Seneste artikler om lariam:

Nyt fra USA
Voice of America News bragte den 6. april 2001 en opsigtsvækkende historie, hvori beskadigelse af hjernen pga lariam bliver omtalt og dokumenteret :

Unintended Damage

by Carolyn Weaver

INTRODUCTION: April seventh marks World Health Day… a day the World Health Organization selects to highlight a public health issue. We're going to take this opportunity to highlight a highly dangerous infection--malaria--which still threatens the health of millions. But, ironically, some say the cures may be as devastating as the disease itself.U.S. health officials say the drug "Lariam" has prevented millions of infections, especially in countries where malaria is resistant to other drugs. But in some people, the drug causes severe neuro-psychiatric side effects. VOA's (Voice of America) Carolyn Weaver reports on a life-saving medicine that may also be a prescription for "unintended damage."
NARRATOR Kristi Anderson was a federal criminal investigator when she traveled to South Africa on vacation in 1991. To protect her against malaria -- a potentially fatal disease carried by mosquitoes -- Ms. Anderson's doctor prescribed a drug called mefloquine, sold in the United States under the brand name Lariam. After the third pill, she began having constant dizziness, nausea, and panic attacks.
KRISTI ANDERSON "I would sweat, I would have chills, I'd shake. Almost, always, there was nausea, but sometimes it was a wave of dizziness or vertigo, and then I would start having this feeling of impending doom. I wanted to get out of where I was, I just wanted to get back home or someplace where I felt safe because I was afraid something terrible might happen."
NARRATOR Nauseated and losing weight -- and tormented by anxiety and phobias -- Kristi Anderson quit her job and moved back home to California for a year and a half, until she was well enough to go back to work. But in 1996, she returned to South Africa - and again took Lariam - and again became violently ill. Only then did she begin to suspect the drug was the cause.
KRISTI ANDERSON "He said the damage was in my brain stem."
NARRATOR Neurological tests at Stanford University's California Ear Institute, confirmed Kristi's suspicion finding damage to a part of the brain, the vestibular system, that controls balance.
KRISTI ANDERSON "He told me, from the Lariam patients he had seen and what his tests showed, he believed that Lariam was the cause of my vestibular problems and he thought it was the cause of the earlier problems as well."
NARRATOR A spokesman for the Roche pharmaceutical company, which makes Lariam, declined VOA's requests for an interview, saying the company saw no advantage to participating. In the 12 years since Lariam was approved for use in the United States, Roche has twice added new warnings of possible adverse effects in the package insert given to doctors. It's a long list, including, among other things, nausea, vomiting, dizziness, convulsions, depression, hallucinations, psychotic or paranoid reactions, and anxiety. But few patients ever see the package insert. And many tropical health and travel doctors, like former State Department consultant Martin Wolfe, prescribe Lariam routinely. They're acting on the guidance of the Centers for Disease Control and Prevention, which recommends Lariam as one of the most effective drugs for preventing malaria. It's a disease endemic in many parts of Africa and Asia, where it kills more than one million people, most of them children, every year.
MARTIN WOLFE "We do prescribe it very frequently because it only has to be taken once a week, and we believe the compliance is better with a drug taken once a week than one taken daily. And since we are protecting against a potentially life threatening illness, we want to do the very best we can to encourage people to take their medication."
NARRATOR It's impossible to pin down the incidence, but some experts say the rate of severe reactions is far higher than the one in ten-thousand cited in early research by Roche. A study presented at an infectious disease conference last fall reported mild to serious neuropsychiatric adverse effects in 29% of travelers on Lariam.
RAYMOND WOOSLEY "There are some very serious reactions that appear to be happening more commonly."
NARRATOR Dr. Raymond Woosley is the head of pharmacology at Georgetown University in Washington, D.C.
RAYMOND WOOSLEY "You look in the package insert, they're listed there. So they are real, there is no doubt about that. But the true incidence is something we don't understand, and it really doesn't matter, because they're such severe reactions that patients need to be warned about this."
NARRATOR Colonel Wilbur Milhous was among the military scientists who first developed Lariam at the Walter Reed Army Institute for Medical Research -- and then gave the rights to make and sell the drug to the Roche company. But as reports of severe reactions to Lariam began to emerge -- and as lawsuits were filed over illness and violence allegedly linked to the drug -- he says the government feared that Roche would pull the drug off the market.
WILBUR MILHOUS "There was clearly an unmet medical need which the drug fulfilled. We were frightened from a U.S. perspective, in terms of national contingencies, what would happen if it were withdrawn?"
NARRATOR So, Colonel Milhous says, top government health officials promised Roche they would continue to back Lariam, despite the growing reports of adverse effects. Officials at the Centers for Disease Control and the Food and Drug Administration, which approved the Lariam, declined VOA's request for an interview. But earlier this year, the CDC updated its malaria protection guidelines, offering alternative drugs, including doxycycline and Malarone, for those who do not wish to take Lariam.
WILBUR MILHOUS "This is essentially the type of laboratory where this all started."
NARRATOR Colonel Wilbur Milhous says American health officials now are looking ahead, to the next generation of drugs --largely because of growing resistance to Lariam in some strains of malaria. But there is little doubt that Lariam will continue to be prescribed for months…and years to come, to Peace Corps volunteers, soldiers, and ordinary travelers.
Despite bouts of dizziness, Kristi Anderson has resumed her career, and tends her California flower farm on weekends. She says she's felt more at peace since she came upon a newspaper article about Lariam that explained her mental symptoms.
KRISTI ANDERSON"Reading that article released me from this shame of 'Kristi, you're some kind of weak person and you better watch out because you're going to have a nervous breakdown again sometime, you just better be careful. I realized, that's what made me sick -- that's what happened to me – that's why I became a different person."
NARRATORCarolyn Weaver, VOA-TV.

