The Lariam Debate…Continues

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Army photo / Staff Sgt. Marcus J. Quarterman

The rate of malaria among U.S. troops in Afghanistan, like these, has dropped sharply since the Pentagon stopped routinely giving them an Army-developed medicine, a former Army doctor says.

The use of the drug mefloquine – also known by its trade name, Lariam – has been controversial for years. Developed by the U.S. Army in the 1970s, it was the standard medication to fight malaria provided to U.S. troops headed to Afghanistan, Iraq, and Somalia.

But soldiers complained that taking Lariam in pill form once a week made them feel strange. There were reports of mental ailments – including anxiety, hallucinations, depression and suicidal thoughts – associated with its use.

Yet the Army marched on to the beat of its own drug. “Military personnel will die of malaria if MQ not available,” the science director of the Walter Reed Army Institute of Research – the outfit that developed the drug – warned in 2004.

But reports of problems with the Army-invented drug proved significant enough that its civilian manufacturer, the Swiss company F. Hoffman-La Roche, stopped producing it in the U.S. in 2009. That same year, the U.S. military returned to daily doses of doxycycline, the U.S. military’s pre-Lariam anti-malarial choice, as its primary drug for fighting the mosquito-borne tropical disease, estimated to kill more than 1 million people a year.

So what has happened now that soldiers no longer routinely take Lariam? Are they dying of malaria more often, as the science director of the Walter Reed Army Insitute of Research predicted eight years ago would happen if they didn’t use it?


A recent article in the American Journal of Tropical Medicine and Hygiene reported that 61% of soldiers complied with doxycycline’s daily dosing, while only 38% given Lariam took it once a week as directed.

That caught the eye of Remington Nevin, a former Army public-health doctor now pursuing graduate work at the Johns Hopkins University in Baltimore.

“By conventional wisdom these results appear counterintuitive, and they stand in contrast to earlier findings among civilian travelers and military personnel that suggest observed compliance should be higher with weekly dosing,” he noted in a letter published in the latest issue of the journal.

Even more strikingly, Nevin says that malaria cases dropped dramatically since troops switched to doxycycline.

“Among U.S. military personnel in Afghanistan, over these past three years, and co-incident with the shift away from mefloquine as a preferred chemoprophylaxis, the rate of malaria has actually fallen over 70%,” Nevin said. “Today in Afghanistan, malaria affects only about 1 U.S. service member per 1,000 per year; this rate is extremely low by historical standards, particularly as compared with rates during prior operations in areas of comparable endemicity, including Somalia, where they were nearly ten times higher.”

It seems that no matter how well a medicine may be in controlled trials, it won’t work if people don’t take it as prescribed in the real world.

“Today’s soldiers may be less likely to adhere to mefloquine chemoprophylaxis because of growing awareness of its strong association with psychiatric symptoms and its potential to induce neurotoxicity,” Nevin concluded. “Senior U.S. military medical officials now acknowledge that the neuropsychiatric side effects caused by mefloquine may confound the diagnosis and management of post-traumatic stress disorder and traumatic brain injury, making its routine use less desirable.”

Nevin, who recently testified before a Senate panel on the chronic effects of mefloquine, said the Food and Drug Administration has convened a panel of neurotoxicologists and other experts to review the safety of the drug, based on recent reports of brainstem damage. These reports, Nevin suggests, represent “the tip of the iceberg” and that “thousands of veterans may suffering from the neurologic and psychiatric effects of mefloquine toxicity”


Folks seeking support: search "lariaminfo" all one word for independent victim support group.


On the 12th of May 2002 i sufferred a delerium/psychosis while travelling in nepal waiting to go to Tibet a trip of a life time luckily i was with friends who found me a clinic run by Canadian Drs called my family & my sister travelled to get me & bring me back to Australia I was a wreck a zombie confused frightened agrophobic couldnt use my arms or move much, food tasted strange... i was told once the medicine had left my body in 100 days i would be fine!! But 11 years later I still suffer a myriad of symptoms anxiety, extreme fatigue brain fog extreme intolerence to noise also suicidal periods... thank goodness i have a supportive family especially my Mother but basically I'd like the makers of Lariam & the Dr who prescribed it to me to be made to take it & suffer the damage i have... I have no life my mother is 77 years old & she cant keep caring for me..... I dont know what im going to do!!!


Folks seeking support-- search "lariaminfo" all one word. Independent, non-profit group for we victims.


in 1995  i was  healthy and adventurous when i  went to Bali for a holiday.  i returned a quivering mess after only a few days.

suffering uncontrollable shaking,while being terrified,of going out,or being alone,terrified to close my eyes to sleep, panic attacks,agoraphobia brain fog  etc

It took months to find a doctor who knew anything about the side effects of Lariam,  all the while trying to cope with the mental torture of not understanding what was happening to me. Then to be informed there was no cure!

  altogether i only took 3 Lariam Tablets, yet the symptoms still haunt me today. 

kendall 3 Like

Thanks for posting this article. I took Lariam in 1998 for a short term missions trip to Kenya. I took the 1st dose 1 week prior to departure and had a reaction before I even left the states. The doctors did not recognize that it was an adverse reaction to mefloquine, they just thought I had anxiety. I took my second dose en route to Kenya and shortly after I arrived at my destination I woke up unable to catch my breath. I began having nightmares that caused my heart to race uncontrollably and the panic and fear never left. My blood pressure dropped to dangerously low levels. I had pains in my extremities and chest and later they traveled up the back of my neck into my head. I discontinued use of the drug. When I got home 4 weeks later my symptoms continued to worsen and I began to experience vertigo and suicide ideation. I had chest pain, anxiety, insomnia, depression, weak legs, and brain fog. My friend recently told me I would stare off into space and my eyes would not track. This was not the me I knew. The doctors never attributed my symptoms to Lariam use because at that time the warning labels did not fully disclose all of the negative side effects. It has been 14 years and my life is not the same as it would have been if not affected by this drug. I feel lucky to be alive and thankful the worst is behind me. It did however take several YEARS (6) to get over "the worst." I thought it would never end, in fact sometimes I still wonder if it will come back full throttle. I am overly cautious about any medication I am prescribed now and consider myself to be 90-98% recovered.

