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Drug Interactions between Lariam and Quinaglute Dura-Tabs

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

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Interactions between your drugs

Moderate

quiNIDine mefloquine

Applies to: Quinaglute Dura-Tabs (quinidine) and Lariam (mefloquine)

ADJUST DOSING INTERVAL: The concomitant administration of mefloquine and other antimalarial agents may increase the risk of convulsions and cause ECG abnormalities. Seizures have been reported in patients taking mefloquine concurrently with chloroquine and/or quinine. The mechanism is unknown. Mefloquine monotherapy has been associated with convulsions and arrhythmias.

MANAGEMENT: If these drugs are used to treat severe malaria, mefloquine should not be given until 12 hours after the last dose of quinine, quinidine, or chloroquine. Close clinical monitoring is recommended.

References

  1. 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
  2. "Product Information. Mefloquine Hydrochloride (mefloquine)." Hikma USA (formerly West-Ward Pharmaceutical Corporation) (2021):
  3. Ries S, Pohlmanneden B "Seizures during malaria prophylaxis with mefloquine." Dtsch Med Wochenschr 118 (1993): 1911-2
  4. 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
  5. Davis TME, Dembo LG, Kayeeddie SA, Hewitt BJ, Hislop RG, Batty KT "Neurological, cardiovascular and metabolic effects of mefloquine in healthy volunteers: a double-blind, placebo-controlled trial." Br J Clin Pharmacol 42 (1996): 415-21
  6. Fonteyne W, Bauwens A, Jordaens L "Atrial flutter with 1:1 conduction after administration of the antimalarial drug mefloquine." Clin Cardiol 19 (1996): 967-8
  7. Potasman I, Juven Y, Weller B, Schwartz E "Does mefloquine prophylaxis affect electroencephalographic patterns?" Am J Med 112 (2002): 147-9
  8. Jimenez-Huete A, Gil-Nagel A, Franch O "Multifocal myoclonus associated with mefloquine chemoprophylaxis." Clin Neuropharmacol 25 (2002): 243
View all 8 references

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Drug and food interactions

Moderate

quiNIDine food

Applies to: Quinaglute Dura-Tabs (quinidine)

GENERALLY AVOID: In a small, randomized, crossover study, the administration of quinidine with grapefruit juice (compared to water) to healthy volunteers significantly prolonged the time to reach peak plasma quinidine concentrations and decreased the plasma concentrations of its major metabolite, 3-hydroxyquinidine. These changes were associated pharmacodynamically with both a delay and a reduction in the maximal effect on QTc interval. The proposed mechanism is delay of gastric emptying as well as inhibition of CYP450 3A4-mediated first-pass metabolism in the gut wall induced by certain compounds present in grapefruits.

MANAGEMENT: Given the drug's narrow therapeutic index, patients receiving quinidine therapy should avoid the consumption of grapefruits and grapefruit juice to prevent any undue fluctuations in plasma drug levels.

References

  1. Ace LN, Jaffe JM, Kunka RL "Effect of food and an antacid on quinidine bioavailability." Biopharm Drug Dispos 4 (1983): 183-90
  2. Min DI, Ku YM, Geraets DR, Lee HC "Effect of grapefruit juice on the pharmacokinetics and pharmacodynamics of quinidine in healthy volunteers." J Clin Pharmacol 36 (1996): 469-76
  3. Ha HR, Chen J, Leuenberger PM, Freiburghaus AU, Follah F "In vitro inhibition of midazolam and quinidine metabolism by flavonoids." Eur J Clin Pharmacol 48 (1995): 367-71
  4. Bailey DG, Dresser GR, Kreeft JH, Munoz C, Freeman DJ, Bend JR "Grapefruit-felodipine interaction: Effect of unprocessed fruit and probable active ingredients." Clin Pharmacol Ther 68 (2000): 468-77
View all 4 references

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Moderate

mefloquine food

Applies to: Lariam (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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