Tilbage

1. Fra Lariam Action i USA har vi modtaget nedenstående :
   Dear friends of Lariam Action, In the past two weeks we have sent out 80 press kits to major newspapers in the US, news services, tv and radio stations, and selected personal contacts. The kits contained :
   1) a press release (below),
   2) Escape magazine article, July 1999
   3) copy of a message posted to the Peace Corps bulletin board about the Escape article,
   4) our Lariam Action brochure, "Facts about malaria and anti-malaria drugs."
   Thought you would be interested in this information. Thanks! jeanne
   * * * * *
   June 15, 1999 For Immediate Release Contact Jeanne Lese, 415-492-8424
   Information Blackout about Lariam's Side Effects Outrageous
   OAKLAND, CA—The U.S. media have been silent for too long about the damaging side effects of Lariam® (mefloquine, Roche Pharmaceuticals), asserts Lariam Action USA. And the drug manufacturer's failure to fully disclose in the U.S. information about Lariam's side effects makes the information blackout blacker. Charmian Cohen, director of the organization and a Lariam victim herself, wants to shine some light on this dark situation.

Lariam is the most widely prescribed antimalaria drug in the world. According to Hans Lobel, MD, of the Centers for Disease Control (CDC), at least 12 million people have taken Lariam, which was introduced in the U.S. in 1989. Although no one knows exactly how many people have suffered serious adverse effects from this drug, London's Malaria Advisory Services to Travellers Abroad (MASTA) estimates conservatively that more than 60,000 people could be affected with temporarily disabling neuropsychiatric side effects from Lariam.(1)

Lariam can cause a wide range of dramatic, long-lasting physical and mental side effects. Its physical side effects may include transient to persistent dizziness, insomnia, gastrointestinal problems, severe headache, muscle problems, weakness, and overwhelming fatigue. Lariam's neuropsychiatric side effects may include panic attacks, suicidal ideas, hallucinations, terrifying nightmares, lingering psychoses, and severe, sustained depression. Most side effects occur after the ingestion of 1 to 4 tablets. Even one pill can cause immediate and long-term damage. There is no way to predict who will react to Lariam. And because of the lack of awareness about Lariam in this country, many people who suffer from its side effects are misdiagnosed.

Lariam Action USA's new website supplies much of the missing information American doctors need. Physicians in other countries are better informed about Lariam and are much more cautious about its use. Cohen states, "We provide the U.K.’s patient product information because the U.S. version is badly out of date. We have direct links to the U.K.'s 'Guidelines for the Prevention of Malaria,' the MASTA study, other independent medical studies, articles, websites, and other important Lariam resources."