MichelleSM 2 Like

I am a journalist who took Lariam before assignment to Africa.  It took just three pills of mefloquine to build up to neurotoxic levels for me, and I was diagnosed with brain stem damage (vestibular disorder), hospitalized, and nearly died.  My brain will never work the same.  Seven years later, I am now coaching another victim who is finding he may lose his job and his family because of acute anxiety that began when he was prescribed the drug for a vacation trip.  When are we going to take this drug off the market for prophylaxis?  Doxycycline is safer (or Malarone) and now proven to be more effective.  I always said it's easier to make a habit of taking a pill nightly when you brush your teeth, rather than having to remember weekly to take mefloquine.  


Near the end of the previous comment, I wrote "followed up with a letter for the recent hearings that we scheduled for late October". We did not schedule the hearings. I meant to write "were" scheduled but in the process of typing quickly I accidentally omitted the "re" of were.

CharlesAdamsCogan 2 Like

Last summer, my wife and I and youngest son traveled to Ghana and Togo. As a former Peace Corps volunteer and Fulbright scholar, I had used Lariam without major problems in the past, so when our travel doctors prescribed it for all three of us, we were not concerned and took it as prescribed. My son and I did not have any problems, but my wife almost died. In northern Togo, she began to have extreme anxiety and chest pains and then a seizure. I had to do chest compressions on her to get her breathing again. We managed to come home early from the trip, but were unsure of the cause of her symptoms and continued taking Lariam until a French friend (and former French Volontaire du Progres in Togo) warned us that her symptoms seemed to mirror those of a dangerous adverse reaction to Lariam. We eventually substituted Doxycycline for Lariam, but it takes between two and three weeks before the medicine is totally out of your system and she spent much of June in and out of hospitals. This is not the place for a detailed description of what she went through, but it mirrors the experiences of others who have already commented and we're lucky that she is alive and has recovered sufficiently to go back to work and resume a 'normal' life. Having now read much about the recent (and past) experiences of military personnel, Peace Corps volunteers and even tourists with Lariam, we felt foolish not to have made the connection sooner, but this also seems to be common. We filed a MedWatch report with the FDA and then followed up with a letter for the recent hearings that we scheduled for late October, but postponed because of Hurricane Sandy. I would urge anyone who has had an adverse reaction to Lariam/Mefloquine to file a report to the FDA and also connect with support groups for survivors. Suffering in silence is bad for you, but it also increases the chances that others will suffer in the future.

MefloquineIreland 3 Like

Military and Civilians have all suffered as a result of Lariam/mefloqune.  I have ongoing neuropsychiatric and phsical problems more than 15 years after being prescribed this drug.  And yes, at the time I was perfectly healthy and Lariam was meant to keep me healthy.  Just one of many, many lives ruined by this dangerous drug.

AndrewPrenticeSterioff 1 Like

Lariam and Mefloquine toxicity are still a huge problem among Peace Corps volunteers as Dan Olmstead and Mark Benjamin have already reported in UPI years ago.  Nothing has been done about the problem because the pharmaceutical lobby has so much influence in Washington, D.C.  Lariam and Mefloquine are a net moneymaker for the pharmaceutical industry because the side effects require additional, expensive medications that often have to be paid for by the victims because they are misdiagnosed by doctors paid by the drug companies as mentally ill for unknown or for biological reasons.  The ties between Hoffman-LaRoche and the congress, and the marketing strategy has a grip on Congress, the FDA, the Peace Corps, and the military.

Tamarahco 3 Like

My little brother was an International Committee of the Red Cross delegate who was prescribed Lariam while on duty in Chad, then Congo, in 2009. In 2010 he was "med evac"-ed to the US, and left there with no guidance for months. No one at ICRC stepped in when he was undergoing tests for an array of mysterious symptoms that included crippling anxiety, memory loss and suicidal behavior -- all of which were new to my brother. No one -- not once -- mentioned Lariam or its neuro-psych side effects. My brother killed himself in February, 2010.

I am writing you with this to reinforce the fact that Lariam is not just a military problem.

AbbasKharal 2 Like

The work of Dr. Nevin is truly inspiring. It shows the importance of effects of drugs beyond clinical trials and how well research actually translates into practical clinical medicine around the world. Such observations could lead to changes in current malaria prophylaxis guidelines and serve as an eye opener for policy makers in the healthcare field. Would love to hear more from Dr. Nevin and other such leaders in healthcare about more interesting topics regarding treatment protocols in other mental health and infectious disease scenarios. 


9 December marks the day U.S. Forces entered Somalia 20 years ago. To many Mogadishu Vets (MOGVETs )this date also marks the beginning of a horrible legacy in which thousands of us were given an unregulated 250 MG weekly dose of a prescriptive drug called Mefloquine (Lariam). The damage from this drug has lived on long past our departure from Somalia. The lives of many Somalia Combat Veterans and their families have forever been destroyed as a result of Mefloquine. We as a group want to insure this never happens again and that those who are suffering, many in confused silence, become aware of this travesty and receive the necessary treatment owed to them by our country. Those who believe they were poisoned should join the facebook group International Veterans Against Mefloquine.  We are likely looking at this nation's next Agent Orange which will require significant research to develop treatments for those suffering


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