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It is my understanding that all Peace Corps Volunteers sent to Sub-Saharan Africa are to receive Antimalarials, also known as Malaria Prophylactics. For this particular region of the world, there are three currently used prophylactics that fight against the asexual blood stages of the malaria parasite: Mefloquine (Lariam), Doxycycline (Vibramycin), Malarone (Atovaquone and Proguanil). Mefloquine, the most widely prescribed prophylactic by the Peace Corps and worldwide, has proven to be 90% effective in the prevention of malaria. However, it has also proven to have the following side effects:
Ø Physiological reactions:
o Upset Stomach/Nausea
o Vomiting
o Diarrhea
o Stomach/Abdominal Pain
o Loss of Appetite
o Ringing in Ears
o Headache
o Sleepiness/Drowsiness/Fatigue
o Insomnia
o Tingling in Fingers/Toes
o Difficulty Walking/Driving/Operating Machinery
o Seizures/Convulsions/Shakes
o Sweating/Chills
o Liver Damage/Disturbed Function
o Eye Damage
o Hearing Impairment
o Malaise/Bodily Discomfort
o Fever
o Leucopenia/Low White Blood Cell Count
o Leucocytosis
o Thrombocytopenia/Low Platelet Count
Ø Musculoskeletal reactions:
o Muscle Cramping
o Asthenia/Lack of Strength/Muscle Weakness
o Myalgia/Muscle Pain
o Arthralgia/Joint Pain
Ø Skin Disorders:
o Rashes
o Exanthema/Skin Eruptions
o Erythema/Skin Redness
o Urticaria/Hives
o Pruritus/Itching
o Alopecia/Loss of Hair
o Stevens Johnson syndrome (rare)
Ø Neuro-Psychiatric reactions:
o Neuropathies – sensory & motor: Paresthesia, Tremor & Ataxia
o Tinnitus & Vestibular disorders – Dizziness/Loss of Balance
o Unusual/vivid Dreams/Nightmares
o Nervousness/Anxiety
o Mild-Severe Depression
o Changes in Mood
o Panic Attacks/Paranoia
o Forgetfulness/Memory Loss
o Confusion
o Hallucinations
o Agitation/Violent Behavior/Psychotic reactions
o Suicidal Ideation/Suicide
o Disruption of Neuronal Calcium Homeostasis causing Neuronal Cell Death & Injury
o Permanent Brain Stem Injury
o Overt Psychosis – losing touch with reality (reported 1:6,000-10,000 or 1:800 for treatment dosages)
Ø Cardiovascular/Circulatory reactions:
o Hypotension/Low Blood Pressure
o Hypertension/High Blood Pressure
o Tachycardia/Rapid Heart Rate
o Bradycardia/Slow Heart Rate
o Irregular Pulse
o Cardiac conduction disorders
o Cardiac Arrest (when combined with Quinine or Quinidine)
Many people experience little or no serious side effects when taking Mefloquine, however, there is NO guarantee as to who or who will not experience any or all of the above-mentioned side effects. Often times, those people that do experience the more serious side effects may experience them years (and sometimes permanently) after using the prophylactic. Studies also show an increased susceptibility to young women and users already under mental or physical stress. The FDA is currently investigating 600 reports of adverse reactions to Mefloquine, half of which include some kind of psychiatric side effect, such as 13 cases of suicidal thoughts, 4 attempted suicides and 1 actual suicide death. There are also several pending lawsuits, some initiated by former Peace Corps volunteers, against the use of Mefloquine as well as investigations in high-profile military incidences caused by Mefloquine use. Over and over, I have read and heard accounts from former Peace Corps volunteers and Military personnel who have experienced many of the above-mentioned side effects some of which have lasted for years after service. All too often those same Peace Corps volunteers have been made to feel guilty and ridiculed for complaining to their Medical Directors and Peace Corps Staff about their symptoms. Senator Chris Dodd, D-Conn & former Peace Corps volunteer, and Senator Dianne Feinstein, D-Cali, have both called for further investigation into the effects of Mefloquine. I have attached Senator Feinstein’s letter for your reference. In fact, even the pharmaceutical company Hoffmann-La Roche reissued warnings about the adverse effects of Lariam (Mefloquine); I have also attached their statement as well for your reference. The University of Edinburgh’s College of Medicine urges travelers taking Mefloquine to seek out alternative antimalarials. Even Wikipedia suggests using other vaccinations, like Malarone and Doxycycline, with less risk of severe side effects, which are equally effective in malaria prevention.