Over the past two years, Lariam Action USA has heard from nearly 500 people reporting significant Lariam side effects. Cohen observes, "Lariam is given to healthy people who want to avoid getting malaria. We are told how effective Lariam is at preventing the disease, but we hear nothing about its dark side. After you've suffered a severe toxic Lariam reaction firsthand, and compared horror stories with others with similar experiences, you develop a sense of outrage. Enough is enough. No one else should have to endure this suffering."

Despite mounting reports of serious Lariam reactions and litigation against the manufacturer, the media in America have ignored the Lariam story. Two notable exceptions are "Malaria's Not So Magic Bullet" in ESCAPE magazine, July 1999, and "Some Find Malaria Drug Worse Than the Disease," San Francisco Examiner, May 17, 1998 (both online). In other countries however there is no Lariam blackout. Ireland and Denmark have had extensive media coverage about Lariam in 1999. Lariam documentaries were aired in the U.K. in1996–97 and in Canada in 1997. MP John Cummins' investigation of the use of Lariam by Canadian troops in Somalia has been widely reported in the Canadian press. Many attribute the soldiers’ uncharacteristic violence in that war to psychotic side effects of Lariam.

Tilbage

Det australske TV program Insight er udsendt nationalt samt genudsendt dagen efter. Sheldon Johnston er fra den australske patientforening. Han har fået SÅ mange henvendelser efter udsendelsen, at han er ved at drukne, henvendelser både fra lariam-ofre og fra læger - og fra Roche.
Her er hele udsendelsesteksten:

