Q: 32 year old male who just returned from Bangladesh after 4 weeks trip has been admitted to ICU with active suicidal ideations. According to family, patient has no previous psychiatric history. Patient took all required vaccinations before departing and list of medications shows only mefloquine (larium) while abroad. All lab work is normal except for EKG which showed prolong QTc interval?

Answer: Mefloquine, a popular drug for prevention of Malaria as it requires to take only once a week while travelling carries a potential for serious neuropsychiatric side effects that may persist even after discontinuing administration of the drug. It may include anxiety, hallucinations, depression, unusual behavior, suicidal ideations, dizziness, loss of balance, tinnitus, headache, insomnia, vivid dreams, seizures etc. It is estimated that about 11-17% of travelers are incapacitated to some degree. It may also cause prolong QTc interval.

References:                             

AlKadi, HO (2007). "Antimalarial drug toxicity: a review". Chemotherapy 53 (6): 385–91.

Schlagenhauf, P. (1999). "Mefloquine for malaria chemoprophylaxis 1992-1998". Travel Med 6 (2): 122–123.

Jacquerioz, FA; Croft, AM (2009-10-07). Jacquerioz, Frederique A, ed. "Drugs for preventing malaria in travellers". Cochrane database of systematic reviews (Online) (4): CD006491