Mefloquine (brand name: Lariam) has been issued by the U.S. Military since the early 1990s as the primary antimalarial drug for troops. Veterans deployed to Africa or the Middle East were likely ordered to take mefloquine however little has been explained of its toxicity The U.S. Military takes the threat of malaria so seriously that both the Navy and Marine Corps Public Health Center and Army Public Health Center strongly advocated for Directly Observed Therapy (DOT); this is where a trained, chain-of-command authority watches to make sure that service members actually swallow each dose of antimalarial drug. The typical dosing is one tablet once a week for four weeks prior to deployment, one tablet weekly while deployed, and one tablet once a week for four weeks after coming home from deployment. U.S. Military Guidelines state that service members should seek medical evaluation if they have any drug side effects, but concede that “this information is usually presented at the unit level.”
Known Side Effects of Mefloquine Toxicity
The FDA warns that side effects of mefloquine include dizziness, balance problems (including vertigo), and tinnitus which may continue for months or years after discontinuing use. Mefloquine is also known to cause anxiety, paranoia, hallucinations, depression, restlessness, confusion, and unusual behavior. In more serious cases symptoms can include suicidal behavior, committing suicide, severe anxiety, paranoia, hallucinations, depression, feeling restless, insomnia, and abnormal dreams. The FDA advises contacting your health care professional immediately if any of these side effects occur during or following the use of mefloquine.
Studies have shown that mefloquine has been found to cause permanent brain stem injuries in animal testing, and has since been shown to cause brain stem injuries in humans. These brain stem injuries account for the otherwise unexplained vestibular symptoms- i.e. unexplained dizziness, vertigo, tinnitus, or loss of balance- exhibited by people who have suffered from mefloquine toxicity. Researchers are currently looking into possible connections between sleep apnea and brain stem injury from mefloquine.
Despite knowing about these side effects, it wasn’t until 2013 that the FDA issued the following Boxed Warning for mefloquine:
The Assistant Secretary of Defense then issued a memorandum in 2013 stating that atovaquone-proguanil and doxycycline were now the military’s first choice of antimalarial drugs and that mefloquine should only be used for service members with an intolerance to the other two drugs.
Applying for benefits due to mefloquine toxicity
Symptoms such as anxiety, depression, nightmares, dizziness, and paranoia typically begin within the first one to four weeks of taking mefloquine. Many veterans may not have even realized these symptoms were related to mefloquine, as they could easily be attributed to their impending deployment. Continued use of mefloquine while deployed would likely cause an exacerbation of symptoms over time, potentially leading to permanent disabilities.
Looking into mefloquine toxicity may be a good avenue for veterans who began experiencing PTSD-like symptoms prior to an actual trauma and around the same time the veteran took mefloquine. One of the key indicators of mefloquine toxicity is neuropsychiatric symptoms (depression, anxiety, paranoia, nightmares, etc.) with vestibular symptoms. So, a veteran who began to experience anxiety and nightmares, as well as tinnitus, without an obvious explanation may have had mefloquine toxicity.
Finding mefloquine in Your medical records for your claim
Unfortunately, service medical records typically do not list if a service member received mefloquine. Mefloquine was often considered part of a service member’s kit, rather than part of their medical treatment. If the records do indicate mefloquine use, it could be listed as mefloquine, Lariam, mef, or MQ. Instead, look at a veteran’s service records for a list of their assignments. These assignment records should list where a veteran was deployed which would be a good indicator of whether the veteran would have received mefloquine.
The VA has yet to begin to regularly grant claims for service connection for conditions caused by mefloquine or mefloquine toxicity. However, with the vast number of service members who received mefloquine over the last several decades, it is important to consider mefloquine toxicity as a possible cause of a veteran’s neuropsychiatric and vestibular conditions when considering a claim. At this point, an independent medical opinion will likely be necessary to provide the VA with enough evidence to show that a veteran’s conditions are at least as likely as not caused by mefloquine toxicity experienced in service.
What if I deployed to that area but was not given mefloquine?
For veterans who received anti-malarial drugs prior to the early 1990s, your symptoms could still be related to the anti-malarial drugs you received. Mefloquine is derived from quinine. The central, ringed structure of quinine has been used in numerous other antimalarial drugs. Some other, related antimalarial drugs previously used by the U.S. Military include Pentaquine, Iso Pentaquine, Primaquine, Pamaquine, and Tafenoquine.