What is Mefloquine?
Malaria is a serious infectious disease transmitted by mosquitoes and typically found in Iraq, Afghanistan, and many areas in Africa, South America, and Asia. Mefloquine is a round, white tablet taken once a week that can help prevent malaria for travelers. For decades, this drug was administered to both civilians and military personnel, including those serving in Iraq and Afghanistan.
What Health Effects are Associated with Mefloquine Toxicity?
In 2009, Pentagon officials issued a policy listing mefloquine as a last-choice preventive in areas where malaria strains are resistant to other available medications. This policy came in response to increasing concern over reported health effects associated with mefloquine use. The Food and Drug Administration (FDA) took action in 2013 when it placed a black box warning on mefloquine, indicating the drug can cause ongoing or permanent neurological and psychiatric conditions.
Neurological effects of mefloquine toxicity
The most common neurological effects of mefloquine toxicity include seizures, peripheral neuropathy, tremors, ataxia (i.e. loss of control of movement), vertigo (i.e. dizziness), and tinnitus.
Psychiatric effects of mefloquine toxicity
The psychiatric effects of mefloquine toxicity include, but are not limited to, anxiety, panic attacks, paranoia/persecutory delusions, dissociative psychosis, amnesia and other memory problems, and violent and suicidal behavior.
VA maintains that the most commonly reported side effects from mefloquine are nausea, vomiting, diarrhea, dizziness, difficulty sleeping, and bad dreams. However, VA indicates that these effects are usually mild and may not necessarily cause people to stop taking the medicine. VA does recognize that other side effects exist, including those mentioned above, but it is not fully understood how these side effects occur or persist over time. As a result, VA instructs individuals with the following conditions to not take mefloquine:
- Psychiatric conditions including active depression, a recent history of depression, generalized anxiety disorder, psychosis, schizophrenia, or other major psychiatric disorders
- Seizure disorders (epilepsy)
- Certain heart conditions (irregular heartbeat and conduction problems)
- Those taking certain medications, as advised by a health care provider
VA Disability Benefits for Health Problems Related to Mefloquine Toxicity
Veterans may file a claim for disability compensation for health problems they believe are related to mefloquine use during military service. However, VA does not currently offer presumptive service connection for any conditions claimed to be associated with mefloquine toxicity. Instead, veterans will have to prove service connection on a direct basis by showing their conditions are caused by their in-service mefloquine use. Historically, VA has rejected these claims on the basis that there was no evidence of mefloquine prescribing in veterans’ medical records. However, there are a few cases in which VA has awarded service-connected compensation for mefloquine-related conditions where exposure was established by lay evidence and further supported by expert reports. Ultimately, VA decides these claims on a case-by-case basis.
Importantly, a recent Walter Reed Army Institute research study concluded that symptoms related to mefloquine toxicity mimic those of post-traumatic stress disorder (PTSD). As such, it is difficult to distinguish possible mefloquine-induced toxicity and PTSD, and thereby raises some questions regarding possible linkages between the two diagnoses.