Generic Name: Mefloquine Hydrochloride
VA Class: AP101
Chemical Name: (R*,S*)-(±)-α-2-Piperidinyl-2,8-bis(trifluoromethyl)-4-quinolinemethanol
Molecular Formula: C17H16F6N2O
CAS Number: 53230-10-7
Uses for Lariam
Prevention of Malaria
Prevention (prophylaxis) of malaria caused by Plasmodium falciparum (including chloroquine-resistant P. falciparum) or P. vivax;1 2 50 51 54 62 63 64 105 115 121 130 134 designated an orphan drug by FDA for prevention of P. falciparum malaria resistant to chloroquine or other antimalarials.56
Recommended by CDC and others as a drug of choice for prophylaxis in those traveling to areas where chloroquine-resistant P. falciparum has been reported;115 121 134 also can be used for prophylaxis in those traveling to areas where chloroquine-resistant P. falciparum malaria has not been reported.115 121 134
Risk of acquiring malaria varies substantially from traveler to traveler and from region to region (even within a single country) because of differences in intensity of malaria transmission within the various regions and season, itinerary, duration, and type of travel.115 121 Malaria transmission occurs in large areas of Africa, Central and South America, parts of the Caribbean, Asia (including South Asia, Southeast Asia, and the Middle East), Eastern Europe, and the South Pacific.115 Mosquito avoidance measures must be used in conjunction with prophylaxis since no drug is 100% effective in preventing malaria.121
Choice of antimalarial for prophylaxis depends on traveler’s risk of acquiring malaria in area(s) visited, risk of exposure to drug-resistant P. falciparum, other medical conditions (e.g., pregnancy), cost, and potential adverse effects.115 121 134
Active only against asexual erythrocytic forms of Plasmodium (not exoerythrocytic stages) and cannot prevent delayed primary attacks or relapse of P. ovale or P. vivax malaria or provide a radical cure;1 115 134 terminal prophylaxis with 14-day regimen of primaquine may be indicated in addition to mefloquine prophylaxis if travelers were exposed in areas where P. ovale or P. vivax is endemic.1 115 134
Information on risk of malaria in specific countries and mosquito avoidance measures and recommendations regarding whether prevention of malaria indicated and choice of antimalarials for prevention are available from CDC at and .115
Treatment of Uncomplicated Malaria
Treatment of uncomplicated malaria caused by mefloquine-susceptible P. falciparum (including chloroquine-resistant P. falciparum) or P. vivax;1 2 134 143 144 designated an orphan drug by FDA for this use.56
For treatment of uncomplicated malaria caused by chloroquine-resistant P. falciparum or treatment of uncomplicated malaria when plasmodial species not identified, CDC recommends fixed combination of atovaquone and proguanil (atovaquone/proguanil), fixed combination of artemether and lumefantrine (artemether/lumefantrine), or regimen of quinine in conjunction with doxycycline, tetracycline, or clindamycin.143 144
For treatment of uncomplicated malaria caused by chloroquine-susceptible P. falciparum, P. malariae, or P. knowlesi or treatment of uncomplicated malaria when plasmodial species not identified and infection was acquired in areas where chloroquine resistance has not been reported, CDC recommends chloroquine (or hydroxychloroquine).143 144 Alternatively, CDC states that any of the regimens recommended for treatment of uncomplicated chloroquine-resistant P. falciparum malaria may be used if preferred, more readily available, or more convenient.143 144
Although mefloquine is an option for treatment of uncomplicated malaria caused by susceptible Plasmodium,143 144 CDC recommends the drug be used only when other recommended treatment regimens cannot be used.143
For treatment of uncomplicated malaria caused by chloroquine-resistant P. vivax, CDC recommends regimen of quinine and doxycycline (or tetracycline) given in conjunction with primaquine, atovaquone/proguanil given in conjunction with primaquine, or mefloquine given in conjunction with primaquine.144 143 Because quinine, doxycycline (or tetracycline), atovaquone/proguanil, and mefloquine are active only against asexual erythrocytic forms of Plasmodium (not exoerythrocytic stages), 14-day regimen of primaquine indicated to prevent delayed primary attacks or relapse and provide a radical cure whenever any of these drugs used for treatment of P. vivax or P. ovale malaria.134 143
Pediatric patients with uncomplicated malaria generally can receive same treatment regimens recommended for adults using age- and weight-appropriate drugs and dosages.143 144 For treatment of uncomplicated chloroquine-resistant P. falciparum in children <8 years of age, atovaquone/proguanil or artemether/lumefantrine usually recommended; mefloquine can be considered if no other options available.144 For treatment of chloroquine-resistant P. vivax malaria in children <8 years of age, CDC recommends mefloquine given in conjunction with primaquine.143 144 Alternatively, if mefloquine not available or not tolerated and if potential benefits outweigh risks, atovaquone/proguanil or artemether/lumefantrine can be used for treatment of chloroquine-resistant P. vivax in this age group.143 144
A drug of choice for treatment of uncomplicated malaria caused by chloroquine-resistant P. falciparum or chloroquine-resistant P. vivax in pregnant women.143 (See Pregnancy under Cautions.)
