Lariam and Halfan

Ashley Croft¹ has performed a service in exposing the disgraceful failure to test properly the antimalarial drugs Lariam (mefloquine) and Halfan (halofantrine) (JRSM 2007;100:170-174). The side-effects of these drugs were not widely recognized until the mid-1990s, but incredibly, a randomized controlled study was not undertaken until 2001!²

In 1995, my wife and I, on our way back from Tristan da Cunha, were on board RMS St Helena, which called at The Gambia, where we had a day ashore. For this reason we had been advised to take malaria prophylaxis. We shared a table with the ship's doctor, who remarked on the number of passengers, mainly women, who were complaining of depression: he attributed this to the Lariam which they had been prescribed. We had put our faith in chloroquine and proguanil instead.

Unfortunately, the ship's doctor did not think to send an adverse reaction report, which was a pity since such a report might have produced action earlier than 2001.

I was astonished to find that mefloquine (but not halofantrine) was still listed in the September 2006 issue of the British National Formulary with an entry identical to that of March 2001—a mild warning about neuropsychiatric disorders, depression, convulsions and hypersensitivity to quinine. In both issues of the BNF there is a 17-line list of side-effects!

I cannot agree with Croft's plea for more research on mefloquine and halofantrine on the grounds that they are ‘undoubtedly lifesaving drugs.’ In my view, Lariam should be withdrawn, as has presumably occurred with Halfan.