Lariam - A Bad Trip

Insight, Thursday February 17th, 2000

Reporter: Alan Sunderland

EACH YEAR AT LEAST THREE MILLION AUSTRALIANS HEAD OFF OVERSEAS...ON BUSINESS, ON HOLIDAYS, OR TO VISIT FRIENDS AND RELATIVES. ALMOST ONE IN THREE OF THESE TRAVELLERS FLY TO EXOTIC AND DANGEROUS DESTINATIONS... THE BACKBLOCKS OF ASIA, THE JUNGLES OF AFRICA.
traveller: "Have you got your passport? Where are you flying to? Harare? Okay, have you got your passport and ticket there please. Yes I do"
BUT WHAT MANY DON'T REALISE IS THAT ONE THE BIGGEST DANGERS THEY COULD FACE IS FROM SOMETHING THEY'RE CARRYING WITH THEM. A DRUG, DESIGNED FOR THEIR PROTECTION, THAT'S DRIVING SOME PEOPLE INTO DEEP DEPRESSION, HALLUCINATIONS, THOUGHTS OF SUICIDE, EVEN SELF-MUTILATION...ALMOST FIVE YEARS AGO, SHELDON JOHNSTON WAS ONE OF THOSE AUSTRALIANS OFF TO SEE THE WORLD. A FIT, ADVENTUROUS YOUNG MAN AND A SEASONED TRAVELLER, HE WAS ABOUT TO EMBARK ON A SEVEN MONTH ADVENTURE IN AFRICA...
Sheldon Johnston: "I was on an overland truck trip going through Africa., I started in London..."
BEFORE HE LEFT LONDON, SHELDON WAS CAREFUL TO GET ALL THE ROUTINE MEDICAL PROTECTION HE NEEDED, INCLUDING ANTI-MALARIALS...
Sheldon Johnston:"I didn't really even see a doctor, I just saw a practice nurse whose job it was to jab me with a needle and send me on my way with a prescription."
THAT PRESCRIPTION WAS ABOUT TO TAKE SHELDON JOHNSTON ON A JOURNEY INTO HELL....
Sheldon Johnston: "I thought my body was just adjusting and I'd gotten through it after a week, but one little illness after another, what I mistakenly thought was a cold, dehydration sickness, what was misdiagnosed as malaria and typhoid, all along the way I visited five hospitals in Nigeria and Cameroon."
EVENTUALLY, SHELDON SUFFERED A SEIZURE IN THE WILDS OF CAMEROON, AND FINISHED UP, EMACIATED AND EXHAUSTED, IN YET ANOTHER TINY HOSPITAL...
Sheldon Johnston: "So I was on a drip overnight in this small village hospital, and I would say that I was gravely ill at that stage. I think a few of my travel companions in hindsight were actually afraid that I was going to die..."
WE MOVE FORWARD A YEAR NOW, TO 1996. ANOTHER YOUNG AUSTRALIAN ON ANOTHER DREAM HOLIDAY IN AFRICA....
Lesley Gidding: "I just wanted to backpack around East Africa, and so I landed in Zimbabwe and worked my way up to, through Malawi, Tanzania, Kenya and Uganda, and I worked in Tanzania and then headed off to Kenya and Uganda"
LESLEY GIDDING ALSO GOT ALL HER VACCINATIONS AND HER ANTI-MALARIALS. AND, LIKE SHELDON, HER TRIP WAS ABOUT TO TURN INTO A NIGHTMARE...
Lesley Gidding: "I remember, actually I was reading my journal last night to remind me of how I was feeling at that time, and I was writing that my head was spinning, and that I was in this haze, and I didn't quite under stand where I was or what was happening to me and I was really scared"
Lesley reading: "16th March 1997. I'm tired, numb and hazy headed. I'll probably maybe if I can write again when things become clearer." "I don't feel anything. Nothing. Absolutely nothing feels real to me at the moment, and hasn't done for a long long time."
A VIDEO SHOT BY LESLEY'S FRIENDS AT THE TIME SHOW HER PUTTING A BRAVE FACE ON HER AFRICAN HOLIDAY, BUT BEHIND THE SCENES THINGS WERE VERY DIFFERENT...LESLEY HAD BOUTS OF FEVER, FLU-LIKE SYMPTOMS AND VOMITING. BUT THAT WAS NOTHING COMPARED TO WHAT HER MIND WAS GOING THROUGH..
Lesley Gidding: "I went into this really weird, I won't call it a depression, but it was more like anxiety and paranoia. I really thought that people were following me, I really thought that people were going to hurt me."
MONTHS EARLIER, IN A DIFFERENT PART OF AFRICA, SHELDON JOHNSTON HAD BEEN EXPERIENCING THE SAME MENTAL SYMPTOMS ALONG WITH HIS PHYSICAL SUFFERING...
