thousands of people in the field.

TAPE: CUT THREE – JOHN DRAKE :05
“I went back to my room and I just had a bit of a breakdown…”

TEXT: 27-year-old John Drake was told he would take Lariam weekly when
he left for a Peace Corps posting in Africa last June. He says the Peace
Corps offered no warnings about possible side effects other than
nightmares. Hours after he took his second pill, his anxiety turned
into paranoia. He ran into the bush in the middle of the night,
screaming at noisy frogs.

TAPE: CUT FOUR – DRAKE :15
“I thought I was crazy, I thought my whole life I’d lived in a mental
hospital and I’m just now becoming aware of this or something. A few
minutes later, I realized that probably wasn’t the case, but I was very
confused.”

TEXT: The Peace Corps flew John Drake back to Washington and placed him
in a psychiatric hospital, where he was put on strong anti-psychotic
drugs – and told he would need to take them for life. John Drake
disregarded that advice, stopped taking the drugs, and says his symptoms
cleared up quickly. But he is angry the Peace Corps never told him that
Lariam might have been responsible.

TAPE: CUT FIVE – JOHN DRAKE :28
“That’s probably what upsets me the most about the Peace Corps, is that
they were perfectly willing to let some psychiatrist put me on
anti-psychotics for the rest of my life, and they were willing to let me
think that I just went over to Africa and freaked out and lost my mind,
and that it’s just my problem – and that isn’t the reality of the
situation.”

TEXT: David Gootnick, the Peace Corps’ medical director, says he cannot
comment on John Drake’s case, but that generally speaking, he does not
know for a fact that Lariam has caused mental breakdowns in some
volunteers.

TAPE: CUT SIX – DAVID GOOTNICK :23
“You know, when someone has a mental health problem, under almost any
circumstance, if they’re taking Lariam or mefloquine, this can be very
difficult, near to impossible, to determine that their mental health
problem was or was not related to Lariam. So it is not uncommon for
volunteers to be medically evacuated for the reasons you describe. I
don’t know of any cases where we’ve specifically and definitively
determined that the problem was caused by Lariam.”

TEXT: However, Dr. Gootnick notes there have been several cases where
the Department of Labor approved workmen’s compensation wages to Peace
Corps volunteers for disability they claimed was caused by Lariam.
Despite those cases, Dr. Gootnick says the drug has prevented thousands
of infections – and saved lives.

TAPE: CUT SEVEN — DAVID GOOTNICK :12
“We re very pleased and proud that since we started using Lariam twelve
years ago, not a single volunteer has died of malaria. That is an
extraordinary record and something we’re quite proud of.”

TEXT: Even critics of Lariam agree that severe side effects are rare,
but they say patients need to be better informed about the possibility.
The voices of those critics may have been heard. Earlier this year, the
federal Centers for Disease Control and Prevention updated its malaria
protection guidelines. It now suggests alternative drugs, including the
old stand-by doxycycline and the newly-approved Malarone, for those who
cannot or do not wish to take Lariam.

[For VOA News Now, this is CarolynWeaver.]

More Information on Malaria, Treatment, and Side Effects