Because of resistance, not recommended for treatment of malaria acquired in Southeast Asia.144
Assistance with diagnosis or treatment of malaria is available from CDC Malaria Hotline at 770-488-7788 or 855-856-4713 from 9:00 a.m. to 5:00 p.m. Eastern Standard Time or CDC Emergency Operation Center at 770-488-7100 after hours and on weekends and holidays.143 144
Lariam Dosage and Administration
A mefloquine medication guide and information wallet card are available from the manufacturer to help individuals understand the risks of malaria, risks and benefits of taking mefloquine to prevent malaria, and the rare but potentially serious adverse effects associated with the drug.1
As required by law, a copy of the mefloquine medication guide must be supplied to patients each time mefloquine is dispensed for prevention of malaria.1
Administer orally with ample water (at least 8 oz [240 mL] of water for an adult).1
Do not administer on an empty stomach.1
If patient receiving mefloquine for treatment of malaria vomits within 30 minutes after receiving a dose, give a full dose as replacement; if vomiting occurs within 30–60 minutes after the dose, give 50% of the dose as replacement.1 128 129 If vomiting recurs, monitor patient closely and consider alternative malaria treatment if improvement not observed within reasonable period of time.1
When a dose <125 mg (<½ of a 250-mg tablet) indicated for pediatric patients, gelatin capsules containing the calculated pediatric dosage should be prepared extemporaneously by a pharmacist using a crushed tablet.115 134
Available as mefloquine hydrochloride; dosage in the US usually expressed in terms of the salt.1 Each 250-mg tablet of mefloquine hydrochloride commercially available in the US is equivalent to 228 mg of mefloquine base.1 Other formulations (e.g., 275-mg mefloquine hydrochloride tablets containing 250 mg of the base) may be available in other countries.134 161
Dosage in children is based on body weight.1
Prevention of P. falciparum or P. vivax Malaria
Infants and children weighing ≤45 kg: Approximately 5 mg/kg once weekly on same day each week, preferably after main meal.1 (See Table 1.) Only limited experience in those weighing <20 kg (especially those weighing <5 kg).1 121
Dosage Once Weekly
5 mg/kg (prepared extemporaneously)
>9 up to 19
62.5 mg (¼ of a 250-mg tablet; prepared extemporaneously)
>19 up to 30
125 mg (½ of a 250-mg tablet)
>30 up to 45
187.5 mg (¾ of a 250-mg tablet)
Initiate mefloquine prophylaxis 1–2 weeks prior to entering malarious area and continue during and for 4 weeks after leaving the area.1 105 115 121 134 CDC recommends initiating mefloquine prophylaxis ≥2 weeks before travel.115 If there are concerns about tolerance or drug interactions, it may be advisable to initiate mefloquine prophylaxis 3–4 weeks prior to travel in individuals receiving other drugs to ensure that the combination of drugs is well tolerated and to allow ample time to switch to another antimalarial if necessary.1 105 115 134
If exposure occurred in areas where P. ovale or P. vivax is endemic, terminal prophylaxis with a 14-day regimen of primaquine may be indicated;115 134 give during final 2 weeks of mefloquine prophylaxis or, if not feasible, give after mefloquine prophylaxis discontinued.115
Treatment of Uncomplicated P. falciparum or P. vivax Malaria
Children ≥6 months of age: Manufacturer recommends 20–25 mg/kg and states that dividing dosage into 2 doses given 6–8 hours apart may reduce incidence and severity of adverse effects.1 CDC and other experts recommend that children receive 2-dose regimen consisting of an initial dose of 15 mg/kg followed by 10 mg/kg 6–12 hours later (total dose of 25 mg/kg).134 144
If a response not attained within 48–72 hours, use an alternative antimalarial; do not use mefloquine for retreatment.1
Prevention of P. falciparum or P. vivax Malaria
Initiate mefloquine prophylaxis 1–2 weeks prior to entering malarious area and continue during and for 4 weeks after leaving the area.1 105 115 121 134 CDC recommends initiating mefloquine prophylaxis ≥2 weeks before travel.115 If there are concerns about tolerance or drug interactions, it may be advisable to initiate mefloquine prophylaxis 3–4 weeks prior to travel in individuals receiving other drugs to ensure that the combination of drugs is well tolerated and to allow ample time to switch to another antimalarial if required.1 115
If exposure occurred in areas where P. ovale or P. vivax is endemic, terminal prophylaxis with a 14-day regimen of primaquine may be indicated;115 134 give during final 2 weeks of mefloquine prophylaxis or, if not feasible, give after mefloquine prophylaxis discontinued.115
