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LARIAM 250MG TABLETS

Active substance(s): MEFLOQUINE / MEFLOQUINE HYDROCHLORIDE

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Patient Alert Card

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Lariam®
250mg

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Patient Alert Card
Lariam® 250mg
(mefloquine)
This educational material is
provided by Roche Products Limited
and mandatory as a condition of the
Marketing Authorisation in order to
further minimise important selected
risks.
Prepared February 2016

(mefloquine)

This item should only be given to
patients prescribed Lariam.
This card tells you about important
possible mental side effects with
Lariam.
Also read the Patient Leaflet that
comes with this medicine - this gives
you the full information about Lariam.
Keep this card with you at all times.
Present this card to every doctor you
see.
What should I know
about Lariam?
● Lariam is a prescription medicine
used to prevent and treat malaria.
Malaria is a life-threatening
infection. Lariam does not work for
all types of malaria.

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● As instructed by your doctor, you
must take Lariam: before you travel,
during your stay and after your
return from a malaria area.
● Do not take Lariam if you have, or
have ever had any mental problems
because Lariam may cause serious
mental problems in some people
including suicide, suicidal thoughts
and self- endangering behaviour.
Do not take Lariam if you have,
or have ever had:
● depression, thoughts about suicide.
● any other mental problem, including
anxiety disorder, schizophrenia or
psychosis (losing touch with reality).
● fits (seizures or convulsions).
● an allergy to quinine, quinidine,
Lariam or any of its ingredients.
● severe liver problems.
● blackwater fever (a complication of
malaria that affects the blood and
kidneys).
Do not take Lariam if you are
currently taking:
● a medicine called Halofantrine.
When should I seek advice from
my health care provider?
● When taking Lariam, it is important
to be aware of its possible side
effects. Unusual changes in mood or
behaviour, mental problems and fits
are all adverse events which may
occur when taking Lariam.

Do not start taking Lariam if you are
at risk of developing such events.
(Please refer to the ‘Do not take
Lariam if you have, or have
ever had: ’ section of this card).
Lariam may cause serious
mental problems in some
people. Tell your doctor right
away if you experience any of
the following while taking
Lariam:
● suicidal thoughts
● self-endangering behaviour
● severe anxiety
● feelings of mistrust towards
others
● seeing or hearing things that are
not there
● depression
● feeling restless
● unusual behaviour
● feeling confused
Please seek medical help
immediately if you experience
serious mental problems while
taking Lariam.
Lariam should be stopped
immediately and replaced with
another medicine to prevent malaria.

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Other side effects from Lariam
may include:
Fits (seizures or convulsions), liver
problems, heart problems, nausea,
vomiting, diarrhoea, abdominal pain,
dizziness or loss of balance (vertigo),
headache, sleeping problems
(sleepiness, unable to sleep,
bad dreams).
How to take Lariam:
● Take the tablets once a week,
always on the same day.
● Take the 1st dose of Lariam
10 days before you leave: this is
to make sure that Lariam
administration is well tolerated.
● Take the 2nd dose 3 days before
you leave.
● You should continue taking the
tablets throughout your stay and
for 4 weeks after your return.
When should I get advice from
my doctor?
● At any time: if you experience
side effects.
● If you are not sure if you have
had any of the problems listed in
the ‘Do not take Lariam if you
have, or have ever had: ’ section
of this card.

● If you think you might have any of
the mental side effects listed in the
‘Lariam may cause serious mental
problems in some people. Tell your
doctor right away if you experience
any of the following while taking
Lariam:’ section of this card.
If you get any side effects, talk to your
doctor, pharmacist or nurse. This
includes any possible side effects not
listed in the package leaflet. You can
also report side effects directly via the
Yellow Card Scheme at
www.mhra.gov.uk/yellowcard
or to Roche Products Ltd.
Please contact Roche Drug Safety
Centre by emailing
welwyn.uk_dsc@roche.com
or calling +44 (0)1707 367554.
By reporting side effects you can help
provide more information on the safety
of this medicine.
I am taking malaria
chemoprophylaxis with Lariam
(mefloquine)

Address:

Doctor’s phone:

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Doctor’s stamp:

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Date of birth:
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Please also notify:

Other medicines/conditions:

Name:

..............................................................

..........................................................

..............................................................

