mefloquine (Rx)

Brand and Other Names:
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Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

tablet

  • 250mg

Acute Malaria Infections

Indicated for the treatment of mild-to-moderate acute malaria caused by mefloquine-susceptible strains of P. falciparum (both chloroquine-susceptible and resistant strains) or by Plasmodium vivax

1250 mg PO once

Malaria Prevention

250 mg PO qWeek

Start 1-2 weeks before arrival in endemic area; continue 4 weeks after leaving endemic area

Dosing Considerations

If a full-treatment course does not lead to improvement within 48-72 hr, mefloquine should not be used for retreatment; an alternative therapy should be used

Similarly, if previous prophylaxis with mefloquine failed, mefloquine should not be used for curative treatment

Insufficient clinical data exist to document the effect of mefloquine in malaria caused by P. ovale or P. malariae

Patients with acute P. vivax malaria, treated with mefloquine, are at high risk of relapse because mefloquine does not eliminate exoerythrocytic (hepatic phase) parasites; to avoid relapse, after initial treatment of the acute infection with mefloquine, patients should subsequently be treated with an 8-aminoquinoline derivative (eg, primaquine)

Chloroquine-Resistant Malaria (Orphan)

Prevention and treatment of chloroquine-resistant Faciparum malaria

Orphan indication sponsor

  • Mepha AG; 4143 Dornach; Postfash 137, Switzerland

Administration

Take with food and >8 oz water

May repeat full or partial dose if vomited

Dosage Forms & Strengths

tablet

  • 250mg

Acute Malaria Infections

Indicated for the treatment of mild-to-moderate acute malaria caused by mefloquine-susceptible strains of P. falciparum (both chloroquine-susceptible and resistant strains) or by Plasmodium vivax

<6 months old: Safety and efficacy not established

>6 months old: 20-25 mg/kg PO as single dose or may divide in 2 doses  

Malaria Prevention

5 to <10 kg: 31.25 mg (1/8 tablet) PO qWeek

10 to <20 kg: 62.5 mg (1/4 tablet) PO qWeek

20 to <30 kg: 125 mg (1/2 tablet) PO qWeek

30-45 kg: 187.5 mg (3/4 tablet) PO qWeek

>45 kg: 250 mg (1 tablet) PO qWeek

Start 1-2 weeks before arrival in endemic area; continue 4 weeks after leaving endemic area

Dosing Considerations

If a full-treatment course does not lead to improvement within 48-72 hr, mefloquine should not be used for retreatment; an alternative therapy should be used

Similarly, if previous prophylaxis with mefloquine failed, mefloquine should not be used for curative treatment

Insufficient clinical data exist to document the effect of mefloquine in malaria caused by P. ovale or P. malariae

Patients with acute P. vivax malaria, treated with mefloquine, are at high risk of relapse because mefloquine does not eliminate exoerythrocytic (hepatic phase) parasites; to avoid relapse, after initial treatment of the acute infection with mefloquine, patients should subsequently be treated with an 8-aminoquinoline derivative (eg, primaquine)

Administration

Take with food and >8 oz water

May repeat full or partial dose if vomited

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Interactions

Interaction Checker

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            Contraindicated (1)

            • lefamulin

              lefamulin will increase the level or effect of mefloquine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated. Lefamulin is contraindicated with CYP3A substrates know to prolong the QT interval.

            Serious - Use Alternative (142)

            • abametapir

              abametapir will increase the level or effect of mefloquine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. For 2 weeks after abametapir application, avoid taking drugs that are CYP3A4 substrates. If not feasible, avoid use of abametapir.

            • afatinib

              mefloquine increases levels of afatinib by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug. Reduce afatinib daily dose by 10 mg if not tolerated when coadministered with P-gp inhibitors.

            • amantadine

              mefloquine increases toxicity of amantadine by QTc interval. Avoid or Use Alternate Drug. Mefloquine may enhance the QTc prolonging effect of high risk QTc prolonging agents.

            • amiodarone

              mefloquine increases toxicity of amiodarone by QTc interval. Avoid or Use Alternate Drug. Mefloquine may enhance the QTc prolonging effect of high risk QTc prolonging agents.

              amiodarone will increase the level or effect of mefloquine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

            • amitriptyline

              mefloquine increases toxicity of amitriptyline by QTc interval. Avoid or Use Alternate Drug. Mefloquine may enhance the QTc prolonging effect of high risk QTc prolonging agents.

            • amoxapine

              mefloquine increases toxicity of amoxapine by QTc interval. Avoid or Use Alternate Drug. Mefloquine may enhance the QTc prolonging effect of high risk QTc prolonging agents.

            • apalutamide

              apalutamide will decrease the level or effect of mefloquine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Coadministration of apalutamide, a strong CYP3A4 inducer, with drugs that are CYP3A4 substrates can result in lower exposure to these medications. Avoid or substitute another drug for these medications when possible. Evaluate for loss of therapeutic effect if medication must be coadministered. Adjust dose according to prescribing information if needed.

            • apomorphine

              apomorphine and mefloquine both increase QTc interval. Avoid or Use Alternate Drug.

            • aripiprazole

              mefloquine increases toxicity of aripiprazole by QTc interval. Avoid or Use Alternate Drug. Mefloquine may enhance the QTc prolonging effect of high risk QTc prolonging agents.

            • arsenic trioxide

              mefloquine increases toxicity of arsenic trioxide by QTc interval. Avoid or Use Alternate Drug. Mefloquine may enhance the QTc prolonging effect of high risk QTc prolonging agents.

            • artemether

              mefloquine increases toxicity of artemether by QTc interval. Avoid or Use Alternate Drug. Mefloquine may enhance the QTc prolonging effect of high risk QTc prolonging agents.

            • asenapine

              mefloquine increases toxicity of asenapine by QTc interval. Avoid or Use Alternate Drug. Mefloquine may enhance the QTc prolonging effect of high risk QTc prolonging agents.

            • atazanavir

              atazanavir increases levels of mefloquine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Potential for increased toxicity. Avoid coadministration during and for 15 weeks after discontinuing mefloquine. .

              mefloquine increases toxicity of atazanavir by QTc interval. Avoid or Use Alternate Drug. Mefloquine may enhance the QTc prolonging effect of high risk QTc prolonging agents.

            • BCG vaccine live

              mefloquine decreases effects of BCG vaccine live by pharmacodynamic antagonism. Contraindicated.

            • bortezomib

              mefloquine increases toxicity of bortezomib by QTc interval. Avoid or Use Alternate Drug. Mefloquine may enhance the QTc prolonging effect of high risk QTc prolonging agents.

            • bosutinib

              mefloquine increases levels of bosutinib by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug.

            • ceritinib

              ceritinib and mefloquine both increase QTc interval. Avoid or Use Alternate Drug.

            • chloral hydrate

              mefloquine increases toxicity of chloral hydrate by QTc interval. Avoid or Use Alternate Drug. Mefloquine may enhance the QTc prolonging effect of high risk QTc prolonging agents.

            • chloramphenicol

              chloramphenicol will increase the level or effect of mefloquine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Potential for increased toxicity. Avoid coadministration during and for 15 weeks after discontinuing mefloquine.

            • chloroquine

              chloroquine, mefloquine. Mechanism: unknown. Contraindicated. Risk of convulsions.

            • ciprofloxacin

              mefloquine increases toxicity of ciprofloxacin by QTc interval. Avoid or Use Alternate Drug. Mefloquine may enhance the QTc prolonging effect of high risk QTc prolonging agents.

            • citalopram

              mefloquine and citalopram both increase QTc interval. Avoid or Use Alternate Drug. ECG monitoring is recommended, along with drugs that may prolong the QT interval.

            • clarithromycin

              clarithromycin will increase the level or effect of mefloquine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Potential for increased toxicity. Avoid coadministration during and for 15 weeks after discontinuing mefloquine.

              clarithromycin and mefloquine both increase QTc interval. Avoid or Use Alternate Drug.