Sheldon Johnston: "It was like there was a fog over my brain, and wading through glug just trying to keep my eyes open.""I was also very depressed for no reason, but, to the point where I realised it was madness, there was just no reason behind it, I was almost so, of, errrr, shake my head and think, no I'm not really that sad about being here on holiday and having a good time, you know."
EVENTUALLY, SHELDON BECAME SO SICK HE WAS FLOWN TO LONDON. AT THE HOSPITAL FOR TROPICAL DISEASES IN KINGS CROSS, THE CAUSE OF HIS ILLNESS WAS FINALLY DISCOVERED...
Sheldon Johnston: "After waiting, I was seen by a doctor, after about fifteen minutes of consultation, he was very quick to deduce that I'd probably had mefloquine toxicity."
MEFLOQUINE... MARKETED AROUND THE WORLD UNDER THE BRAND NAME LARIAM. IT'S A HIGHLY EFFECTIVE PREVENTION AND TREATMENT FOR MALARIA. BUT THERE'S A CATCH.WHEN SHELDON ARRIVED BACK IN SYDNEY, AN EMACIATED AND SICK MAN, HE'D DISCOVERED FROM BITTER EXPERIENCE THAT LARIAM CAN CAUSE SEVERE NEURO-PSYCHIATRIC SIDE EFFECTS IN SOME USERS....AS HE BEGAN THE SLOW RECOVERY FROM HIS BOUTS OF DEPRESSION AND SICKNESS, SHELDON DECIDED TO RECORD HIS EXPERIENCE FOR OTHERS, AND RESEARCH THE PROBLEMS OF LARIAM...
Sheldon Johnston: "I started typing out the details of what happened, and that developed into what became a web-site, it wasn't really intended that way.""I very naively put my e-mail address on there, hoping that someone might come back to me and just share their experience."
IT WAS LIKE OPENING THE FLOODGATES. DOZENS OF PEOPLE SENT IN MESSAGES. THOSE DOZENS TURNED INTO HUNDREDS...
Sheldon Johnston: "When that response came back, my in-box was just inundated. I had to take my e-mail address off immediately."
LESLEY GIDDING HAD RETURNED FROM AFRICA UNAWARE OF THE REASON FOR HER MENTAL AND EMOTIONAL PROBLEMS. SHE WAS STILL BATTLING DEEP DEPRESSION AND ANXIETY ATTACKS...
Lesley Gidding: "I described it as my really dark place and I didn't know how to get out. I was just, life was way too bad."'I was thinking life is too much, I'd really like, you know, I'm not saying that I had suicidal tendencies but I thought about it."
AFTER NEARLY TWO YEARS SUFFERING IN IGNORANCE, LESLEY LOOKED UP MALARIA ON THE INTERNET ONE DAY, AND FOUND SHELDON'S SITE...
Lesley Gidding: "And I started reading these things and this was in the middle of this depression and I was seeing a therapist, and I just started crying when I was reading what other people had said on Sheldon's page, because for the first time in all these years, I thought, these people are going through exactly what I went through, and it was amazing it was just this, like a light came on...""I'm not bent, I'm not twisted, its lariam."
SO, IF IT'S THE LARIAM, IF TAKING A COMMONLY PRESCRIBED DRUG CAN CAUSE THAT MANY HEALTH PROBLEMS, THE OBVIOUS QUESTION IS WHY IS IT STILL BEING PRESCRIBED? WHY IS IT STILL BEING TAKEN BY THOUSANDS OF AUSTRALIANS EVERY YEAR?THE FIRST POINT TO MAKE IS THAT MALARIA IS A VERY SERIOUS HEALTH PROBLEM. TWO AND A HALF MILLION PEOPLE, HALF OF THEM CHILDREN UNDER FIVE, DIE FROM THE DISEASE EVERY YEAR, AND THE RATE IS RISING. ANY DRUG THAT CAN OFFER PROTECTION TO TRAVELLERS IS WELCOMED WITH OPEN ARMS BY THE MEDICAL ESTABLISHMENT...THE ARMY MALARIA INSTITUTE IN QUEENSLAND IS ONE OF AUSTRALIA'S LEADING CENTRES FOR MALARIA RESEARCH...
Army researcher : "We've collected some mosquitoes from overseas, and what we have to do, we have to dissect the mosquitoes, remove the salivary glands, and also the head."
THE MALARIA PARASITE BECOMES RESISTANT TO MORE AND MORE DRUGS ALL THE TIME. LARIAM EMERGED ABOUT TEN YEARS AGO AS A NEW AND QUITE EFFECTIVE WEAPON AGAINST MALARIA, PARTICULARLY IN DRUG RESISTANT REGIONS....
Col. Mike Epstein: "Yes, it is a good drug, there is no doubt about that, and it has been responsible for saving many many lives."
FOR THAT REASON, LARIAM IS ONE OF THE TWO DRUGS MOST COMMONLY PRESCRIBED FOR AUSTRALIANS TRAVELLING TO MALARIA PRONE AREAS...