..........................................................
Phone:

..............................................................
In case of emergency,
please notify:

..........................................................
..........................................................

Name:
Doctor’s name:
..............................................................
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Package leaflet: Information for the patient

Lariam® 250 mg
Tablets

Mefloquine

Read all of this leaflet carefully before you start taking this medicine because it contains important
information for you.
-

Keep this leaflet. You may need to read it again.
If you have any further questions, ask your doctor, pharmacist or nurse.
This medicine has been prescribed for you only. Do not pass it on to others. It may harm them, even if
their signs of illness are the same as yours.
If you get any side effects, talk to your doctor, pharmacist or nurse. This includes any possible side
effects not listed in this leaflet. See section 4.

-

What is in this leaflet
1.
2.
3.
4.
5.
6.

What Lariam is and what it is used for
What you need to know before you take Lariam
How to take Lariam
Possible side effects
How to store Lariam
Contents of the pack and other information

Tell your doctor, pharmacist, or nurse if you are taking, have recently taken or might take any other
medicines including:
● halofantrine, or you have been prescribed a course of halofantrine (see section 2 “Things you should
know before taking Lariam”)
● medicines such as quinine, quinidine, or chloroquine, used to treat or to prevent malaria
● medicines for any heart trouble, or high blood pressure, such as β-blocking agents, calcium channel
blockers
● antihistamines for allergies
● medicines for some mental problems (psychiatric disorders). Anti-depressants such as tricyclic
anti-depressants, selective serotonin reuptake inhibitors (SSRIs), bupropion or anti-psychotics such as
phenothiazines.
● medicines used to treat epilepsy, such as sodium valproate, carbamazepine, phenobarbital, phenytoin
● ketoconazole (used to treat fungal infections) – you should also ask your doctor for advice before taking
ketoconazole within 15 weeks after taking Lariam
● antibiotics used to treat bacterial infections for example rifampicin, penicillins, cephalosporins
● efavirenz (used to treat HIV infections)
● tramadol (used to treat severe pain)
● medicines for blood clotting disorders or diabetes, as your doctor may wish to monitor you before you
travel
If you need an oral vaccine to help prevent you from catching typhoid, you should arrange to receive it at
least 3 days before you need to start taking Lariam. Otherwise, Lariam may stop the vaccine from working
properly.
Pregnancy and breast-feeding
Pregnant women should not normally take these tablets.
Due to the seriousness of malaria during pregnancy, it is recommended that you should not travel to an area
where you could become infected with malaria if you are pregnant, think that you may be pregnant, or if
you are planning to have a baby.
Lariam should be avoided by women who are breast-feeding.

1. What Lariam is and what it is used for
Lariam tablets contain the active ingredient mefloquine. Lariam is used to treat malaria and to help prevent
you from catching malaria.
Malaria is a life threatening disease and a major health risk for travellers visiting tropical countries.
It occurs when small parasites are passed from one person to another by the bites of certain mosquitoes.
Lariam is especially useful if you are travelling to countries where there is a type of malaria which is
particularly difficult to treat. No single medicine is effective against all malaria parasites. The choice of a
particular medicine depends on the sensitivity of the malaria parasites found in the area to be visited. Your
doctor will advise you whether Lariam is suitable for the area to which you wish to go.
To help minimise your chance of catching the disease and to protect you from possible serious side
effects it is important that you read this leaflet carefully. Ask your doctor to explain anything you do
not understand.

If you are pregnant or breast-feeding, think that you may be pregnant, or planning to have a baby, ask your
doctor for advice before taking this medicine, as he or she may decide that you should not use this
medicine.
Driving and using machines
Take special care if you perform activities requiring alertness and coordination (accurate small movements)
and spatial awareness (being aware of distances) such as driving, piloting an aircraft, operating machinery,
cycling, and deep-sea diving as Lariam can cause dizziness, loss of balance and mental problems. If you
are in any doubt about whether you can do a particular activity, talk to your doctor.
In a small number of patients it has been shown that dizziness, vertigo and loss of balance may persist for
months or longer after stopping Lariam.
Lariam contains lactose
If you have been told by your doctor that you have an intolerance to some sugars, such as lactose or
galactose, you should not take Lariam. Contact your doctor before taking this medicinal product.

