The Quinism Foundation Calls on the Department of Veterans Affairs to Update its Mefloquine Website

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Veterans and VA Health Care Providers Must Be Provided With Up-To-Date Information That Accurately Reflects the Health Risks Posed by the Neurotoxic Drug

The Quinism Foundation has sent correspondence to Dr. Ralph L. Erickson, Department of Veterans Affairs (VA) Chief Consultant for Post Deployment Health Services, calling on the VA to update misleading, incomplete, and inaccurate information related to the antimalarial drug mefloquine (previously marketed in the U.S. as Lariam®) listed on a VA Public Health website last updated nearly a year ago. [1]

Mefloquine has been widely used by the Department of Defense (DoD), particularly for the prevention (or prophylaxis) of malaria among U.S. military personnel, since it was licensed by the U.S. Food and Drug Administration (FDA) in 1989. In 2013, the FDA warned that mefloquine can cause long-lasting and even permanent adverse effects.

“The foundation is calling on the VA to emphasize mefloquine’s proven association with chronic and disabling adverse effects,” said Remington Nevin, MD, MPH, DrPH, executive director of The Quinism Foundation. “This association is readily conceded by the VA in the numerous successful veterans’ claims for service-connected disability awarded due to exposure to mefloquine. The foundation is also calling on the VA to acknowledge the widespread misuse of mefloquine by the U.S. military, and to acknowledge that this misuse has contributed to veterans developing chronic and disabling effects.”

Following the 2013 FDA warnings, DoD declared mefloquine “a drug of last resort”, and all but eliminated the drug’s use. However, recent media coverage has revealed that the VA is unable to fully account for which service members were previously exposed to the drug, and which veterans may be affected. [2] In 2012, DoD conceded that, “Some deploying Service members have been provided mefloquine for malaria prophylaxis without appropriate documentation in their medical records and without proper screening for contraindications.” [3]

In the foundation’s correspondence, Dr. Nevin noted “that the U.S. military has determined mefloquine is neurotoxic, and it that has widely misused mefloquine over more than a quarter-century.” According to Dr. Nevin, examples of this misuse include “failing to issue proper warnings for its safe use, failing to distribute required medication guides and wallet cards, failing to restrict its use among those with contraindications, and failing to document all use of the drug in military medical records.”

In its correspondence, the foundation also reiterated its call, sent in previous correspondence to VA secretary nominee Robert Wilkie, that recent veterans be screened for a history of symptomatic exposure to the drug. [4]

“Screening for symptomatic exposure during a clinical encounter can be as quick and simple as asking the veteran ‘Did you take mefloquine’, and if so, ‘While you were taking the drug, did you experience one or more of these symptoms?’” noted Dr. Nevin. “If the veteran reports symptomatic exposure, clinicians should retain an index of suspicion that any chronic neurologic or psychiatric symptoms, including those reported, could represent effects of mefloquine poisoning, a medical condition also known as chronic quinoline encephalopathy or neuropsychiatric quinism.”

About The Quinism Foundation

The Quinism Foundation promotes and supports education and research on quinism, the family of medical disorders caused by poisoning by quinoline drugs, including mefloquine and tafenoquine. Founded in January 2018, the foundation’s board of directors includes retired U.S. Navy Commander William Manofsky, retired U.S. Army Lieutenant Colonel Gregory Alderete, retired U.S. Navy Chief Petty Officer Michael Little, and retired U.S. Army Colonel and former psychiatry consultant to the Army Surgeon General Dr. Elspeth Ritchie.

Dr. Nevin is a board-certified occupational medicine and preventive medicine physician and former U.S. Army medical officer and epidemiologist. He is author of more than 30 scientific publications on malaria and the quinoline antimalarials, including “Screening for Symptomatic Mefloquine Exposure”, published in Federal Practitioner (see: https://www.mdedge.com/fedprac/article/132560/mental-health/screening-symptomatic-mefloquine-exposure-among-veterans).

1. U.S. Department of Veterans Affairs. Public Health. Exposures. Mefloquine (Lariam®). July 26, 2017 (see: https://www.publichealth.va.gov/exposures/mefloquine-lariam.asp).
2. McCarren, A. Veterans say anti-malarial drug they were ordered to take isn't in medical records. May 1, 2018 (see: https://www.wusa9.com/article/news/local/veterans-say-anti-malarial-drug-they-were-ordered-to-take-isnt-in-medical-records/65-547667488).
3. Assistant Secretary of Defense for Health Affairs. Memorandum Dated 17 Jan 2012, Subject: Service Review of Mefloquine Prescribing Practices.
4. McCarren, A. Antimalarial drug prompts plea to Congress. June 20, 2018. (see: https://www.wusa9.com/article/news/local/antimalarial-drug-prompts-plea-to-congress/65-565647402).

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