            • clomipramine

              mefloquine increases toxicity of clomipramine by QTc interval. Avoid or Use Alternate Drug. Mefloquine may enhance the QTc prolonging effect of high risk QTc prolonging agents.

            • cobicistat

              cobicistat will increase the level or effect of mefloquine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Potential for increased toxicity. Avoid coadministration during and for 15 weeks after discontinuing mefloquine.

            • conivaptan

              conivaptan will increase the level or effect of mefloquine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Potential for increased toxicity. Avoid coadministration during and for 15 weeks after discontinuing mefloquine.

            • crizotinib

              crizotinib and mefloquine both increase QTc interval. Avoid or Use Alternate Drug.

            • dabrafenib

              mefloquine and dabrafenib both increase QTc interval. Avoid or Use Alternate Drug. Mefloquine may enhance the QTc prolonging effect of high risk QTc prolonging agents

            • dapsone

              mefloquine increases toxicity of dapsone by unspecified interaction mechanism. Avoid or Use Alternate Drug. Increased risk of hemolytic reactions.

            • dapsone topical

              mefloquine, dapsone topical. unspecified interaction mechanism. Avoid or Use Alternate Drug. Avoid coadministration of dapsone topical with oral dapsone or antimalarial medications because of the potential for hemolytic reactions.

            • darunavir

              darunavir increases levels of mefloquine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Potential for increased toxicity. Avoid coadministration during and for 15 weeks after discontinuing mefloquine. .

            • dasatinib

              mefloquine increases toxicity of dasatinib by QTc interval. Avoid or Use Alternate Drug. Mefloquine may enhance the QTc prolonging effect of high risk QTc prolonging agents.

            • desflurane

              mefloquine increases toxicity of desflurane by QTc interval. Avoid or Use Alternate Drug. Mefloquine may enhance the QTc prolonging effect of high risk QTc prolonging agents.

            • diphenhydramine

              mefloquine increases toxicity of diphenhydramine by QTc interval. Avoid or Use Alternate Drug. Mefloquine may enhance the QTc prolonging effect of high risk QTc prolonging agents.

            • disopyramide

              mefloquine increases toxicity of disopyramide by QTc interval. Avoid or Use Alternate Drug. Mefloquine may enhance the QTc prolonging effect of high risk QTc prolonging agents.

            • dofetilide

              mefloquine increases toxicity of dofetilide by QTc interval. Avoid or Use Alternate Drug. Mefloquine may enhance the QTc prolonging effect of high risk QTc prolonging agents.

              dofetilide increases toxicity of mefloquine by QTc interval. Avoid or Use Alternate Drug.

            • dosulepin

              mefloquine increases toxicity of dosulepin by QTc interval. Avoid or Use Alternate Drug. Mefloquine may enhance the QTc prolonging effect of high risk QTc prolonging agents.

            • doxepin

              mefloquine increases toxicity of doxepin by QTc interval. Avoid or Use Alternate Drug. Mefloquine may enhance the QTc prolonging effect of high risk QTc prolonging agents.

            • doxepin cream

              mefloquine increases toxicity of doxepin cream by QTc interval. Avoid or Use Alternate Drug. Mefloquine may enhance the QTc prolonging effect of high risk QTc prolonging agents.

            • dronedarone

              mefloquine increases toxicity of dronedarone by QTc interval. Avoid or Use Alternate Drug. Mefloquine may enhance the QTc prolonging effect of high risk QTc prolonging agents.

            • edoxaban

              mefloquine will increase the level or effect of edoxaban by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug. Dose adjustment may be required with strong P-gp inhibitors. DVT/PE treatment: Decrease dose to 30 mg PO once daily. NVAF: No dose reduction recommended

            • encorafenib

              encorafenib and mefloquine both increase QTc interval. Avoid or Use Alternate Drug.

            • entrectinib

              entrectinib and mefloquine both increase QTc interval. Avoid or Use Alternate Drug.

            • enzalutamide

              enzalutamide will decrease the level or effect of mefloquine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

            • eribulin

              eribulin and mefloquine both increase QTc interval. Avoid or Use Alternate Drug. Potential for enhanced QTc-prolonging effects; if concurrent use is necessary then ECG monitoring is recommended.

            • escitalopram

              mefloquine increases toxicity of escitalopram by QTc interval. Avoid or Use Alternate Drug. Mefloquine may enhance the QTc prolonging effect of high risk QTc prolonging agents.

            • everolimus

              mefloquine increases levels of everolimus by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug.

            • famotidine

              mefloquine increases toxicity of famotidine by QTc interval. Avoid or Use Alternate Drug. Mefloquine may enhance the QTc prolonging effect of high risk QTc prolonging agents.

            • felbamate

              mefloquine increases toxicity of felbamate by QTc interval. Avoid or Use Alternate Drug. Mefloquine may enhance the QTc prolonging effect of high risk QTc prolonging agents.

            • fexinidazole

              fexinidazole and mefloquine both increase QTc interval. Avoid or Use Alternate Drug. Avoid coadministration of fexinidazole with drugs known to block potassium channels or prolong QT interval.

              fexinidazole will increase the level or effect of mefloquine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Fexinidazole inhibits CYP3A4. Coadministration may increase risk for adverse effects of CYP3A4 substrates.

            • fluoxetine

              mefloquine increases toxicity of fluoxetine by QTc interval. Avoid or Use Alternate Drug. Mefloquine may enhance the QTc prolonging effect of high risk QTc prolonging agents.

            • fosamprenavir

              fosamprenavir increases levels of mefloquine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Potential for increased toxicity. Avoid coadministration during and for 15 weeks after discontinuing mefloquine. .

            • foscarnet

              mefloquine increases toxicity of foscarnet by QTc interval. Avoid or Use Alternate Drug. Mefloquine may enhance the QTc prolonging effect of high risk QTc prolonging agents.

            • fosphenytoin

              mefloquine increases toxicity of fosphenytoin by QTc interval. Avoid or Use Alternate Drug. Mefloquine may enhance the QTc prolonging effect of high risk QTc prolonging agents.

            • galantamine

              mefloquine increases toxicity of galantamine by QTc interval. Avoid or Use Alternate Drug. Mefloquine may enhance the QTc prolonging effect of high risk QTc prolonging agents.

            • hydroxychloroquine sulfate

              hydroxychloroquine sulfate and mefloquine both increase QTc interval. Avoid or Use Alternate Drug.

            • ibuprofen/famotidine

              mefloquine increases toxicity of ibuprofen/famotidine by QTc interval. Avoid or Use Alternate Drug. Mefloquine may enhance the QTc prolonging effect of high risk QTc prolonging agents.

            • ibutilide

              mefloquine increases toxicity of ibutilide by QTc interval. Avoid or Use Alternate Drug. Mefloquine may enhance the QTc prolonging effect of high risk QTc prolonging agents.

            • idelalisib

              idelalisib will increase the level or effect of mefloquine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Idelalisib is a strong CYP3A inhibitor; avoid coadministration with sensitive CYP3A substrates

            • iloperidone

              mefloquine increases toxicity of iloperidone by QTc interval. Avoid or Use Alternate Drug. Mefloquine may enhance the QTc prolonging effect of high risk QTc prolonging agents.

            • imipramine

              mefloquine increases toxicity of imipramine by QTc interval. Avoid or Use Alternate Drug. Mefloquine may enhance the QTc prolonging effect of high risk QTc prolonging agents.

            • indapamide

              mefloquine increases toxicity of indapamide by QTc interval. Avoid or Use Alternate Drug. Mefloquine may enhance the QTc prolonging effect of high risk QTc prolonging agents.

            • indinavir

              indinavir increases levels of mefloquine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Potential for increased toxicity. Avoid coadministration during and for 15 weeks after discontinuing mefloquine. .

