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Drug Interactions between Diamox Sequels and mefloquine

This report displays the potential drug interactions for the following 2 drugs:

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Interactions between your drugs

Moderate

acetaZOLAMIDE mefloquine

Applies to: Diamox Sequels (acetazolamide) and mefloquine

GENERALLY AVOID: Mefloquine may increase the risk of seizures and decrease the effectiveness of anticonvulsant drugs in patients with epilepsy. The use of mefloquine alone and in combination with other related antimalarial agents (e.g., quinine, quinidine, chloroquine) has been associated with convulsions in some patients. Coadministration of mefloquine with certain anticonvulsant medications may also result in reduced seizure control by lowering the plasma levels of the anticonvulsant. In one case report, a patient with a seizure disorder previously well controlled on valproic acid and carbamazepine experienced several seizure episodes after taking mefloquine (250 mg weekly) for malaria prophylaxis. A subsequent kinetics study performed on the patient revealed a significant reduction in sodium valproate half-life (5.65 hours vs. reported normal of 8 to 20 hours) and no change in carbamazepine half-life. The author suggested that mefloquine be administered to epileptic patients with caution, particularly if being treated with sodium valproate. Additional clinical data with other antiepileptics are unavailable.

MANAGEMENT: According to product labeling, mefloquine may precipitate convulsions in patients with a history of seizure disorder and should not be used for malaria prophylaxis in such patients. If mefloquine administration is required for curative treatment of malaria, anticonvulsant blood levels should be closely monitored and the anticonvulsant dosage adjusted accordingly as needed. Patients should be advised to notify their physician if they experience a loss of seizure control.

References

  1. Singh K, Shanks GD, Wilde H "Seizures after mefloquine." Ann Intern Med 114 (1991): 994
  2. Weinke T, Trautmann M, Held T, et al. "Neuropsychiatric side effects after the use of mefloquine." Am J Trop Med Hyg 45 (1991): 86-91
  3. Bem JL, Kerr L, Stuerchler D "Mefloquine prophylaxis: an overview of spontaneous reports of severe psychiatric reactions and convulsions." J Trop Med Hyg 95 (1992): 167-79
  4. Jallon P "Use of mefloquine in epileptic patients." J Neurol Neurosurg Psychiatry 51 (1988): 732
  5. "Product Information. Mefloquine Hydrochloride (mefloquine)." Hikma USA (formerly West-Ward Pharmaceutical Corporation) (2021):
  6. Ries S, Pohlmanneden B "Seizures during malaria prophylaxis with mefloquine." Dtsch Med Wochenschr 118 (1993): 1911-2
  7. Ruff TA, Sherwen SJ, Donnan GA "Seizure associated with mefloquine for malaria prophylaxis." Med J Aust 161 (1994): 453
  8. Pous E, Gascon J, Obach J, Corachan M "Mefloquine-induced grand mal seizure during malaria chemoprophylaxis in a non-epileptic subject." Trans R Soc Trop Med Hyg 89 (1995): 434
  9. Potasman I, Juven Y, Weller B, Schwartz E "Does mefloquine prophylaxis affect electroencephalographic patterns?" Am J Med 112 (2002): 147-9
  10. Jimenez-Huete A, Gil-Nagel A, Franch O "Multifocal myoclonus associated with mefloquine chemoprophylaxis." Clin Neuropharmacol 25 (2002): 243
  11. Ridtitid W, Wongnawa M, Mahatthanatrakul W, Chaipol P, Sunbhanich M "Effect of rifampin on plasma concentrations of mefloquine in healthy volunteers." J Pharm Pharmacol 52 (2000): 1265-9
  12. "Product Information. Lariam (mefloquine)." Pharmaco Australia Ltd (2022):
  13. "Product Information. Mefloquine (mefloquine)." AA Pharma Inc (2017):
  14. "Product Information. Lariam (mefloquine)." Neon Healthcare Ltd (2022):
View all 14 references

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Drug and food interactions

Moderate

mefloquine food

Applies to: mefloquine

ADJUST DOSING INTERVAL: Food enhances the oral absorption and bioavailability of mefloquine. The proposed mechanism is increased drug solubility in the presence of food. In 20 healthy volunteers, administration of a single 750 mg oral dose of mefloquine 30 minutes following a high-fat meal increased the mean peak plasma concentration (Cmax) and area under the concentration-time curve (AUC) of mefloquine by 73% and 40%, respectively, compared to administration in the fasting state. The Cmax and AUC of the carboxylic acid metabolite were also increased by 35% and 33%, respectively, compared to fasting. In addition, the time to reach peak plasma concentration (Tmax) of mefloquine was significantly shorter after food intake (17 hours) than in the fasting state (36 hours). There was no difference in the elimination half-life of mefloquine and metabolite, or the Tmax for the metabolite.

MANAGEMENT: To ensure maximal oral absorption, mefloquine should be administered immediately after a meal with at least 8 ounces of water.

References

  1. "Product Information. Mefloquine Hydrochloride (mefloquine)." Hikma USA (formerly West-Ward Pharmaceutical Corporation) (2021):
  2. Schmidt LE, Dalhoff K "Food-drug interactions." Drugs 62 (2002): 1481-502

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Therapeutic duplication warnings

No warnings were found for your selected drugs.

Therapeutic duplication warnings are only returned when drugs within the same group exceed the recommended therapeutic duplication maximum.

See also

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Drug Interaction Classification

These classifications are only a guideline. The relevance of a particular drug interaction to a specific individual is difficult to determine. Always consult your healthcare provider before starting or stopping any medication.
Major Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.
Moderate Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.
Minor Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan.
Unknown No interaction information available.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

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