It should not be used in patients with a history of epilepsy or any psychiatric disorder

It should not be used in children below two years.

Avoid its use with quinine, quinidine or any other drugs which may cause disturbance of heart beat before or after mefloquine.

It should not be used during pregnancy.

Driving or operating any machinery should be avoided.

Quinine

This drug is obtained from the bark of the plant cinchona which is cultivated in eastern India. The plant originated in South America where it grew wild. For almost a century, until the 1940s, the drug enjoyed an unrivalled role in the treatment of malaria. Its value declined gradually with the discovery of newer drugs during the Second World War, which were more effective and less toxic. Its actions are similar to chloroquine. It is still used in the treatment of certain multiresistant strains of the malarial parasites causing brain fever (cerebral malaria).

Dosage: It is given in a dose of 300 to 600 mg orally, three to four times a day for 7 to 10 days. In cerebral malaria this drug has to be given by intravenous route with glucose and saline.

Adverse Effects: The adverse effects of large doses of quinine are quite serious and in some hypersensitive individuals maybe caused even by small doses. These include ringing sounds in the ears, loss of hearing, vertigo, blurring of vision, skin rashes, nausea, vomiting, diarrhoea, abdominal pain, fever, convulsions, fall in blood pressure, and depression of respiration. It may also cause destruction of red blood cells (haemolytic anaemia).

Precautions

Stop the drug immediately if allergy or pal our of skin (due to haemolytic anaemia) occur.

Avoid its use if you suffer from ringing in the ear or visual disturbances (optic neuritis).

Take the drug after meals.

Avoid its use during the first few months of pregnancy. It may cause abortion.

Primaquine

It is used for a complete cure. It is usually given along with or after chloroquine. Although it has prophylactic properties, it is not used for this purpose because of its toxic nature. Primaquine is given in a dose of 15 mg per day for 2 weeks, for a complete

cure.

Adverse Effects: In therapeutic doses it may cause abdominal discomfort and anaemia: Large doses may cause marked discomfort and alteration in blood (methaemoglobinaemia) and destruction of red blood cells (haemolytic anaemia) in individuals who have low level of an enzyme called G-6 PD. Spot tests are available for testing of G-6-PD deficiency state. If

C-6-PD deficiency is detected, bulaquin (AABLAQUIN) is available which is claimed to be tolerated well in a dose of 25 mg per day for 5 days.

The drug should be taken under the supervision of a physician.

The drug should be stopped immediately if darkening of urine occurs.

Its concurrent use with quinacrine should be avoided.

Avoid its use if you are suffering from rheumatoid arthritis.

Note: Due to its toxic side-effects the drug is not allowed to be sold in regular chemist shops and is available only through the public health department.