            • isoflurane

              mefloquine increases toxicity of isoflurane by QTc interval. Avoid or Use Alternate Drug. Mefloquine may enhance the QTc prolonging effect of high risk QTc prolonging agents.

            • isradipine

              mefloquine increases toxicity of isradipine by QTc interval. Avoid or Use Alternate Drug. Mefloquine may enhance the QTc prolonging effect of high risk QTc prolonging agents.

            • itraconazole

              mefloquine increases toxicity of itraconazole by QTc interval. Avoid or Use Alternate Drug. Mefloquine may enhance the QTc prolonging effect of high risk QTc prolonging agents.

              itraconazole will increase the level or effect of mefloquine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Potential for increased toxicity. Avoid coadministration during and for 15 weeks after discontinuing mefloquine.

            • ivosidenib

              ivosidenib and mefloquine both increase QTc interval. Avoid or Use Alternate Drug. Avoid coadministration of QTc prolonging drugs with ivosidenib or replace with alternate therapies. If coadministration of a QTc prolonging drug is unavoidable, monitor for increased risk of QTc interval prolongation.

              ivosidenib will decrease the level or effect of mefloquine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of sensitive CYP3A4 substrates with ivosidenib or replace with alternative therapies. If coadministration is unavoidable, monitor patients for loss of therapeutic effect of these drugs.

            • ketoconazole

              mefloquine increases toxicity of ketoconazole by QTc interval. Avoid or Use Alternate Drug. Mefloquine may enhance the QTc prolonging effect of high risk QTc prolonging agents.

              ketoconazole will increase the level or effect of mefloquine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Potential for increased toxicity. Avoid coadministration during and for 15 weeks after discontinuing mefloquine.

            • lidocaine

              mefloquine increases toxicity of lidocaine by QTc interval. Avoid or Use Alternate Drug. Mefloquine may enhance the QTc prolonging effect of high risk QTc prolonging agents.

            • lithium

              mefloquine increases toxicity of lithium by QTc interval. Avoid or Use Alternate Drug. Mefloquine may enhance the QTc prolonging effect of high risk QTc prolonging agents.

            • lonafarnib

              mefloquine will increase the level or effect of lonafarnib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. If coadministration of lonafarnib (a sensitive CYP3A substrate) with weak CYP3A inhibitors is unavoidable, reduce to, or continue lonafarnib at starting dose. Closely monitor for arrhythmias and events (eg, syncope, heart palpitations) since lonafarnib effect on QT interval is unknown.

            • lopinavir

              lopinavir increases levels of mefloquine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Potential for increased toxicity. Avoid coadministration during and for 15 weeks after discontinuing mefloquine. .

              mefloquine increases toxicity of lopinavir by QTc interval. Avoid or Use Alternate Drug. Mefloquine may enhance the QTc prolonging effect of high risk QTc prolonging agents.

            • loxapine

              mefloquine increases toxicity of loxapine by QTc interval. Avoid or Use Alternate Drug. Mefloquine may enhance the QTc prolonging effect of high risk QTc prolonging agents.

            • lumefantrine

              mefloquine increases toxicity of lumefantrine by QTc interval. Avoid or Use Alternate Drug. Mefloquine may enhance the QTc prolonging effect of high risk QTc prolonging agents.

            • macimorelin

              macimorelin and mefloquine both increase QTc interval. Avoid or Use Alternate Drug. Macimorelin causes an increase of ~11 msec in the corrected QT interval. Avoid coadministration with drugs that prolong QT interval, which could increase risk for developing torsade de pointes-type ventricular tachycardia. Allow sufficient washout time of drugs that are known to prolong the QT interval before administering macimorelin.

            • maprotiline

              mefloquine increases toxicity of maprotiline by QTc interval. Avoid or Use Alternate Drug. Mefloquine may enhance the QTc prolonging effect of high risk QTc prolonging agents.

            • mifepristone

              mefloquine increases toxicity of mifepristone by QTc interval. Avoid or Use Alternate Drug. Mefloquine may enhance the QTc prolonging effect of high risk QTc prolonging agents.

              mifepristone will increase the level or effect of mefloquine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

            • mirtazapine

              mefloquine increases toxicity of mirtazapine by QTc interval. Avoid or Use Alternate Drug. Mefloquine may enhance the QTc prolonging effect of high risk QTc prolonging agents.

            • mobocertinib

              mobocertinib and mefloquine both increase QTc interval. Avoid or Use Alternate Drug. If coadministration unavoidable, reduce mobocertinib dose and monitor QTc interval more frequently.

            • moexipril

              mefloquine increases toxicity of moexipril by QTc interval. Avoid or Use Alternate Drug. Mefloquine may enhance the QTc prolonging effect of high risk QTc prolonging agents.

            • nefazodone

              nefazodone will increase the level or effect of mefloquine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Potential for increased toxicity. Avoid coadministration during and for 15 weeks after discontinuing mefloquine.

            • nelfinavir

              nelfinavir increases levels of mefloquine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Potential for increased toxicity. Avoid coadministration during and for 15 weeks after discontinuing mefloquine. .

            • nicardipine

              mefloquine increases toxicity of nicardipine by QTc interval. Avoid or Use Alternate Drug. Mefloquine may enhance the QTc prolonging effect of high risk QTc prolonging agents.

              nicardipine will increase the level or effect of mefloquine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Potential for increased toxicity. Avoid coadministration during and for 15 weeks after discontinuing mefloquine.

            • nilotinib

              mefloquine increases toxicity of nilotinib by QTc interval. Avoid or Use Alternate Drug. Mefloquine may enhance the QTc prolonging effect of high risk QTc prolonging agents.

            • nortriptyline

              mefloquine increases toxicity of nortriptyline by QTc interval. Avoid or Use Alternate Drug. Mefloquine may enhance the QTc prolonging effect of high risk QTc prolonging agents.

            • octreotide

              mefloquine increases toxicity of octreotide by QTc interval. Avoid or Use Alternate Drug. Mefloquine may enhance the QTc prolonging effect of high risk QTc prolonging agents.

            • octreotide (Antidote)

              mefloquine increases toxicity of octreotide (Antidote) by QTc interval. Avoid or Use Alternate Drug. Mefloquine may enhance the QTc prolonging effect of high risk QTc prolonging agents.

            • olanzapine

              mefloquine increases toxicity of olanzapine by QTc interval. Avoid or Use Alternate Drug. Mefloquine may enhance the QTc prolonging effect of high risk QTc prolonging agents.

            • ondansetron

              mefloquine and ondansetron both increase QTc interval. Avoid or Use Alternate Drug. Avoid with congenital long QT syndrome; ECG monitoring recommended with concomitant medications that prolong QT interval, electrolyte abnormalities, CHF, or bradyarrhythmias.

            • oxytocin

              mefloquine increases toxicity of oxytocin by QTc interval. Avoid or Use Alternate Drug. Mefloquine may enhance the QTc prolonging effect of high risk QTc prolonging agents.

            • paliperidone

              mefloquine increases toxicity of paliperidone by QTc interval. Avoid or Use Alternate Drug. Mefloquine may enhance the QTc prolonging effect of high risk QTc prolonging agents.

            • paroxetine

              mefloquine increases toxicity of paroxetine by QTc interval. Avoid or Use Alternate Drug. Mefloquine may enhance the QTc prolonging effect of high risk QTc prolonging agents.

            • pazopanib

              mefloquine increases levels of pazopanib by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug.

            • phenytoin

              phenytoin will decrease the level or effect of mefloquine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

            • pimozide

              mefloquine increases toxicity of pimozide by QTc interval. Avoid or Use Alternate Drug. Mefloquine may enhance the QTc prolonging effect of high risk QTc prolonging agents.

            • pomalidomide

              mefloquine increases levels of pomalidomide by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug.

