One of the concerns about long term mefloquine use was the fear of late toxicity due to accumulation of the drug. However, recent pharmacokinetic studies have shown that the steady-state concentration of metloquine was achieved by the eighth to ninth week of prophylaxis. Despite its long elimination half-life, weekly administration did not lead to toxic accumulation of the drug.
One of the main arguments against the use of mefloquine has been the large number of contraindications to the drug. There is little evidence to support contraindications other than a history of seizures or psychosis and presence of cardiac conduction abnormalities. Except for a single anecdotal case, there are no data to support the previous contraindication of mefloquine use in conjunction with beta- and calcium channel blockers. With respect to the contraindication for airline pilots, the study from Boudreau et al in Hawaii and a recent unpublished study of airline pilots in flight simulators showed no change in fine motor coordination or judgement. Finally, the contra indication of metloquine use in the latter half of pregnancy has been refuted by studies in Malawi on over 2000 women and in a recent placebo controlled trial in Thai women; both studies showed no significant adverse outcome with mefloquine use . Malaria experts at the Centers for Disease Control and Prevention in Atlanta, Georgia suggest that mefloquine can be considered for prophylaxis of women in their second and third trimester of pregnancy where exposure to chloroquine-resistant Plasmodium falciparum is unavoidable. Since mefloquine has been shown to be safe in the latter half of pregnancy it is very difficult to argue that infants weighing less than 15 kg should not be given the drug for prophylaxis. Unfortunately, there are no prophylaxis studies of mefloquine use in infancy. Take advantage of this chance to find birth control pills
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Mefloquine is more efficacious, has similar tolerability and few absolute contraindications relative to other drugs recommended for malaria chemoprophylaxis. Except for those travelling to areas of Southeast Asia where multidrug-tesistant malaria is present, mefloquine remains the drug of choice for travellers to all other drug resistant areas of the world.