Comprehensive Review of Mefloquine in Malaria Treatment and Prevention

Abstract

Clinically, mefloquine remains effective in many regions for treating uncomplicated P. falciparum malaria, often combined with artesunate as part of artemisinin-based combination therapies (ACTs). Despite its widespread past use, increasing resistance in parts of Southeast Asia has decreased its effectiveness as a standalone treatment. However, it still serves as a valuable option in areas with low resistance or when used in combination therapies. Safety concerns have significantly impacted how mefloquine is viewed and used. Common side effects include gastrointestinal discomfort and dizziness, while rare but serious adverse events involve anxiety, depression, hallucinations, and seizures. These neuropsychiatric effects, although infrequent, have led to revised prescribing guidelines, especially in military and travel medicine settings. Mefloquine is contraindicated for individuals with a history of psychiatric disorders or epilepsy.