Treatment of Uncomplicated P. vivax or P. falciparum Malaria
A single dose of 1250 mg (five 250-mg tablets) recommended by manufacturer.1 CDC and others recommend a 2-dose regimen consisting of an initial 750-mg dose (three 250-mg tablets) followed by a 500-mg dose (two 250-mg tablets) given 6–12 hours later (total dose of 1250 mg).134 144
If a response not attained within 48–72 hours, use an alternative antimalarial; do not use mefloquine for retreatment.1
Prevention of P. falciparum or P. vivax MalariaOral
Maximum 250 mg once weekly.105
Treatment of P. falciparum or P. vivax MalariaOral
No specific recommendations available regarding need for dosage adjustment in individuals with hepatic impairment.1 Increased mefloquine plasma concentrations may occur because of decreased elimination.1 (See Hepatic Impairment under Cautions.)
No specific recommendations available regarding need for dosage adjustment in individuals with renal impairment.1
Cautions for Lariam
Hypersensitivity to mefloquine, structurally related drugs (e.g., quinine, quinidine), or any ingredient in the formulation.1
Malaria prevention in individuals with active depression, recent history of depression, generalized anxiety disorder, psychosis, schizophrenia, or other major psychiatric disorders.1 (See Neuropsychiatric Effects under Cautions.)
History of seizures.1 (See Nervous System Effects under Cautions.)
Nervous System Effects
Dizziness,1 2 50 51 54 61 63 64 68 69 75 76 77 78 98 101 103 headache,1 2 61 62 63 64 75 77 103 and insomnia1 2 50 51 54 61 63 64 75 76 77 101 are the most frequently reported nervous system effects in patients receiving mefloquine. Abnormal dreams,1 50 51 61 64 70 altered consciousness,70 76 forgetfulness,1 motor and sensory neuropathy (including paresthesia, tremor, ataxia),1 seizures,1 18 62 64 74 78 84 85 88 113 vertigo,1 62 103 and tinnitus and hearing impairment1 also reported.
Patients with epilepsy or history of seizures may be at increased risk of seizure,1 although seizures have occurred in those without such a history.2 64 74 75 78 128 Do not use for prevention of malaria in epilepsy patients; use for treatment of malaria in such patients only if there are compelling medical reasons for such use.1
Some adverse nervous system effects (e.g., dizziness or vertigo, tinnitus and hearing impairment, loss of balance) may occur shortly after mefloquine initiation, can continue for months or years after drug discontinuance, and may be permanent in some cases.1
Discontinue mefloquine and substitute alternative antimalarial if neurologic effects (e.g., dizziness or vertigo, loss of balance) occur in a patient receiving mefloquine for malaria prevention.1
Severe neuropsychiatric disorders have been reported occasionally with mefloquine,1 63 78 86 including agitation or restlessness, anxiety, depression, mood changes, panic attacks, forgetfulness, confusion, hallucinations, aggression, psychotic or paranoid reactions, and encephalopathy.1 In some patients, these symptoms have been reported to continue for months or years after mefloquine was discontinued.1
Do not use mefloquine for prevention of malaria in any individual with active depression, recent history of depression, generalized anxiety disorder, psychosis, schizophrenia, or other major psychiatric disorders.1 Use mefloquine with caution in individuals with a previous history of depression.1
Some neuropsychiatric manifestations (e.g., acute anxiety, depression, restlessness, confusion) occurring in a patient receiving mefloquine prophylaxis suggest a risk for more serious psychiatric events or adverse neurologic effects.1
Neuropsychiatric effects can occur in adults or children and may be particularly difficult to identify in children.1 If used for prolonged periods (e.g., for malaria prevention), evaluate patient periodically for neuropsychiatric effects.1 Vigilance required to monitor for such manifestations, especially in nonverbal children.1
Discontinue mefloquine and substitute alternative antimalarial if neuropsychiatric manifestations (e.g., acute anxiety, depression, restlessness or confusion, suicidal ideation) occur in a patient receiving mefloquine for malaria prevention.1
Concomitant or sequential use with some other antimalarials (e.g., chloroquine, quinine, quinidine, halofantrine [not commercially available in US]) or certain other drugs (e.g., ketoconazole) may increase risk of potentially fatal prolongation of QTc interval and/or may increase risk for seizures.1 135 (See Interactions.)