2. What you need to know before you take Lariam
Do not take Lariam if you have or have previously experienced:
● an allergy to mefloquine or any of the other ingredients of this medicine (see section 6 “Contents of the
pack and other information”) or to similar medicines such as quinine or quinidine
● depression, thoughts about suicide and self-endangering behaviour
● any other mental problem, including anxiety disorder, schizophrenia or psychosis (losing touch with
reality)
● fits (seizures or convulsions)
● severe liver problems
● blackwater fever (a complication of malaria that affects the blood and kidneys)
If any of the above applies to you, make sure your doctor knows, so that your doctor can prescribe a
different medicine for prevention or treatment of malaria.
Also, consult your doctor immediately if you are already being treated with halofantrine, or you have been
prescribed a course of halofantrine. Halofantrine (which is used to treat malaria) and Lariam taken at the
same time can slow the heartbeat to a dangerous level. Therefore, to help avoid the possibility of a
dangerous alteration in heart rhythm, you must not take halofantrine if you are already taking, or have
taken Lariam within the last 15 weeks.
Warnings and precautions
Lariam may cause serious mental problems in some people. Tell your doctor immediately if you
experience any of the following while taking Lariam:












suicidal thoughts
self-endangering behaviour
severe anxiety
feelings of mistrust towards others (paranoia)
seeing or hearing things that are not there (hallucinations)
nightmares / abnormal dreams
insomnia
depression
feeling restless
unusual behaviour
feeling confused

Please seek medical help immediately if you experience serious mental problems while taking
Lariam. Lariam should be stopped immediately and replaced with another medicine to prevent
malaria.
Talk to your doctor, pharmacist, or nurse before taking Lariam if you have:
● epilepsy
● fits (seizures or convulsions)
● heart problems, especially changes in heart rhythm
● liver or kidney problems
● eye problems (e.g. loss of fine detail, colours seem faded, sudden loss of vision, poor vision at night)
● blood or lymphatic disorder (abnormal blood test showing a decrease or an increase in white blood
cells, a decrease in red blood cells or platelets)
● neuropathy with signs of e.g. pins and needles, weakness, numbness, new or worsening clumsiness or
unsteadiness on your feet, or shaking of the hands and fingers
● inflammation of the lungs, also known as pneumonitis. This is a serious, potentially life-threatening
allergic reaction in the lungs which may cause fever, chills, cough, shortness of breath or chest pain.
● previously contracted malaria even though you were taking Lariam tablets for malaria prevention
● experienced a mild to serious potential life threatening allergic reaction to Lariam or any of its
ingredients
● low blood glucose due to a pre-existing condition called congenital hyperinsulinemic hypoglycaemia
Some side effects may occur after you have stopped taking Lariam. In a small number of patients it has
been shown that depression, dizziness or vertigo and loss of balance may persist for months or longer, even
after you have stopped taking Lariam.

3. How to take Lariam
Always take this medicine exactly as your doctor has told you. Check with your doctor if you are not sure.
The advice you are given will depend on whether you are taking the tablets for prevention or treatment of
malaria. Take the tablets with plenty of water, and preferably after a meal. Swallow the tablets whole, do
not suck or chew them.
Malaria prevention
Please read the following section if you are taking the tablets to help prevent you from catching malaria.
Important
● Take the tablets once a week, always on the same day.
● Take the 1st dose 10 days before you leave: this is to make sure that Lariam is well tolerated. Take
the 2nd dose 3 days before you leave.
● Continue taking the tablets on the same day of the week throughout your stay and for 4 weeks after
your return.
● The full course of tablets is at least 6 weeks, depending on your length of stay.
● For effective prevention you must take the full course of tablets.
● No anti-malarial tablets can be 100% guaranteed to work. There is a chance you could still get
malaria during or after taking medicine to prevent it. If you develop a fever or flu-like symptoms
during your travels or within 2 to 3 months after you leave the malarious area, check with a doctor
immediately.
Adults and children over 45 kg body weight, dose:
One tablet weekly (always on the same day).
A pack of 8 tablets is enough to help prevent you from catching malaria if you are staying for 2 weeks in an
area where malaria is present and you start taking the tablets at 10 days and 3 days before departure.
Adults weighing less than 45 kg (99 lbs) should take the children’s dose (see below).
Whether you are an adult or a child you should not take the tablets for more than 12 months.
Children’s dose:
The tablets are not recommended for children under 3 months of age, i.e., those who weigh less than 5 kg
(11 lbs). For children over this weight, the dose is shown in the table below. The tablets can be divided by
breaking along the score lines. As in adults, the dose should be taken once weekly on the same day, and
continued for 4 weeks after return.
Weight

Age (approx.)