            • posaconazole

              mefloquine increases toxicity of posaconazole by QTc interval. Avoid or Use Alternate Drug. Mefloquine may enhance the QTc prolonging effect of high risk QTc prolonging agents.

              posaconazole will increase the level or effect of mefloquine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Potential for increased toxicity. Avoid coadministration during and for 15 weeks after discontinuing mefloquine.

            • procainamide

              mefloquine increases toxicity of procainamide by QTc interval. Avoid or Use Alternate Drug. Mefloquine may enhance the QTc prolonging effect of high risk QTc prolonging agents.

            • promethazine

              mefloquine increases toxicity of promethazine by QTc interval. Avoid or Use Alternate Drug. Mefloquine may enhance the QTc prolonging effect of high risk QTc prolonging agents.

            • protriptyline

              mefloquine increases toxicity of protriptyline by QTc interval. Avoid or Use Alternate Drug. Mefloquine may enhance the QTc prolonging effect of high risk QTc prolonging agents.

            • quetiapine

              mefloquine increases toxicity of quetiapine by QTc interval. Avoid or Use Alternate Drug. Mefloquine may enhance the QTc prolonging effect of high risk QTc prolonging agents.

            • quinidine

              quinidine, mefloquine. Mechanism: pharmacodynamic synergism. Contraindicated. Risk of ECG abnormalities, cardiac arrest.

              mefloquine increases toxicity of quinidine by QTc interval. Avoid or Use Alternate Drug. Mefloquine may enhance the QTc prolonging effect of high risk QTc prolonging agents.

            • quinine

              quinine, mefloquine. Mechanism: pharmacodynamic synergism. Contraindicated. Risk of ECG abnormalities, cardiac arrest.

              mefloquine increases toxicity of quinine by QTc interval. Avoid or Use Alternate Drug. Mefloquine may enhance the QTc prolonging effect of high risk QTc prolonging agents.

            • ribociclib

              ribociclib increases toxicity of mefloquine by QTc interval. Avoid or Use Alternate Drug.

            • rimegepant

              mefloquine will increase the level or effect of rimegepant by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug.

            • riociguat

              mefloquine will increase the level or effect of riociguat by decreasing metabolism. Avoid or Use Alternate Drug. Coadministration of riociguat (substrate of CYP isoenzymes 1A1, 2C8, 3A, 2J2) with strong CYP inhibitors may require a decreased initial dose of 0.5 mg PO TID; monitor for signs of hypotension and reduce dose if needed

            • risperidone

              mefloquine increases toxicity of risperidone by QTc interval. Avoid or Use Alternate Drug. Mefloquine may enhance the QTc prolonging effect of high risk QTc prolonging agents.

            • ritonavir

              ritonavir increases levels of mefloquine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Potential for increased toxicity. Avoid coadministration during and for 15 weeks after discontinuing mefloquine. .

              ritonavir increases toxicity of mefloquine by QTc interval. Avoid or Use Alternate Drug.

            • salmeterol

              mefloquine increases toxicity of salmeterol by QTc interval. Avoid or Use Alternate Drug. Mefloquine may enhance the QTc prolonging effect of high risk QTc prolonging agents.

            • saquinavir

              saquinavir increases levels of mefloquine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Potential for increased toxicity. Avoid coadministration during and for 15 weeks after discontinuing mefloquine. .

            • sertraline

              mefloquine increases toxicity of sertraline by QTc interval. Avoid or Use Alternate Drug. Mefloquine may enhance the QTc prolonging effect of high risk QTc prolonging agents.

            • sevoflurane

              mefloquine increases toxicity of sevoflurane by QTc interval. Avoid or Use Alternate Drug. Mefloquine may enhance the QTc prolonging effect of high risk QTc prolonging agents.

            • silodosin

              mefloquine increases levels of silodosin by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug.

            • solifenacin

              mefloquine increases toxicity of solifenacin by QTc interval. Avoid or Use Alternate Drug. Mefloquine may enhance the QTc prolonging effect of high risk QTc prolonging agents.

            • sotalol

              mefloquine increases toxicity of sotalol by QTc interval. Avoid or Use Alternate Drug. Mefloquine may enhance the QTc prolonging effect of high risk QTc prolonging agents.

            • sulfamethoxazole

              mefloquine increases toxicity of sulfamethoxazole by QTc interval. Avoid or Use Alternate Drug. Mefloquine may enhance the QTc prolonging effect of high risk QTc prolonging agents.

            • tacrolimus

              mefloquine increases toxicity of tacrolimus by QTc interval. Avoid or Use Alternate Drug. Mefloquine may enhance the QTc prolonging effect of high risk QTc prolonging agents.

            • tamoxifen

              mefloquine increases toxicity of tamoxifen by QTc interval. Avoid or Use Alternate Drug. Mefloquine may enhance the QTc prolonging effect of high risk QTc prolonging agents.

            • tetrabenazine

              mefloquine increases toxicity of tetrabenazine by QTc interval. Avoid or Use Alternate Drug. Mefloquine may enhance the QTc prolonging effect of high risk QTc prolonging agents.

            • thioridazine

              mefloquine increases toxicity of thioridazine by QTc interval. Avoid or Use Alternate Drug. Mefloquine may enhance the QTc prolonging effect of high risk QTc prolonging agents.

            • thiothixene

              mefloquine increases toxicity of thiothixene by QTc interval. Avoid or Use Alternate Drug. Mefloquine may enhance the QTc prolonging effect of high risk QTc prolonging agents.

            • tipranavir

              tipranavir increases levels of mefloquine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Use alternatives if available. Potential for increased toxicity. Avoid coadministration during and for 15 weeks after discontinuing mefloquine. .

            • tizanidine

              mefloquine increases toxicity of tizanidine by QTc interval. Avoid or Use Alternate Drug. Mefloquine may enhance the QTc prolonging effect of high risk QTc prolonging agents.

            • tolterodine

              mefloquine increases toxicity of tolterodine by QTc interval. Avoid or Use Alternate Drug. Mefloquine may enhance the QTc prolonging effect of high risk QTc prolonging agents.

            • topotecan

              mefloquine increases levels of topotecan by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug.

            • toremifene

              mefloquine and toremifene both increase QTc interval. Avoid or Use Alternate Drug. Concurrent use of toremifene with agents causing QT prolongation should be avoided. If concomitant use is required it's recommended that toremifene be interrupted. If interruption not possible, patients requiring therapy with a drug that prolongs QT should be closely monitored. ECGs should be obtained for high risk patients.

            • trimethoprim

              mefloquine increases toxicity of trimethoprim by QTc interval. Avoid or Use Alternate Drug. Mefloquine may enhance the QTc prolonging effect of high risk QTc prolonging agents.

            • trimipramine

              mefloquine increases toxicity of trimipramine by QTc interval. Avoid or Use Alternate Drug. Mefloquine may enhance the QTc prolonging effect of high risk QTc prolonging agents.

            • tucatinib

              tucatinib will increase the level or effect of mefloquine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid concomitant use of tucatinib with CYP3A substrates, where minimal concentration changes may lead to serious or life-threatening toxicities. If unavoidable, reduce CYP3A substrate dose according to product labeling.

            • typhoid vaccine live

              mefloquine decreases effects of typhoid vaccine live by pharmacodynamic antagonism. Contraindicated.

            • umeclidinium bromide/vilanterol inhaled

              mefloquine increases toxicity of umeclidinium bromide/vilanterol inhaled by QTc interval. Avoid or Use Alternate Drug. Exercise extreme caution when vilanterol coadministered with drugs that prolong QTc interval; adrenergic agonist effects on the cardiovascular system may be potentiated.

            • vandetanib

              mefloquine, vandetanib. Either increases toxicity of the other by QTc interval. Avoid or Use Alternate Drug. Avoid coadministration with drugs known to prolong QT interval; if a drug known to prolong QT interval must be used, more frequent ECG monitoring is recommended.

