Larium? More like scarium

It seems like I learn something new everyday during the preparations leading up to my Philippines trip. When I was first told that I would need an antimalarial drug for the trip, I didn’t think much about. Honestly, who thinks much about malaria unless you work in some sort of medical profession? I also didn’t think much about it when my doctor prescribed Lariam®. Although he did say, rather nonchalantly, that there were some severe side effects — the one that stands out in my memory is hearing loss. At the time his summation that it was better than malaria sufficed for me.

Fast forward a month later and I still hadn’t got my prescription filled, so one day when I was talking to my sister (who is a RN) she told me the day I took the pill probably wasn’t going to be pleasant. Feeling ill one day a week for a few weeks seemed like a small sacrifice to stay malaria free.

Fast forward a few weeks later, after having the prescription filled (more on that later) and here I am, slightly freaked out with the idea of taking my prescribed antimalarial. During our monthly preparation meeting, Brad – a GSE team member, asked the rest of us what antimalarial we were taking as he was still undecided. At first, I thought this was a weird question because I am hardly one to question or prescribe a medicine that I know nothing about, but I was later grateful that he asked.

When I told him that I was prescribed Lariam®, he kind of foiled his face and said he had several friends who traveled to malaria-prevalent countries and they wouldn’t touch the stuff. Awesome! He then goes on to say that his friends who took it had severe nightmares, and other psychological problems — including spending a night in a psychological hospital. Really awesome! Now I’m freaking out but don’t think much about it until I’m going to bed that night (because everybody thinks about important things right before bed, right?)

So, the next day I look at the great source of non-biased, totally-official, never-wrong information that exists on Wikipedia. Some background information:

Mefloquine is an orally-administered antimalarial drug used as a prophylaxis against and treatment for malaria. It also goes by the trade name Lariam (manufactured by Roche Pharmaceuticals) and chemical name mefloquine hydrochloride (formulated with HCl). Mefloquine was developed in the 1970s at the Walter Reed Army Institute of Research in the U.S. as a synthetic analogue of quinine.

Mefloquine is used to prevent malaria (malaria prophylaxis) and also in the treatment of chloroquine-resistant falciparum malaria. As mefloquine resistance spreads, mefloquine has started to lose its efficacy.

Mefloquine is the drug of choice to treat malaria (though not necessarily to prevent malaria) caused by chloroquine-resistant Plasmodium vivax. Wikipedia

And now for some of the good stuff:

Mefloquine may have severe and permanent adverse side-effects. It is known to cause severe depression, anxiety, paranoia, aggression, nightmares, insomnia, seizures, birth defects, peripheral motor-sensory neuropathy, vestibular (balance) damage and central nervous system problems. For a complete list of adverse physical and psychological effects — including suicidal ideation — see the most recent product information.

In 2002 the word suicide was added to the official product label, though proof of causation has not been established.

In the 1990s, there were reports in the media that the drug may have played a role in the Somalia Affair, which involved the torture and murder of a Somali citizen whilst in the custody of Canadian peacekeeping troops. There has been similar controversy, since three murder-suicides involving Special Forces soldiers at Fort Bragg, N.C., in the summer of 2002. To date, more than 19 cases of vestibular damage following the use of mefloquine have been diagnosed by military physicians. The same damage has been diagnosed among business travelers and tourists. Wikipedia

Excuse my French, but that scares the living shit out of me. I consequently stopped reading about it, because it wasn’t helping – and the fact is I need to take it. So, this morning when I went to pick up my prescription, which still wasn’t ready, I asked the pharmacist (who was very helpful, and eased my mind a bit). She basically went over the side effects with me, which by itself didn’t help, but she did say that most of the side effects would probably be stomach related. Now, that I can handle; but freaking out is slightly different. She also said that if she had to take something, this would be her choice, which was by far the most reassuring.

Lucky for me, I get to start taking my weekly dose next week. And then nine more weeks after that, including four after I am home. Good times indeed.

And just to briefly talk about my experience picking up the actual prescription, let’s just say that insurance, like it does for most things, made it more difficult than it should have been. I dropped my prescription off around 1:00 p.m. and decided to wait around in the store while it was being filled. 30–40 minutes later and I was at the counter ready to leave, but of course there was a problem. My prescription insurance would not let them fill the full prescription because it was exceeding the limit.

The prescription is for 10 tablets – one a week, starting the week before I leave to continue the weeks while I am there, and then four weeks after my return. Basically they would only allow an amount that wouldn’t get me through the trip. That becomes a problem when you’re in a different country, and can’t just go to the corner drugstore. Of course I could pay for the extras, but I’m not sure I should have to – and the staff at Walgreens must have been thinking along the same lines. An hour and a half later I leave the story without the prescription, and am told to check back in the following days.

That was on Thursday of last week, and I still don’t have the prescription in my possession. Everybody at Walgreens was very helpful, and dealt with my insurance so that I didn’t have to. Their customer service was beyond what I would expect, and I can safely say I will give them more of my patronage (although their 20 oz soda was a ridiculous $1.60).

After another visit to the pharmacy this morning and a few more phone calls, it seems that my prescription is ready for pickup. It was quite a hassle, but now I have the awesome side effects to look forward to; but still I am happy to have my potentially life-saving antimalarial.