Mefloquine is a myocardial depressant, and mefloquine-induced changes in several cardiac parameters have been described.1 2 Bradycardia,1 2 76 94 extrasystoles,1 2 reversible sinus arrhythmia,2 94 100 first degree AV-block,1 and prolongation of QTc interval and abnormal T waves reported.1
Hypertension,1 hypotension,1 flushing,1 syncope,1 chest pain,1 tachycardia,1 palpitations,1 62 77 98 and irregular pulse1 reported. Cardiopulmonary arrest,1 pericarditis,2 cardiovascular collapse,2 and MI2 reported rarely.1 2
Visual disturbances reported infrequently in patients receiving mefloquine.1 50 63 64 77 103 Dose-related ocular lesions (retinal degeneration, retinal edema, lenticular opacity) reported in long-term animal studies.1
If used for prolonged periods (e.g., for malaria prevention), periodically perform ophthalmic examinations.1
Selection and Use of Antimalarials
Do not use for treatment of malaria in patients who received the drug for prevention of malaria.1
Concomitant or sequential use with some other antimalarials (e.g., chloroquine, quinine, quinidine, halofantrine [not commercially available in US]) may result in serious adverse effects.1 135 147 (See Interactions.)
If used for prolonged periods (e.g., for malaria prevention), periodically evaluate liver function.1
Manufacturer states use mefloquine during pregnancy only when clearly needed and advise women of childbearing potential to use effective contraceptive measures while receiving the drug and for up to 3 months after last dose.1
CDC and AAP recommend mefloquine as the drug of choice for prevention of malaria in women who are pregnant, or likely to become pregnant, if exposure to chloroquine-resistant P. falciparum unavoidable.105 115 CDC also states that mefloquine is a drug of choice for treatment of uncomplicated malaria caused by chloroquine-resistant P. falciparum or chloroquine-resistant P. vivax.143 144
Although reproduction studies in mice, rats, and rabbits have shown teratogenic effects at doses similar to those used for malaria treatment,1 published data on use of mefloquine for prevention or treatment of malaria during pregnancy have not shown an increased risk of teratogenic effects or adverse pregnancy outcomes compared to the background rate in the general population.1
Because amount of mefloquine consumed by a nursing infant likely to be small, some clinicians suggest that risk to nursing infants of maternal use of prophylactic dosages of mefloquine is low.2 102 107 115 128
Safety and efficacy not established for treatment of malaria in children <6 months of age.1
CDC states use of mefloquine for prevention or chemoprophylaxis of malaria may be considered in infants and children of any age, depending on risk of exposure to drug-resistant Plasmodium.115
Use in children for treatment of acute uncomplicated malaria caused by P. falciparum is supported by evidence from adequate and well-controlled studies in adults and from published open-label and comparative studies in children <16 years of age.1 100 101 102
Because of risks associated with malaria infection in children <6 weeks of age or weighing <5 kg, some experts recommend advising parents of such infants not to travel to countries with endemic malaria.105
Children ≤6 years of age being treated for malaria experience early vomiting (within 1 hour of drug administration) more frequently than individuals 7–50 years of age;18 68 70 76 early vomiting may be a possible cause of treatment failure in some children.1 If a replacement dose not tolerated (see Administration under Dosage and Administration), closely monitor child and consider alternative antimalarial treatment if child does not improve within a reasonable period of time.1
Response in patients ≥65 years of age does not appear to differ from that in younger adults.1
Because mefloquine associated with ECG abnormalities, consider the greater frequency of cardiac disease observed in the elderly and weigh benefits of mefloquine therapy in geriatric individuals against possibility of adverse cardiac effects.1
Mefloquine elimination may be prolonged and plasma concentrations increased in patients with hepatic impairment, resulting in increased risk of adverse effects.1
Common Adverse Effects
GI effects (nausea, vomiting, loose stools or diarrhea, abdominal pain); CNS effects (dizziness, vertigo); neuropsychiatric events (headache, somnolence, sleep disorders); rash; pruritus.1 2 50 51 61 63 76 113 138