Doctor & patient: "Christine this looks like a fantastic trip you're about to do, you've got a nice long trip, too...""We have a choice between two medicines, medications. The first one is an antibiotic called doxycycline, and the second one is not an antibiotic called mefloquine, trade name lariam.""You have problems with antibiotics? Okay, that says to me that probably we should be focussing on the issue of lariam."
Dr Tony Gherardin: "Mefloquine is one of our mainstays as you are aware for malaria prophylaxis against chloroquine resistant malaria, so it is a very useful tool and one of the two major choices for the high risk areas."
BUT WHAT ABOUT THE WORRYING SIDE-EFFECTS? THE SORT OF MENTAL AND PHYSICAL HEALTH PROBLEMS EXPERIENCED BY PEOPLE LIKE SHELDON AND LESLEY. WELL, FOR A LONG TIME, THE ARGUMENT HAS BEEN THAT THOSE SERIOUS SIDE EFFECTS ARE EXTREMELY RARE...
Dr Tony Gherardin: "The number of people who need to withdraw from mefloquine is not that high."Col, Mike Epstein: "Now these side effects are relatively rare, it occurs in about one in ten thousand cases."
HOFFMAN LA ROCHE, THE COMPANY THAT MAKES LARIAM, HAS ALWAYS ACKNOWLEDGED THAT THE DRUG CAN HAVE NASTY SIDE EFFECTS.IN THE FIRST FEW YEARS OF ITS USE, THE COMPANY'S OWN MONITORING OF THOSE EFFECTS INCLUDED REPORTS OF CONVULSIONS, SEVERE DEPRESSION, ATTEMPTED SUICIDE, HALLUCINATIONS AND PSYCHOTIC EPISODES.THE CONCLUSION, HOWEVER, WAS THAT THEY WERE EXTREMELY RARE, PERHAPS ONE IN TEN THOUSAND. BUT SINCE THEN, THINGS HAVE CHANGED...AS EARLY AS 1993, QUESTIONS WERE BEING ASKED ABOUT THE BEHAVIOUR OF CANADIAN SOLDIERS IN SOMALIA, AFTER AN OUTBREAK OF AGGRESSIVE BEHAVIOUR, AND THE KILLING OF TWO SOMALI TEENAGERS.THE TROOPS WERE TAKING LARIAM, BUT NO CONCLUSIVE LINK WAS EVER ESTABLISHED.SINCE THEN, HOWEVER, A GROWING BODY OF OVERSEAS RESEARCH HAS POINTED TO A MUCH HIGHER RATE OF SIDE EFFECTS WITH LARIAM THAN ANYONE IMAGINED.MOST IMPORTANTLY, THIS STUDY PUBLISHED IN THE BRITISH MEDICAL JOURNAL MORE THAN TWO YEARS AGO SURVEYED TRAVELLERS TAKING LARIAM.IT FOUND THAT ONE IN EVERY 140 TRAVELLERS WILL EXPERIENCE A NEURO-PSYCHIATRIC SIDE EFFECT BAD ENOUGH TO INTERRUPT THEIR DAY TO DAY ACTIVITIES. ONE IN SIX HUNDRED WILL FINISH UP IN HOSPITAL.
WE TRIED TO TALK TO HOFFMAN LA ROCHE ABOUT THESE NEW STUDIES, AND ABOUT HOW SAFE THEY CONSIDERED LARIAM TO BE. BUT THE COMPANY'S AUSTRALIAN PRESIDENT SAYS THEY CAN'T COMMENT, BECAUSE THEY'RE INVOLVED IN LEGAL ACTION OVERSEAS IN RELATION TO THE DRUG. INSIGHT HAS LEARNED THAT HUNDREDS OF PEOPLE IN THE UNITED STATES AND BRITAIN ARE TAKING LEGAL ACTION OVER THE SIDE-EFFECTS OF USING LARIAM.IN THE MEANTIME, TRAVELLERS ARE STILL HEADING OVERSEAS, AND THEY'RE STILL BEING PRESCRIBED LARIAM. THERE HAVE BEEN REGULAR CALLS FOR MORE DETAILED STUDIES TO CONFIRM EXACTLY WHAT'S GOING ON, BUT THAT RESEARCH HAS NEVER BEEN DONE...
Dr. Bernie Hudson: "It's very difficult. The answer as far as adverse reactions and the rates is probably somewhere between one in 140 and one in 10,000.""I think the article from the UK probably didn't get as much exposure to doctors here in Australia."
Dr Tony Gherardin: "I believe mefloquine is a drug that does have a rate of nuisance and perhaps even more than nuisance side effects. That rate is poorly defined, there is no doubt. You would be aware the studies are not helpful in this area."
AS AN EXPERT IN TRAVEL MEDICINE, TONY GHERARDIN IS AT LEAST ABLE TO PROPERLY WARN PEOPLE OF SOME OF THE MORE SEVERE SIDE EFFECTS, AND WATCH FOR ANY PROBLEMS...
Doctor & patient: "So, there's the tablet, and there's the instructions, you read up on those, and I want you to take one a week for the three doses, and then we'll talk about how you got on with those."
BUT WITHOUT DEFINITIVE EVIDENCE, AND WITHOUT A PUBLIC DEBATE IN AUSTRALIA TO MATCH THE ONE OVERSEAS,AUSTRALIAN DOCTORS GENERALLY ACCEPT THAT MOST OF THE SIDE EFFECTS FROM LARIAM ARE MILD AND MANAGEABLE...
