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a pregnant woman pharmacyMarch 29 2018

Mefloquine is safe to use for malaria prevention during pregnancy, a Cochrane Review has concluded.

After reviewing five studies relating to the drug’s use in sub-Saharan Africa and one in Thailand between 1987 and 2013, the Cochrane authors said that “mefloquine is efficacious and safe for prevention of malaria in pregnant women living in stable transmission areas.

“The drug has been found to be safe in terms of adverse pregnancy outcomes, such as low birth weight, prematurity, stillbirths and abortions, and congenital malformations. However, it is worse tolerated than other antimalarial drugs.”

Data included in the review covered women living with and without having HIV infection. It also found relative efficacy relating to other malarial chemophrophylaxis. “Mefloquine was more efficacious than sulfadoxine-pyrimethamine in HIV-uninfected women or daily cotrimoxazole prophylaxis in HIV-infected pregnant women for prevention of malaria infection.”

However, in all circumstances, mefloquine “increases risks of drug-related adverse events including vomiting, fatigue/weakness, and dizziness,” said the reviewers. “Overall, the high proportion of mefloquine-related adverse events constitutes an important barrier to its effectiveness for malaria preventive treatment in pregnant women.”

The Summary of Product Characteristics for Larium notes that mefloquine is teratogenic in mice and rats, and embryo-toxic in rabbits, “however, large clinical experience with Lariam as prophylactic treatment has not revealed an embryotoxic or teratogenic effect.”

Links:
Cochrane Library announcement          http://www.cochrane.org/CD011444/INFECTN_mefloquine-preventing-malaria-pregnant-women
http://cochranelibrary-wiley.com/doi/10.1002/14651858.CD011444.pub2/full
Larium SPC      

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