Dose

5 – 19 kg
(approx. 11 – 43 lbs)

3 months – 5 years

¼ tablet

20 – 30 kg
(approx. 44 – 67 lbs)

6 – 8 years

½ tablet

31 – 45 kg
(approx. 68 – 99 lbs)

9 – 14 years

¾ tablet

Malaria treatment
Please read the following section if you are taking the tablets to treat malaria.
Your doctor will tell you how much medicine you need to take. This will depend on your weight and
whether you have been living in a malarious area. Normally, you should not receive more than 6 tablets in
total. You may be advised to split the total dose into 2 or 3 smaller doses, 6 - 8 hours apart, to reduce the
likelihood or severity of side effects.

Children
Experience with Lariam in infants less than 3 months old or weighing less than 5 kg is limited.
Other medicines and Lariam
Before taking Lariam, make sure your doctor knows if you are taking other medicines (including those you
have obtained without a prescription).
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If you take more Lariam than you should, either for prevention or treatment
If you take too many tablets the likelihood and severity of the side effects as described in section 4 may
increase. There are no specific antidotes.
If you take too many tablets or someone else accidentally takes your medicine, contact your doctor,
pharmacist or nearest hospital immediately.
If you forget to take Lariam, either for prevention or treatment
If you miss a dose, take it as soon as possible. If it is nearly time for your next dose, skip the missed dose
and carry on as before. Do not take a double dose.

● pancreas problems; symptoms may include stomach pain, nausea, vomiting, changes to blood pressure
or heart rates and breathlessness
● indigestion
● rash
● hair loss
● sweating
● muscle weakness
● muscle cramps
● joint pains
● muscle pains
● oedema
● chest pain
● tiredness
● fever or chills
Whilst taking this medicine, if you experience these or any other symptoms that concern you, tell your
doctor.

4. Possible side effects
Like all medicines, this medicine can cause side effects although not everybody gets them.
Lariam may cause serious mental problems in some people. Stop taking this medicine and contact
your doctor immediately if you experience any of the following while taking Lariam:

Reporting of side effects

Common (may affect up to 1 in 10 people):
● depression
● anxiety
Not known (frequency cannot be estimated from the available data):
● suicide
● attempted suicide
● suicidal thoughts
● self-endangering behaviour
● losing touch with reality (psychosis)
● feelings of mistrust towards others (paranoia)
● panic attacks
● unusual behaviour
● feeling confused
● seeing or hearing things that are not there (hallucinations)
● aggression
● agitation
● feeling restless
● unusual changes in your mood
● disturbance in attention
Please seek medical help immediately if you experience serious mental problems while taking
Lariam. Lariam should be stopped immediately and replaced with another medicine to prevent
malaria.
If you develop any of the following potentially serious symptoms, you should STOP taking this
medicine and also consult a doctor immediately.
Not known (frequency cannot be estimated from the available data):
● a mild to serious potential life-threatening allergic reaction (anaphylaxis) to Lariam or any of its
ingredients with symptoms such as difficulty in breathing, swollen tongue, itching and severe rash
● severe changes in texture and appearance of the skin, especially serious blistering and peeling that
affects the mouth, eyes and genitals (Stevens Johnson syndrome)
● fits (seizures or convulsions)
● heart problems e.g. severe changes in heartbeat, including pounding, racing or skipped beats
(palpitations)
● inflammation of the lungs, also known as pneumonitis. This is a serious, potentially life-threatening
allergic reaction in the lungs which may cause fever, chills, cough, shortness of breath or chest pain.
● severe liver problems which might be demonstrated by a transient increase in your liver enzymes
shown by blood tests or other symptoms such as tender, firm or possibly enlarged liver, jaundice
(yellowing of skin/eyes), dark urine, light coloured stools and generalised itchiness
Other possible side effects
Very common (may affect more than 1 in 10 people):
● sleeping problems (sleepiness, unable to sleep, bad dreams)

If you get any side effects, talk to your doctor, pharmacist, or nurse. This includes any possible side
effects not listed in this leaflet. You can also report side effects directly via the Yellow Card Scheme at:
www.mhra.gov.uk/yellowcard or search for MHRA Yellow Card in the Google Play or Apple App Store.
By reporting side effects you can help provide more information on the safety of this medicine.