            • vardenafil

              mefloquine increases toxicity of vardenafil by QTc interval. Avoid or Use Alternate Drug. Mefloquine may enhance the QTc prolonging effect of high risk QTc prolonging agents.

            • vemurafenib

              vemurafenib and mefloquine both increase QTc interval. Avoid or Use Alternate Drug. Concomitant use of vemurafenib with drugs that prolong QT interval is not recommended. Mefloquine may also increase vemurafenib levels.

              mefloquine increases toxicity of vemurafenib by QTc interval. Avoid or Use Alternate Drug. Mefloquine may enhance the QTc prolonging effect of high risk QTc prolonging agents.

            • venetoclax

              mefloquine will increase the level or effect of venetoclax by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug. If a P-gp inhibitor must be used, reduce the venetoclax dose by at least 50%. Monitor more closely for signs of venetoclax toxicities.

            • venlafaxine

              mefloquine increases toxicity of venlafaxine by QTc interval. Avoid or Use Alternate Drug. Mefloquine may enhance the QTc prolonging effect of high risk QTc prolonging agents.

            • vilanterol/fluticasone furoate inhaled

              mefloquine increases toxicity of vilanterol/fluticasone furoate inhaled by QTc interval. Avoid or Use Alternate Drug. Exercise extreme caution when vilanterol coadministered with drugs that prolong QTc interval; adrenergic agonist effects on the cardiovascular system may be potentiated.

            • vincristine liposomal

              mefloquine increases levels of vincristine liposomal by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug.

            • voriconazole

              voriconazole will increase the level or effect of mefloquine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Potential for increased toxicity. Avoid coadministration during and for 15 weeks after discontinuing mefloquine.

            • vorinostat

              mefloquine increases toxicity of vorinostat by QTc interval. Avoid or Use Alternate Drug. Mefloquine may enhance the QTc prolonging effect of high risk QTc prolonging agents.

            • voxelotor

              voxelotor will increase the level or effect of mefloquine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Voxelotor increases systemic exposure of sensitive CYP3A4 substrates. Avoid coadministration with sensitive CYP3A4 substrates with a narrow therapeutic index. Consider dose reduction of the sensitive CYP3A4 substrate(s) if unable to avoid.

            • ziprasidone

              mefloquine increases toxicity of ziprasidone by QTc interval. Avoid or Use Alternate Drug. Mefloquine may enhance the QTc prolonging effect of high risk QTc prolonging agents.

            Monitor Closely (131)

            • acebutolol

              mefloquine increases levels of acebutolol by decreasing metabolism. Use Caution/Monitor. Risk of arrhythmia.

            • albuterol

              albuterol and mefloquine both increase QTc interval. Use Caution/Monitor.

            • alfuzosin

              mefloquine and alfuzosin both increase QTc interval. Use Caution/Monitor.

              alfuzosin and mefloquine both increase QTc interval. Use Caution/Monitor.

            • amlodipine

              mefloquine increases levels of amlodipine by decreasing metabolism. Use Caution/Monitor. Risk of arrhythmia.

            • amobarbital

              amobarbital will decrease the level or effect of mefloquine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • aprepitant

              aprepitant will increase the level or effect of mefloquine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • arformoterol

              arformoterol and mefloquine both increase QTc interval. Use Caution/Monitor.

            • artemether/lumefantrine

              mefloquine decreases levels of artemether/lumefantrine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Mefloquine decreases bile production; take Coartem (lumefantrine) during food consumption.

            • atenolol

              mefloquine increases levels of atenolol by decreasing metabolism. Use Caution/Monitor. Risk of arrhythmia.

            • atogepant

              mefloquine will increase the level or effect of atogepant by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • atomoxetine

              atomoxetine and mefloquine both increase QTc interval. Use Caution/Monitor.

            • avapritinib

              mefloquine will increase the level or effect of avapritinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • axitinib

              mefloquine increases levels of axitinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • bedaquiline

              mefloquine and bedaquiline both increase QTc interval. Modify Therapy/Monitor Closely. ECG should be monitored closely

            • berotralstat

              mefloquine increases levels of berotralstat by P-glycoprotein (MDR1) efflux transporter. Modify Therapy/Monitor Closely. Reduced berotralstat dose to 110 mg/day when coadministered with P-gp inhibitors.

            • betaxolol

              mefloquine increases levels of betaxolol by decreasing metabolism. Use Caution/Monitor. Risk of arrhythmia.

            • betrixaban

              mefloquine increases levels of betrixaban by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Decrease betrixaban dose to 80 mg PO once, then 40 mg PO qDay if coadministered with a P-gp inhibitor.

            • bicalutamide

              bicalutamide will increase the level or effect of mefloquine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • bisoprolol

              mefloquine increases levels of bisoprolol by decreasing metabolism. Use Caution/Monitor. Risk of arrhythmia.

            • bosentan

              bosentan will decrease the level or effect of mefloquine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • bupivacaine implant

              mefloquine, bupivacaine implant. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: Local anesthetics may increase the risk of developing methemoglobinemia when concurrently exposed to drugs that also cause methemoglobinemia.

            • carbamazepine

              carbamazepine will decrease the level or effect of mefloquine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • carvedilol

              mefloquine increases levels of carvedilol by decreasing metabolism. Use Caution/Monitor. Risk of arrhythmia.

            • celiprolol

              mefloquine increases levels of celiprolol by decreasing metabolism. Use Caution/Monitor. Risk of arrhythmia.

            • cenobamate

              cenobamate will decrease the level or effect of mefloquine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

            • ceritinib

              mefloquine increases levels of ceritinib by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

            • cimetidine

              cimetidine will increase the level or effect of mefloquine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • ciprofloxacin

              ciprofloxacin and mefloquine both increase QTc interval. Use Caution/Monitor. Ciprofloxacin elicits minimal effects on QT interval. Caution if used in combination with other drugs known to affect QT interval or in patients with other risk factors.

            • clevidipine

              mefloquine increases levels of clevidipine by decreasing metabolism. Use Caution/Monitor. Risk of arrhythmia.

            • clotrimazole

              clotrimazole will increase the level or effect of mefloquine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • clozapine

              clozapine will increase the level or effect of mefloquine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              clozapine and mefloquine both increase QTc interval. Use Caution/Monitor.

            • crizotinib

              crizotinib will increase the level or effect of mefloquine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • crofelemer

              crofelemer increases levels of mefloquine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Crofelemer has the potential to inhibit CYP3A4 at concentrations expected in the gut; unlikely to inhibit systemically because minimally absorbed.

            • cyclosporine

              cyclosporine will increase the level or effect of mefloquine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • dabigatran

              mefloquine will increase the level or effect of dabigatran by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Atrial fibrillation: Avoid coadministering dabigatran with P-gp inhibitors if CrCl <30 mL/min. DVT/PE treatment: Avoid coadministering dabigatran with P-gp inhibitors if CrCl <50 mL/min

            • dabrafenib

              dabrafenib will decrease the level or effect of mefloquine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely.

            • degarelix

              degarelix and mefloquine both increase QTc interval. Use Caution/Monitor.

            • desipramine

              desipramine will increase the level or effect of mefloquine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • deutetrabenazine

              deutetrabenazine and mefloquine both increase QTc interval. Use Caution/Monitor.

            • diltiazem

              mefloquine increases levels of diltiazem by decreasing metabolism. Use Caution/Monitor. Risk of arrhythmia.

              diltiazem will increase the level or effect of mefloquine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • dolasetron

              dolasetron and mefloquine both increase QTc interval. Use Caution/Monitor.

            • donepezil

              donepezil and mefloquine both increase QTc interval. Use Caution/Monitor.

            • doxycycline

              doxycycline will increase the level or effect of mefloquine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • dronedarone

              dronedarone will increase the level or effect of mefloquine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • duvelisib

              duvelisib will increase the level or effect of mefloquine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Coadministration with duvelisib increases AUC of a sensitive CYP3A4 substrate which may increase the risk of toxicities of these drugs. Consider reducing the dose of the sensitive CYP3A4 substrate and monitor for signs of toxicities of the coadministered sensitive CYP3A substrate.