Malarone is probably the newest prophylactic on the market, and therefore, one of the most effective vaccinations against malaria. Studies show that there is a 98% prevention rate for Malarone verses Mefloquine’s 90% success rate. Malarone, while it does have side effects, including: headache, fever, dizziness, nausea, vomiting, insomnia, rash and hair loss, is substantially better tolerated than Mefloquine. Most notable is that Malarone does not report any Neuro-Psychiatric side effects. Malarone is just as available as Mefloquine since its approval in August of 2000; however, Malarone is more expensive than Mefloquine since the dosage is a pill taken once a day, whereas Mefloquine is a pill taken once a week. Dr. Patricia M. Young, M.D., Medical Director, International Travelers Clinic, Medical College of Wisconsin states this about Malarone, “I currently recommend this medication as the drug of choice for travelers entering areas with chloraquine-resistant malaria.”
The third alternative is Doxycycline. The most notable side effect, aside from diarrhea, fever, nausea, vomiting, rashes, blurred vision, hypertension, GERD and esophageal ulcerations, is the extreme photosensitivity. Reports have come in from users complaining of second and third-degree burns. I, personally, have had second-degree burns caused by sun exposure, which caused blistering, and nausea as well as an increased risk for skin cancer.
Under no circumstances will I take Mefloquine. Furthermore, I am appalled and astounded that than organization that stresses the importance of Volunteer safety and security uses Mefloquine as their primary malaria prophylactic for Peace Corps Volunteers, especially after all the research and reports that have come out regarding its dangerous side effects. Not to mention, the denial of such side effects by the Peace Corps and lack of accountability is beyond me. Entering into Peace Corps service, living and working in a foreign land and adapting to a new culture for an extended period of time are already extraordinarily stressful undertakings. I cannot fathom why the Peace Corps would subject their volunteers to any additional, unnecessary mental strain when there are two other, equally effective malaria vaccinations. In addition, I am not willing to take the risk or gamble my mental health to even try and see if I have any adverse reactions to Mefloquine; I refuse to be a guinea pig. I am fully aware that the two other prophylactics possess side effects, however neither of them indicate any adverse psychiatric reactions. My first choice for malaria prevention is Malarone, with Doxycycline in a distant second. If the Peace Corps cannot offer me an alternative to Mefloquine, then I will be forced to rethink my decision to enter the Peace Corps. I really hope it does not come to that.
Sincerely,
Marie
Attachments:
Ø FDA 2002 Safety Alert – Lariam
Ø Hoffmann-La Roche publication on Lariam
Ø Letter from Sen. Dianne Feinstein
Sources:
Ø The University of Edinburgh College of Medicine – Anti-malarial Agents: www.link.med.ed.ac.uk/RIDU/antimal.htm
Ø Wikipedia: Mefloquine
Ø Medline Plus – Drug Information: www.nlm.nih.gov/medlineplus/print/druginfo/medmaster/a603030.html
Ø Lariam (Mefloquine) Side Effects Lawsuits: www.lariam-lariaum-side-effects.com/pages/lariam_side_effects.html
Ø The Journal of Neuropsychiatry & Clinical Neurosciences – Cognitive and Neuropsychiatric Side Effects of Mefloquine: http://neuro.psychiatryonline.org/cgi/content/full/13/2/302
Ø Healthlink – Medical College of Wisconsin: http://healthlink.mcw.edu/article/979237802.html
Ø Medsafe – New Zealand Medicines and Medical Devices Safety Authority: www.medsafe.govt.nz/consumers/cmi/m/Malarone.htm
Ø EMedTV – Health Information Brought To Life: http://antibotics.emedtv.com/doxycycline/doxycycline-side-effects.html
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