Interactions for Lariam
Substrate for and inhibitor of P-glycoprotein.1
Drugs Affecting or Metabolized by Hepatic Microsomal Enzymes
Potential pharmacokinetic interaction with drugs that are CYP3A4 inhibitors (possible increased mefloquine concentrations and increased potential for adverse effects associated with the drug).1 Use concomitantly with caution.1
Potential pharmacokinetic interaction with drugs that are CYP3A4 inducers (possible decreased mefloquine concentrations and possible decreased efficacy of the antimalarial).1 Use concomitantly with caution.1
Pharmacokinetic interactions not expected if mefloquine used concomitantly with drugs that are substrates for CYP isoenzymes.1
Drugs Affecting P-glycoprotein Transport System
Potential pharmacokinetic interactions if used concomitantly with drugs that are substrates for or are known to modify expression of P-glycoprotein; clinical importance unknown.1
Drugs Affecting QT Interval
Possibility of prolongation of QT interval if used concomitantly with other drugs that alter cardiac conduction, including antiarrhythmic agents, β-adrenergic blocking agents, calcium-channel blocking agents, antihistamines, tricyclic antidepressants, and phenothiazines.1 Some experts state that mefloquine may be used concomitantly with β-adrenergic blocking agents in patients without an underlying arrhythmia.105 134
Anticonvulsants (carbamazepine, phenobarbital, phenytoin, valproic acid)
Artemether/lumefantrine: Decreased concentrations and AUC of lumefantrine possibly because of mefloquine-induced decrease in bile production;145 146 no effect on pharmacokinetics of artemether or mefloquine145 146
Artemether/lumefantrine: If used shortly after mefloquine, administer artemether/lumefantrine dose with food and monitor for decreased efficacy145
Chloroquine, quinine, or quinidine: Do not use concomitantly with mefloquine;134 use sequentially with caution;134 do not administer mefloquine until ≥12 hours after last dose of any of these drugs;1 if initiating quinidine in a patient who received mefloquine within preceding 12 hours, do not use loading dose of quinidine144
Halofantrine: Do not use concomitantly with mefloquine or within 15 weeks after last mefloquine dose1
HIV protease inhibitors (PIs)
Ritonavir-boosted PIs: Pharmacokinetic interaction unknown155
HIV PIs: Some experts recommend caution if mefloquine used in patients receiving PIs155
Do not use ketoconazole concomitantly with mefloquine or within 15 weeks after last mefloquine dose1
Manufacturer of mefloquine states use concomitantly with caution;1 some experts recommend avoiding concomitant use if possible and considering use of rifabutin (instead of rifampin) or using an alternative antimalarial155
Some evidence that peak blood or plasma concentrations of mefloquine are substantially higher in Asians than in other ethnic groups.2 30 37 38 Reason for this ethnic variation not determined; may involve differences in volume of distribution secondary to the relatively lower body fat in Asians or differences in enterohepatic circulation of mefloquine in Asians.2 40
Plasma Protein Binding
Undergoes biliary excretion and extensive enterohepatic circulation;30 some evidence suggests that enterohepatic circulation and fecal elimination may be increased in patients with malaria compared with those in healthy adults.30
Terminal elimination half-life shows considerable interindividual variation, ranging from 13–33 days (mean: 21 days) in healthy adults and about 10–15 days in patients with uncomplicated malaria.1 2 30 31 35 37 38 39 41 42 45 47
Faster elimination in patients with uncomplicated malaria relative to healthy individuals may result from decreased enterohepatic recirculation and increased fecal elimination.30
Mefloquine elimination may be prolonged in patients with hepatic impairment, resulting in higher plasma concentrations.1
Actions and Spectrum
A blood schizonticidal agent1 2 11 active against asexual erythrocytic forms of most strains of Plasmodium falciparum, P. malariae, P. ovale, and P. vivax, including some chloroquine-resistant P. falciparum.2 11 113 161 Not active against mature gametocytes or against intrahepatic stages of plasmodial development.2 11