Doctor & patient: "It does have a relatively high rate of some minor side effects. Which ones? Dizziness can occur, and that's quite common, sometimes weird dreams or vivid dreams, now some people say that's tremendous, but it can be a little off-putting if you first take it, and also sometimes there can be the issues of mood swings, and some people do, particularly young women, can feel a bit depressed on this."
BUT THE PEOPLE WE'VE SPOKEN TO SAY THE SYMPTOMS THEY SUFFERED WEREN'T MINOR, THEY WEREN'T MERELY OFF-PUTTING, AND THEY WERE MUCH, MUCH MORE THAN A "NUISANCE"...
Lesley Gidding: "I remember waking up every now and then and having a shower because I was dripping wet, and then going back to bed and it was awful, it was probably the worst thing I've ever been through physically."
Sheldon Johnston: "I wouldn't say that I've ever been the same person since. I guess anybody who's been through that sort of experience wouldn't come out the same person."
DR ANDREW FULLER AT MELBOURNE'S ALFRED HOSPITAL KNOWS JUST HOW SERIOUS THE REACTION TO LARIAM CAN BE...
Dr. Fuller: "Well, how are you getting on David, what sort of symptoms have you had in the last couple of weeks?"
"David": "Oh, I'm pretty down, I'm not as bad as I was before Christmas, all the spate of attacks I had from October onwards I was fairly suicidal again, but I'm not as bad as I was then, but I'm still always on that morbid thought level."
DAVID HAS SUFFERED BOUTS OF DEPRESSION, ANXIETY AND NERVOUS TREMORS FOR TEN YEARS AFTER BEING GIVEN LARIAM...
Dr. Fuller: " He describes the classic, what I think are the classic symptoms of waves of symptoms every three or four weeks."
DAVID IS AN EXTREME CASE, BUT ANDREW FULLER HAS NOW SEEN NINE PATIENTS WHO'VE SUFFERED DEPRESSION FOR UP TO THREE YEARS AFTER TAKING LARIAM...
Dr. Fuller: "Mefloquine is a tissue drug. It penetrates into fatty tissues like the brain, the liver and so forth, which I think explains why it takes such a long time for these patients to get better."
SHEREE YEOMANS IS ANOTHER OF DR FULLER'S PATIENTS. SHE WAS GIVEN LARIAM ON A TRIP TO AFRICA, AND SPENT YEARS RECOVERING FROM THE EFFECTS...
Sheree Yeomans: "I was just, yeah, severely depressed, very angry and aggressive. Obviously angry, number one, because of how I felt, but secondly that this drug can be given so easily and just disrupt my life when I was in such a happy period of my life."
THE ANTI-DEPRESSANTS SHEREE HAD TO TAKE MEANT HER PLANS TO START A FAMILY HAD TO WAIT THREE YEARS UNTIL SHE RECOVERED. HER HUSBAND SAYS THE DRUG CHANGED HER COMPLETELY...
Trevor Dove: "You know it was just scary, just the difference it made, you know her attitude and aggression and then the next minute she'd be totally within herself, withdrawn and the weirdest thing I've ever seen."
SHEREE AND MARK ARE BY NO MEANS THE WORST CASES ANDREW FULLER HAS SEEN...
Dr. Fuller: "I've had a patient, for instance, who thought he was Jesus Christ, and got up on a table in a foreign country, in Vietnam in fact, and really did think he was Jesus Christ and needed some haloperidol to calm him down."
MANY OF THE DOCTORS WHO KNOW AND UNDERSTAND THE PROBLEMS OF LARIAM SUGGEST THAT THESE WORRYING SIDE EFFECTS ARE BEING UNDER-REPORTED , BECAUSE THEY'RE MENTAL AND PSYCHOLOGICAL, RATHER THAN PHYSICAL...
Dr. Hudson: "Modern medicine often doesn't have very good tools for objectively evaluating some of those adverse events. So the person that says I don't know what it was, doc, but I just don't feel right might pass with flying colours on all the tests that are done, but they'll just say I'm never going to take that drug again, because I know that I just didn't feel well."Dr. Fuller: "When you prescribe mefloquine, I think you should say if you get any, when you have the first dose, before you leave Australia, when you have the first dose, if you have any dizziness or any funny feelings in the head, or anything odd in the head, please stop, do not take any more and consult your doctor."