            • efavirenz

              efavirenz will decrease the level or effect of mefloquine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              efavirenz and mefloquine both increase QTc interval. Use Caution/Monitor.

            • elagolix

              elagolix decreases levels of mefloquine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Elagolix is a weak-to-moderate CYP3A4 inducer. Monitor CYP3A substrates if coadministered. Consider increasing CYP3A substrate dose if needed.

            • eliglustat

              eliglustat increases levels of mefloquine by P-glycoprotein (MDR1) efflux transporter. Modify Therapy/Monitor Closely. Monitor therapeutic drug concentrations, as indicated, or consider reducing the dosage of the P-gp substrate and titrate to clinical effect.

            • elvitegravir/cobicistat/emtricitabine/tenofovir DF

              elvitegravir/cobicistat/emtricitabine/tenofovir DF increases levels of mefloquine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Cobicistat is a CYP3A4 inhibitor; contraindicated with CYP3A4 substrates for which elevated plasma concentrations are associated with serious and/or life-threatening events.

            • encorafenib

              encorafenib, mefloquine. affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Encorafenib both inhibits and induces CYP3A4 at clinically relevant plasma concentrations. Coadministration of encorafenib with sensitive CYP3A4 substrates may result in increased toxicity or decreased efficacy of these agents.

            • erythromycin base

              erythromycin base will increase the level or effect of mefloquine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • erythromycin ethylsuccinate

              erythromycin ethylsuccinate will increase the level or effect of mefloquine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • erythromycin lactobionate

              erythromycin lactobionate will increase the level or effect of mefloquine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • erythromycin stearate

              erythromycin stearate will increase the level or effect of mefloquine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • escitalopram

              escitalopram increases toxicity of mefloquine by QTc interval. Use Caution/Monitor.

            • esmolol

              mefloquine increases levels of esmolol by decreasing metabolism. Use Caution/Monitor. Risk of arrhythmia.

            • etravirine

              etravirine will decrease the level or effect of mefloquine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • ezogabine

              ezogabine, mefloquine. Either increases toxicity of the other by QTc interval. Use Caution/Monitor. Slight and transient QT-prolongation observed with ezogabine, particularly when dose titrated to 1200 mg/day. QT interval should be monitored when ezogabine is prescribed with agents known to increase QT interval.

            • fedratinib

              fedratinib will increase the level or effect of mefloquine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Adjust dose of drugs that are CYP3A4 substrates as necessary.

            • felodipine

              mefloquine increases levels of felodipine by decreasing metabolism. Use Caution/Monitor. Risk of arrhythmia.

            • finerenone

              mefloquine will increase the level or effect of finerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Monitor serum potassium during initiation and dosage adjustment of either finererone or weak CYP3A4 inhibitors. Adjust finererone dosage as needed.

            • flibanserin

              mefloquine will increase the level or effect of flibanserin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Increased flibanserin adverse effects may occur if coadministered with multiple weak CYP3A4 inhibitors.

            • fluconazole

              fluconazole will increase the level or effect of mefloquine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • fostemsavir

              mefloquine and fostemsavir both increase QTc interval. Use Caution/Monitor. QTc prolongation reported with higher than recommended doses of fostemsavir.

            • glecaprevir/pibrentasvir

              mefloquine will increase the level or effect of glecaprevir/pibrentasvir by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

              glecaprevir/pibrentasvir will increase the level or effect of mefloquine by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

            • grapefruit

              grapefruit will increase the level or effect of mefloquine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • haloperidol

              haloperidol and mefloquine both increase QTc interval. Use Caution/Monitor.

              haloperidol will increase the level or effect of mefloquine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • iloperidone

              iloperidone will increase the level or effect of mefloquine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • indacaterol, inhaled

              indacaterol, inhaled, mefloquine. QTc interval. Use Caution/Monitor. Drugs that are known to prolong the QTc interval may have an increased the risk of ventricular arrhythmias.

            • isavuconazonium sulfate

              mefloquine will increase the level or effect of isavuconazonium sulfate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • isoniazid

              isoniazid will increase the level or effect of mefloquine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • isradipine

              mefloquine increases levels of isradipine by decreasing metabolism. Use Caution/Monitor. Risk of arrhythmia.

            • istradefylline

              istradefylline will increase the level or effect of mefloquine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Istradefylline 40 mg/day increased peak levels and AUC of CYP3A4 substrates in clinical trials. This effect was not observed with istradefylline 20 mg/day. Consider dose reduction of sensitive CYP3A4 substrates.

            • ivacaftor

              ivacaftor increases levels of mefloquine by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Ivacaftor and its M1 metabolite has the potential to inhibit P-gp; may significantly increase systemic exposure to sensitive P-gp substrates with a narrow therapeutic index.

            • labetalol

              mefloquine increases levels of labetalol by decreasing metabolism. Use Caution/Monitor. Risk of arrhythmia.

            • lapatinib

              lapatinib will increase the level or effect of mefloquine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • lemborexant

              mefloquine will increase the level or effect of lemborexant by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Lower nightly dose of lemborexant recommended if coadministered with weak CYP3A4 inhibitors. See drug monograph for specific dosage modification.

            • lidocaine

              lidocaine will increase the level or effect of mefloquine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • lomitapide

              mefloquine increases levels of lomitapide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Lomitapide dose should not exceed 30 mg/day.

            • lorlatinib

              lorlatinib will decrease the level or effect of mefloquine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • lumefantrine

              mefloquine decreases levels of lumefantrine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Mefloquine decreases bile production; take Coartem (lumefantrine) during food consumption.

            • metoprolol

              mefloquine increases levels of metoprolol by decreasing metabolism. Use Caution/Monitor. Risk of arrhythmia.

            • metronidazole

              metronidazole will increase the level or effect of mefloquine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • midazolam intranasal

              mefloquine will increase the level or effect of midazolam intranasal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Coadministration of mild CYP3A4 inhibitors with midazolam intranasal may cause higher midazolam systemic exposure, which may prolong sedation.

            • mifepristone

              mifepristone, mefloquine. QTc interval. Modify Therapy/Monitor Closely. Use alternatives if available.

            • mitotane

              mitotane decreases levels of mefloquine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Mitotane is a strong inducer of cytochrome P-4503A4; monitor when coadministered with CYP3A4 substrates for possible dosage adjustments.

            • nadolol

              mefloquine increases levels of nadolol by decreasing metabolism. Use Caution/Monitor. Risk of arrhythmia.

            • nafcillin

              nafcillin will decrease the level or effect of mefloquine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • naldemedine

              mefloquine increases levels of naldemedine by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Monitor naldemedine for potential adverse effects if coadministered with P-gp inhibitors.

            • nebivolol

              mefloquine increases levels of nebivolol by decreasing metabolism. Use Caution/Monitor. Risk of arrhythmia.

            • nevirapine

              nevirapine will decrease the level or effect of mefloquine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • nicardipine

              mefloquine increases levels of nicardipine by decreasing metabolism. Use Caution/Monitor. Risk of arrhythmia.

            • nifedipine

              mefloquine increases levels of nifedipine by decreasing metabolism. Use Caution/Monitor. Risk of arrhythmia.

            • nintedanib

              mefloquine increases levels of nintedanib by P-glycoprotein (MDR1) efflux transporter. Modify Therapy/Monitor Closely. If nintedanib adverse effects occur, management may require interruption, dose reduction, or discontinuation of therapy .

            • nisoldipine

              mefloquine increases levels of nisoldipine by decreasing metabolism. Use Caution/Monitor. Risk of arrhythmia.