5. How to store Lariam
● Keep this medicine out of the sight and reach of children.
● Do not use this medicine after the expiry date which is printed on the carton and blister foil after (EXP).
The expiry date refers to the last day of that month.
● Do not store above 30ºC.
● Keep the blister in the outer carton in order to protect it from moisture.
● Do not throw away any medicines via wastewater or household waste. Ask your pharmacist how to
throw away medicines you no longer use. These measures will help protect the environment.

6. Contents of the pack and other information
What Lariam contains
The active substance in Lariam is mefloquine. Lariam is an anti-malarial. Each tablet contains 250 mg of
mefloquine (as mefloquine hydrochloride).
The other ingredients in Lariam tablets are poloxamer, microcrystalline cellulose, lactose monohydrate,
maize starch, crospovidone, ammonium calcium alginate, talc, and magnesium stearate.
What Lariam looks like and contents of the pack
Appearance: The tablets are white to off-white, cross-scored, and imprinted with Roche on one face.
Pack size: The tablets are available in foil strips in packs of 8.
Marketing Authorisation Holder and Manufacturer
Roche Products Limited
6 Falcon Way
Shire Park
Welwyn Garden City
AL7 1TW
United Kingdom
You can get more information on Lariam from your doctor, pharmacist or nurse.
It is essential that you follow the recommendations given for taking the tablets.
Other preventative actions you should take

Common (may affect up to 1 in 10 people):
● dizziness
● headache
● problems with your vision
● loss of balance (vertigo)
● feeling sick (nausea), being sick (vomiting)
● diarrhoea
● stomach ache (abdominal pain)
● itching

If you are taking Lariam to prevent malaria, you should also take steps to avoid mosquito bites. Some
information on how to avoid bites is given below. This is important as no medicine can be 100%
guaranteed to protect you against malaria.
● Make sure you sleep in a room that is screened against mosquitoes or has full air conditioning, or that
you use a mosquito net (preferably one that has been treated with an insect repellent) over the bed.
● Use insect repellents; ointments, lotions and sprays, to deter mosquitoes.
● In the evening, cover arms and legs with light-coloured, long-sleeved clothes and trousers, and use an
insect repellent. Anklets are also available which have been treated with repellent.
● Vaporising electric “mats”, mosquito coils or tablets can be used at night-time around exposed areas of
the body (ankles and feet).
This leaflet was last revised in February 2018.

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Not known (frequency cannot be estimated from the available data):
● abnormal blood test results showing a decrease or an increase in white blood cells, a decrease in red
blood cells or platelets. Symptoms may include painful mouth or throat ulcers, fever, chills, bruises on
the skin, nosebleeds, bleeding in the stomach or vaginal bleeding.
● kidney problems, failure or infection, causing impairment, cessation, infection, or blood in the urine.
Symptoms may include abnormal blood tests (increased blood creatinine), feeling dehydrated, fatigue,
swelling (oedema), shortness of breath, feeling or being sick, loss of appetite, or headache
● decreased appetite
● fainting
● neuropathy with signs of e.g. “pins and needles”, weakness, new or worsening clumsiness or
unsteadiness on your feet, or shaking of the hands and fingers
● forgetfulness (sometimes lasting for more than 3 months)
● difficulties in talking
● difficulties with sense of smell and taste, eye movement, facial sensation and expression, hearing,
balance, tasting, tongue movement, head-turning, and raising your shoulders
● cataract, dazzled in the evenings or other vision disturbances, blurred vision
● changes to your hearing including ringing in the ears or difficulty in hearing (sometimes prolonged),
everyday sounds seeming too loud
● changes to blood pressure or heart rate
● hot flushes
● breathlessness, cough

Lariam®

Some side effects may occur after you have stopped taking Lariam. In a small number of patients it has
been shown that depression, dizziness or vertigo and loss of balance may persist for months or longer, even
after you have stopped taking Lariam.

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