Mefloquine-resistant Plasmodium reported in geographic areas where mefloquine has been used.2 3 7 18 19 20 21 22 113 114 115 In addition, P. falciparum strains with in vitro resistance to mefloquine identified in areas before introduction of the drug (i.e., intrinsic resistance).2 7 23 25 26
Incidence of mefloquine-resistant P. falciparum varies geographically; reported predominately in areas in Southeast Asia where multidrug-resistant malaria occurs.1 115 Mefloquine-resistant P. falciparum confirmed in areas bordering Thailand and Burma (Myanmar) or Thailand and Cambodia, western provinces of Cambodia, eastern states of Burma on border between Burma and China, along borders of Laos and Burma, adjacent parts of Thailand-Cambodia border, and southern Vietnam.18 115
Cross-resistance between mefloquine and chloroquine reported in P. falciparum and P. vivax in vitro.152 153 Cross-resistance between mefloquine and quinine also reported.1 Cross-resistance between mefloquine and halofantrine (an antimalarial not commercially available in US) documented in vitro in P. falciparum.2 24 135
Advice to Patients
For prevention of malaria, necessity of starting mefloquine prophylaxis 1–2 weeks before arriving in an area with malaria.1
Necessity of taking protective measures to reduce contact with mosquitoes (protective clothing, insect repellents, mosquito nets, remaining in air-conditioned or well-screened areas).1 113 115 121 134
Importance of seeking medical attention as soon as possible if febrile illness develops during or after return from a malaria-endemic area and of informing clinician of possible malaria exposure, including instances when such illness was self-treated as malaria during travel.1 113 115 121 134
Advise patients that some people are unable to take mefloquine because of adverse effects and that it may be necessary to change medications if this occurs.1
Advise patients that dizziness or vertigo, loss of balance, tinnitus, and other central or peripheral nervous system effects have occurred in patients receiving mefloquine; such effects can persist for months or years after the drug is discontinued and may be permanent in some cases.1 If such symptoms occur, importance of avoiding activities requiring alertness and fine motor coordination (e.g., driving, piloting aircraft, operating machinery, deep-sea diving).1 Caution patients receiving mefloquine for malaria prevention to discontinue the drug and contact their clinician if neurologic effects (e.g., dizziness or vertigo, loss of balance) occur; an alternative antimalarial should be substituted.1
Advise patients that neuropsychiatric symptoms ranging from severe anxiety, paranoia, and depression to hallucinations and psychotic behavior have occurred in patients receiving mefloquine;1 some manifestations (e.g., acute anxiety, depression, restlessness, confusion) suggest a risk for more serious psychiatric events or adverse neurologic effects.1 Caution patients receiving mefloquine for malaria prevention to discontinue the drug and contact their clinician if neuropsychiatric manifestations or suicidal ideation occurs; an alternative antimalarial should be substituted.1
Importance of informing clinician of existing or contemplated concomitant therapy, including prescription and OTC drugs and dietary or herbal products, and any concomitant illnesses.1
Importance of women informing clinicians if they are or plan to become pregnant or plan to breast-feed.1 Advise women of childbearing potential to use effective contraceptive measures while receiving mefloquine and for up to 3 months after drug discontinuance.1
Importance of advising patients of other important precautionary information.1 (See Cautions.)
Excipients in commercially available drug preparations may have clinically important effects in some individuals; consult specific product labeling for details.
Please refer to the ASHP Drug Shortages Resource Center for information on shortages of one or more of these preparations.
* available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name
Mefloquine Hydrochloride Tablets (scored)
AHFS DI Essentials. © Copyright, 2016, American Society of Health-System Pharmacists, Inc., 7272 Wisconsin Avenue, Bethesda, Maryland 20814.
Date published: May 01, 2004
Last reviewed: March 05, 2014
Date modified: February 08, 2016
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