            • olodaterol inhaled

              mefloquine and olodaterol inhaled both increase QTc interval. Use Caution/Monitor. Drugs that prolong the QTc interval and may potentiate the effects of beta2 agonists on the cardiovascular system; increased risk of ventricular arrhythmias

            • osilodrostat

              osilodrostat and mefloquine both increase QTc interval. Use Caution/Monitor.

            • osimertinib

              osimertinib and mefloquine both increase QTc interval. Use Caution/Monitor. Conduct periodic monitoring with ECGs and electrolytes in patients taking drugs known to prolong the QTc interval.

            • ozanimod

              ozanimod and mefloquine both increase QTc interval. Modify Therapy/Monitor Closely. The potential additive effects on heart rate, treatment with ozanimod should generally not be initiated in patients who are concurrently treated with QT prolonging drugs with known arrhythmogenic properties.

            • pasireotide

              mefloquine and pasireotide both increase QTc interval. Modify Therapy/Monitor Closely.

            • penbutolol

              mefloquine increases levels of penbutolol by decreasing metabolism. Use Caution/Monitor. Risk of arrhythmia.

            • phenobarbital

              phenobarbital, mefloquine. Either decreases effects of the other by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • pindolol

              mefloquine increases levels of pindolol by decreasing metabolism. Use Caution/Monitor. Risk of arrhythmia.

            • ponatinib

              ponatinib increases levels of mefloquine by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

            • primidone

              primidone will decrease the level or effect of mefloquine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • propranolol

              mefloquine increases levels of propranolol by decreasing metabolism. Use Caution/Monitor. Risk of arrhythmia.

            • quetiapine

              quetiapine, mefloquine. Either increases toxicity of the other by QTc interval. Use Caution/Monitor. Avoid use with drugs that prolong QT and in patients with risk factors for prolonged QT interval. Postmarketing cases show QT prolongation with overdose in patients with concomitant illness or with drugs known to cause electrolyte imbalance or prolong QT.

            • ribociclib

              ribociclib will increase the level or effect of mefloquine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • rifabutin

              rifabutin will decrease the level or effect of mefloquine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • rifampin

              rifampin will decrease the level or effect of mefloquine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • rifapentine

              rifapentine will decrease the level or effect of mefloquine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • rifaximin

              mefloquine increases levels of rifaximin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

            • rilpivirine

              rilpivirine increases toxicity of mefloquine by QTc interval. Use Caution/Monitor. Rilpivirine should be used with caution when co-administered with a drug with a known risk of Torsade de Pointes.

            • rivaroxaban

              mefloquine increases levels of rivaroxaban by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Patients with renal impairment receiving rivaroxaban with drugs that are combined P-gp and weak or moderate CYP3A4 inhibitors may have significant increases in exposure compared with patients with normal renal function and no inhibitor use, since both pathways of rivaroxaban elimination are affected. Since these increases may increase bleeding risk, use rivaroxaban in this situation only if the potential benefit justifies the potential risk.

            • rucaparib

              rucaparib will increase the level or effect of mefloquine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Adjust dosage of CYP3A4 substrates, if clinically indicated.

            • secobarbital

              secobarbital will decrease the level or effect of mefloquine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • selpercatinib

              selpercatinib increases toxicity of mefloquine by QTc interval. Use Caution/Monitor.

            • sertraline

              sertraline will increase the level or effect of mefloquine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • sorafenib

              sorafenib and mefloquine both increase QTc interval. Use Caution/Monitor.

            • sotalol

              mefloquine increases levels of sotalol by decreasing metabolism. Use Caution/Monitor. Risk of arrhythmia.

            • stiripentol

              stiripentol, mefloquine. affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Stiripentol is a CYP3A4 inhibitor and inducer. Monitor CYP3A4 substrates coadministered with stiripentol for increased or decreased effects. CYP3A4 substrates may require dosage adjustment.

            • talazoparib

              mefloquine will increase the level or effect of talazoparib by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Talazoparib is a P-glycoprotein (P-gp) substrate; coadministration with P-gp inhibitors may increase talazoparib systemic exposure.

            • tazemetostat

              mefloquine will increase the level or effect of tazemetostat by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • tecovirimat

              tecovirimat will decrease the level or effect of mefloquine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Tecovirimat is a weak CYP3A4 inducer. Monitor sensitive CYP3A4 substrates for effectiveness if coadministered.

            • tetracycline

              tetracycline will increase the level or effect of mefloquine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • ticagrelor

              ticagrelor will increase the level or effect of mefloquine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • timolol

              mefloquine increases levels of timolol by decreasing metabolism. Use Caution/Monitor. Risk of arrhythmia.

            • tinidazole

              mefloquine will increase the level or effect of tinidazole by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • verapamil

              mefloquine increases levels of verapamil by decreasing metabolism. Use Caution/Monitor. Risk of arrhythmia.

              verapamil will increase the level or effect of mefloquine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • voclosporin

              voclosporin, mefloquine. Either increases effects of the other by QTc interval. Use Caution/Monitor.

            • zileuton

              zileuton will increase the level or effect of mefloquine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            Minor (5)

            • azithromycin

              azithromycin increases toxicity of mefloquine by QTc interval. Minor/Significance Unknown.

            • chloroquine

              chloroquine increases toxicity of mefloquine by QTc interval. Minor/Significance Unknown.

            • ritonavir

              mefloquine decreases levels of ritonavir by unknown mechanism. Minor/Significance Unknown.

            • ruxolitinib

              mefloquine will increase the level or effect of ruxolitinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

            • valproic acid

              mefloquine decreases levels of valproic acid by unspecified interaction mechanism. Minor/Significance Unknown.

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            Adverse Effects

            1-10%

            Anxiety

            Difficulty concentrating

            Headache

            Insomnia

            Lightheadedness

            Vertigo

            Vomiting

            Diarrhea

            Stomach pain

            Nausea

            Visual disturbances

            Tinnitus

            Frequency Not Defined

            Suicidal depression

            Psychiatric Sx

            Pneumonitis

            Seizure

            Abnormal ECG

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            Warnings

            Black Box Warnings

            May cause neuropsychiatric adverse reactions that can persist after mefloquine has been discontinued

            Should not be prescribed for prophylaxis in patients with major psychiatric disorders

            During prophylactic use, if psychiatric or neurologic symptoms occur, the drug should be discontinued and an alternative medication should be substituted

            Contraindications

            Hypersensitivity to mefloquine, related drugs (eg, quinidine, quinine)

            Do not prescribe for prophylaxis in patients with active or recent history of depression, generalized anxiety disorder; history of psychosis, schizophrenia, other major psychiatric disorders, or convulsions

            Cautions

            In case of life-threatening, serious or overwhelming malaria infections due to P. falciparum, patients should be treated with an IV antimalarial drug; following completion of IV treatment, mefloquine may be given to complete the course of therapy

            May increase QT interval; caution with other drugs known to prolong QT interval; halofantrine or strong CYP3A4 inhibitors (eg, ketoconazole) should not be administered concomitantly or within 15 weeks of last dose of mefloquine due to risk of a potentially fatal prolongation of QTc interval

            Transitory and clinically silent ECG alterations have been reported during therapy; alterations included sinus bradycardia, sinus arrhythmia, first-degree AV-block, and abnormal T waves; benefits of therapy should be weighed against possibility of adverse effects in patients with cardiac disease

            Caution with hepatic impairment

            If drug is to be administered for a prolonged period, periodic evaluations including liver function tests and evaluations for neuropsychiatric effects should be performed

            Agranulocytosis and aplastic anemia reported

            Geographical drug resistance patterns of P. falciparum occur and the preferred choice of malaria prophylaxis might be different from one area to another

            Periodic ophthalmic examinations recommended; retinal abnormalities seen in humans with long-term chloroquine use have not been observed with mefloquine use; however, long- term feeding of mefloquine to rats resulted in dose-related ocular lesions

