Mefloquine Dosage

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Usual Adult Dose for:

Usual Pediatric Dose for:

Additional dosage information:

Usual Adult Dose for Malaria

1250 mg orally as a single dose

CDC recommendation for uncomplicated infections due to chloroquine-resistant Plasmodium vivax or P falciparum: 750 mg orally as initial dose, followed by 500 mg orally 6 to 12 hours after initial dose

Approved indication: For treatment of mild to moderate acute malaria due to mefloquine-susceptible P falciparum (both chloroquine-susceptible and -resistant strains) or P vivax

Usual Adult Dose for Malaria Prophylaxis

250 mg orally once a week

Comments:
-Should be taken on the same day of each week, preferably after the main meal
-Prophylaxis should begin 1 week (per manufacturer) to 2 or more weeks (per CDC) before arrival in an endemic area and should continue for 4 weeks after leaving such areas.

Approved indication: For prophylaxis of P falciparum and P vivax malaria infections, including prophylaxis of chloroquine-resistant strains of P falciparum

Usual Pediatric Dose for Malaria

6 months or older: 20 to 25 mg/kg orally as a single dose
Maximum total dose: 1250 mg

CDC recommendation for uncomplicated infections due to chloroquine-resistant P vivax or P falciparum: 15 mg/kg orally as initial dose, followed by 10 mg/kg orally 6 to 12 hours after initial dose
Maximum total dose: 1250 mg

Comments:
-Manufacturer states splitting the total dose into 2 doses given 6 to 8 hours apart may reduce the occurrence or severity of side effects.
-Pediatric dose should not exceed adult dose.
-A second full dose should be given if the patient vomits less than 30 minutes after taking mefloquine.
-An additional half-dose should be given if the patient vomits 30 to 60 minutes after taking mefloquine.
-If vomiting recurs, the patient should be monitored closely and alternative malaria treatment should be considered if improvement is not observed within a reasonable period of time.

Approved indication: For treatment of mild to moderate acute malaria due to mefloquine-susceptible P falciparum (both chloroquine-susceptible and -resistant strains) or P vivax

Usual Pediatric Dose for Malaria Prophylaxis

20 to 30 kg: 125 mg (1/2 tablet) orally once a week
30 to 45 kg: 187.5 mg (3/4 tablet) orally once a week
Greater than 45 kg: 250 mg (1 tablet) orally once a week

CDC recommendation:
9 kg or less: 5 mg/kg orally once a week
Greater than 9 to 19 kg: 62.5 mg (1/4 tablet) orally once a week
Greater than 19 to 30 kg: 125 mg (1/2 tablet) orally once a week
Greater than 30 to 45 kg: 187.5 mg (3/4 tablet) orally once a week
Greater than 45 kg: 250 mg (1 tablet) orally once a week

Comments:
-Approximately 5 mg/kg (maximum: 250 mg/dose) orally once a week
-Should be taken on the same day of each week, preferably after the main meal
-Prophylaxis should begin 1 week (per manufacturer) to 2 or more weeks (per CDC) before arrival in an endemic area and should continue for 4 weeks after leaving such areas.

Approved indication: For prophylaxis of P falciparum and P vivax malaria infections, including prophylaxis of chloroquine-resistant strains of P falciparum

Renal Dose Adjustments

Data not available

Liver Dose Adjustments

Data not available

Precautions

Consult WARNINGS section for dosing related precautions.

Dialysis

Hemodialysis: No adjustment recommended.
CAPD: Data not available

Other Comments

The dosage is expressed in terms of mefloquine hydrochloride (salt).

Administration advice:
-Do not take mefloquine on an empty stomach; take with at least 8 ounces (240 mL) of water.
-Tablets may be crushed and suspended in a small amount of water, milk, or other beverage for patients unable to swallow them whole.

General:
-A Medication Guide and information wallet card (supplied by the manufacturer) must be given to patients when dispensing mefloquine.
-Competent national expert centers should be consulted for current advice on geographical resistance patterns.

For malaria treatment:
-Patients with life-threatening, serious, or overwhelming malaria infections due to P falciparum should be treated with IV antimalarials. Mefloquine may be used to complete the course of therapy after IV therapy is finished.
-If a full treatment course with mefloquine does not lead to improvement within 48 to 72 hours, alternative treatment should be used for retreatment (not mefloquine). Similarly, if previous prophylaxis with mefloquine failed, it should not be used for curative therapy.
-To avoid relapse, after initial treatment of acute P vivax malaria with mefloquine, patients should subsequently be treated with primaquine (to eliminate hepatic phase parasites).

For malaria prophylaxis:
-Mefloquine prophylaxis should start at least 1 week before arrival in an endemic area, continue during the stay, and then continue for 4 weeks after leaving the area.
-In certain cases (e.g., when traveler is taking other medications) it may be desirable to start prophylaxis 2 to 3 weeks prior to travel in order to ensure tolerance.
-The CDC states that mefloquine can be started 3 to 4 weeks in advance to allow potential side effects to occur before travel. If unacceptable side effects develop, there would be time to change the drug before the traveler's departure.

Monitoring:
-Hepatic: Hepatic function (periodically during prolonged use)
-Nervous system: For neuropsychiatric symptoms (especially during prolonged use)
-Ocular: Ophthalmic examinations (periodically during prolonged use)
-Psychiatric: For neuropsychiatric symptoms (especially during prolonged use)

Patient advice:
-Read the Medication Guide and carry the information wallet card during mefloquine use.
-Additional precautions (e.g., protective clothing, insect repellents, bed nets) are important for malaria prophylaxis.
-Seek medical attention for any febrile illness occurring after return from a malaria area.
-Use caution during activities requiring alertness and fine motor coordination (e.g., driving, piloting aircraft, operating machinery, deep-sea diving) while neurologic symptoms persist.

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