Table 2 Proposed contraindications to the use of mefloquine

Mefloquine contraindications:

1.

Known hypersensitivity to the drug.

2.

History of any proven or suspected liver abnormality within the previous 2 years.

3.

History of any proven or suspected thyroid abnormality within the previous 2 years, including any concurrent use of thyroid-stabilising medication.

4.

Concurrent use of drugs known to cause hepatocellular injury. Paracetamol and (especially) aspirin to be used with caution, since both can damage the liver and/or the thyroid.[34, 40] Mefloquine users should not take recreational drugs.

5.

Concurrent use of oral contraceptive pill or HRT. Healthcare advisers should recognise that some female travellers will need alternative contraception.

6.

Concurrent use of drugs known to be thyroid hormone antagonists.[53]

7.

Up to 2 units of alcohol per day may be taken by users of mefloquine prophylaxis until 24 h before their weekly dose, and from 24 h afterwards.

8.

Mefloquine users should avoid concurrent use of any other quinoline derivative (eg, amodiaquine, chloroquine, primaquine, quinidine, quinine, tafenoquine), whether for additional prophylaxis or for treatment.