            Psychiatric and neurologic adverse effects

            • May cause neuropsychiatric adverse reactions, which may be difficult to identify in children; monitor for symptoms, especially in nonverbal children
            • Psychiatric symptoms ranging from anxiety, paranoia, and depression to hallucinations and psychotic behavior can occur; symptoms may occur early in the course of mefloquine use and in some cases, these symptoms have been reported to continue for months or years after mefloquine has been stopped
            • Cases of suicidal ideation and suicide have been reported
            • Should not be prescribed for prophylaxis in patients with active depression, generalized anxiety disorder, psychosis, or schizophrenia or other major psychiatric disorders
            • Dizziness or vertigo, tinnitus, and loss of balance reported; these symptoms were reported to be permanent in some cases
            • May increase the risk of convulsions in patients with epilepsy; prescribed only for curative treatment in such patients and only if there are compelling medical reasons for its use
            • Concomitant administration of mefloquine and quinine or chloroquine may increase the risk of convulsions
            • During prophylactic use, if symptoms emerge, discontinue and substitute treatment with a different antimalarial agent
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            Pregnancy & Lactation

            Pregnancy Category: B

            Lactation: Minimally excreted in human breast milk; based on a study in a few subjects, low concentrations (3% to 4%) excreted; caution advised

            Pregnancy Categories

            A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

            B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

            C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

            D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

            X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

            NA: Information not available.

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            Pharmacology

            Mechanism of Action

            Structural analog of quinine; exact mechanism unknown, acts as a blood schizonticide

            May increase intravesicular pH in parasites

            Absorption

            Bioavailability: Well absorbed; >85%; food enhances bioavailability by ~40%

            Peak plasma time: 17 hr (range 6-24 hr)

            Peak plasma concentration: 1000-2000 mcg/L (after 7-10 wk of 250 mg once weekly dosing)

            Distribution

            Vd: 20 L/kg; blood, urine, CSF, tissues; enters breast milk

            Protein Bound: 98%

            Metabolism

            Extensively metabolized in liver by CYP3A4

            Metabolites: 2,8-bistrifluoromethyl-4-quinoline carboxylic acid is inactive

            Elimination

            Half-life: 21-22 days

            Total clearance (hepatic): 30 mL/min

            Excretion: Mainly in bile and feces; urine (~1.5-9% as unchanged drug)

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            Images

            BRAND FORM. UNIT PRICE PILL IMAGE
            mefloquine oral
            -
            250 mg tablet
            mefloquine oral
            -
            250 mg tablet

            Copyright © 2010 First DataBank, Inc.

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            Patient Handout

            Patient Education
            mefloquine oral

            MEFLOQUINE - ORAL

            (MEFF-low-kwin)

            COMMON BRAND NAME(S): Lariam

            WARNING: Mefloquine may cause mental/mood or nervous system problems. Tell your doctor right away if you have any of these serious side effects, including: mental/mood changes (such as anxiety, depression, restlessness, confusion, hallucinations, suicidal thoughts/attempts), ringing in the ears, dizziness, lightheadedness, loss of balance, or trouble sleeping. These side effects may continue to occur even after stopping mefloquine and certain side effects (such as dizziness, ringing in the ears, loss of balance) may become permanent. This medication should not be used to prevent malaria in people who have mental/mood disorders (such as depression, schizophrenia).

            USES: This medication is used to treat and prevent malaria.

            HOW TO USE: Read the Medication Guide provided by your pharmacist before you start taking mefloquine and each time you get a refill. If you have any questions, ask your doctor or pharmacist. Carry the information wallet card with you at all times.Take this medication by mouth as directed by your doctor. Take it with food or milk to prevent stomach upset. Do not take the medication on an empty stomach. Take each dose of this medication with a full glass (8 ounces or 240 milliliters) of water. If you have trouble swallowing the medication, the tablet may be crushed and placed in a small amount of water, milk, or other beverage.For children, the dosage is based on their weight. Early vomiting may occur in children after taking mefloquine. If vomiting occurs in your child after taking this medication, call the doctor right away to see if your child needs to take another dose of the medication. If vomiting continues, check with your doctor for a different medication to use in place of mefloquine.When using this medication to prevent malaria, it is usually taken once a week. The first dose of this medication should be taken one week before travel, or as directed by your doctor.Take this medication as prescribed for the full course of treatment. It is important that you do not miss any doses and that you take the drug on a regularly scheduled basis. Remember to take it on the same day each week.Upon returning from the malaria area, you should keep taking this medication for 4 more weeks. If you are unable to finish this course of mefloquine, contact your doctor.If this medication is being used for prevention of malaria, it is important to understand that it is still possible to contract the disease. Tell your doctor right away if you develop a fever. Malaria is best treated if therapy is started early.

            SIDE EFFECTS: See also Warning section.Stomach upset/pain, loss of appetite, nausea/vomiting, headache, muscle pain, or diarrhea may occur. If any of these effects persist or worsen, tell your doctor promptly.Remember that this medication has been prescribed because your doctor has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.Tell your doctor right away if you have any serious side effects, including: loss of coordination, numbness/tingling/pain of hands or feet, vision changes, unusual tiredness, persistent nausea/vomiting, dark urine, yellowing skin/eyes.Get medical help right away if you have any very serious side effects, including: fast/slow/irregular heartbeat, fainting, seizures.A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

            PRECAUTIONS: Before taking mefloquine, tell your doctor or pharmacist if you are allergic to it; or to quinine or quinidine; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.Before using this medication, tell your doctor or pharmacist your medical history, especially of: mental/mood disorders (such as depression, anxiety, schizophrenia), seizures, heart problems, liver disorder.This drug may make you dizzy or lose your balance. Alcohol or marijuana (cannabis) can make you more dizzy. Do not drive, use machinery, or do anything that needs alertness until you can do it safely. Limit alcoholic beverages. Talk to your doctor if you are using marijuana (cannabis).Before having surgery, tell your doctor or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).Mefloquine may cause live bacterial vaccines (such as typhoid vaccine) not to work well. Tell your health care professional that you are using mefloquine before having any immunizations/vaccinations.During pregnancy, this medication should be used only when clearly needed. Discuss the risks and benefits with your doctor.This drug passes into breast milk. Consult your doctor before breast-feeding.

            DRUG INTERACTIONS: Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval.Some products that may interact with this drug include: artemether-lumefantrine, beta-blockers (such as atenolol, propranolol), chloroquine, halofantrine, ketoconazole, quinidine, quinine, drugs for seizures (such as phenytoin, valproic acid), ziprasidone.Do not take halofantrine or ketoconazole for 15 weeks after your last dose of mefloquine.Other medications can affect the removal of mefloquine from your body, which may affect how mefloquine works. Examples include rifamycins (such as rifabutin), azole antifungals (such as itraconazole), among others.

            OVERDOSE: If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center.

            NOTES: Do not share this medication with others.It is important to wear protective clothing, insect repellent, and use bednets when trying to prevent malaria.If you are taking this medication for a long time, laboratory and/or medical tests (such as eye exams, liver function) should be performed periodically to monitor your progress or check for side effects. Consult your doctor for more details.

            MISSED DOSE: If you miss a dose, take it as soon as you remember. If it is near the time of the next dose, skip the missed dose. Take your next dose at the regular time. Do not double the dose to catch up.

            STORAGE: Store at room temperature away from light and moisture. Do not store in bathroom. Keep all medications away from children and pets.Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company for more details about how to safely discard your product.

            Information last revised October 2021. Copyright(c) 2021 First Databank, Inc.

            IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.

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            Formulary

            FormularyPatient Discounts

            Adding plans allows you to compare formulary status to other drugs in the same class.

            To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.

            Adding plans allows you to:

            • View the formulary and any restrictions for each plan.
            • Manage and view all your plans together – even plans in different states.
            • Compare formulary status to other drugs in the same class.
            • Access your plan list on any device – mobile or desktop.

            The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
            3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
            4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
            QL Quantity Limits
            Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
            ST Step Therapy
            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
            OR Other Restrictions
            Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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            Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.