DESPITE ALL OF THAT, THERE ARE STILL THOSE WHO BELIEVE THAT THE SIDE-EFFECTS FROM LARIAM USE ARE TOO RARE TO WORRY ABOUT, BUT THE AUSTRALIAN ARMY IS NOT AMONG THEM.THE DRUG IS NOT RECOMMENDED FOR USE BY AUSTRALIAN TROOPS OVERSEAS. OUR SOLDIERS IN EAST TIMOR ARE, WHEREVER POSSIBLE, USING AN ALTERNATIVE DRUG, DOXYCYCLINE.AND THE VERY SAME ARMY MALARIA INSTITUTE THAT CALLS LARIAM A GOOD DRUG THAT CAN SAVE LIVES ALSO SAYS IT DOESN'T WANT SOLDIERS USING IT...
Col. Epstein: "We are concerned with the severe cases that have been associated with the use of mefloquine from a side-effect point of view.""Depression, anxiety, vivid dreams, they ARE serious, and we would prefer our soldiers and all ADF personnel not to come up against those type of symptoms."
IN OTHER WORDS, ITS TOO DANGEROUS TO GIVE TO TRAINED SOLDIERS HEADING OVERSEAS ON ASSIGNMENT, BUT SAFE ENOUGH TO GIVE TO TOURISTS.AND THE ARMY ISN'T THE ONLY PROFESSIONAL ORGANISATION A LITTLE CONCERNED ABOUT LARIAM...
Medicin Sans Frontiers workers talking together: "I think she has gone for a year in Yemen, and now its 1,2,3,4,5,6,7, Australian people in East Timor"
MEDICIN SANS FRONTIERS IS ONE OF THE WORLD'S LEADING HUMANITARIAN AID ORGANISATIONS. IT SENDS THOUSANDS OF DOCTORS, NURSES AND OTHER MEDICAL STAFF AROUND THE WORLD EVERY YEAR. AMONG ITS MANY REGULAR HEALTH PROGRAMS IS A RANGE OF PROJECTS TO FIGHT MALARIA IN DEVELOPING COUNTRIES...
Jean-Yves De Lemps: "A child dies every thirty seconds of malaria, so its first, one of the first priorities of MSF just a big battle against malaria."
BUT EVEN MEDICIN SANS FRONTIERS , WITH ITS FOCUS ON FIGHTING MALARIA, HAS EXPERIENCED FIRST HAND THE SERIOUS PROBLEMS ASSOCIATED WITH LARIAM...
Jean Yves de Lemps: "Yes, I guess we very commonly get some reports about people who have some problems, side effects about mefloquine in the field, so we send more than two thousand people a year and we get a lot of reports that people can be feeling very uncomfortable with mefloquine."
SO COMMON IS THE EXPERIENCE, THAT THE AUSTRALIAN BRANCH OF MEDICIN SANS FRONTIERS HAS HAD TO SEND TWO PEOPLE BACK FROM THE FIELD IN THE LAST COUPLE OF MONTHS. THE FIRST WAS AN AUSTRALIAN MIDWIFE SENT TO MALAWI..
.Jean Yves de Lemps: "After a week she started to feel a lot of anxiety and she had some panic attacks and she was not able to work properly, and she got completely lost. She didn't know what she had to do and why she was here, and after twelve or thirteen days she was really depressed and she start to speak about suicide, and we had an obligation to send her back home."
THE SECOND CASE WAS A FIFTY YEAR OLD SURGEON FROM EUROPE, SENT TO EAST TIMOR. HE SUFFERED FROM SIMILAR SYMPTOMS....
Jean Yves de Lemps: "We sent him back with a nurse with him, and he has been welcomed by a psychiatrist in Europe when he went back. And he has been working for more than thirty years as a surgeon in Europe and he never had any problem before."
THE ORGANISATION NOW ADVISES ITS VOLUNTEERS TO THINK VERY CAREFULLY ABOUT WHAT MALARIA PROTECTION THEY CHOOSE, AND IF ITS LARIAM, TO MONITOR THEIR REACTION VERY CAREFULLY. BUT JEAN-YVES HIMSELF, WHO HAS SPENT FIFTEEN YEARS TRAVELLING FOR MEDICIN SANS FRONTIERS, HAS DRAWN HIS OWN CONCLUSIONS...
Jean-Yves de Lemps: "I never took any mefloquine because I knew there was some bad side effects with mefloquine."
THE MEDICIN SANS FRONTIER EXPERIENCE UNDERLINES A PARTICULARLY WORRYING TREND WHEN IT COMES TO LARIAM. THE PEOPLE WHO KNOW A LOT ABOUT IT TEND TO AVOID IT. BUT IN AUSTRALIA, TOO FEW PEOPLE SEEM TO KNOW A LOT ABOUT IT.MOST OF THE EXPERTS INSIGHT SPOKE TO DIDN'T USE IT AS A FIRST CHOICE DRUG...
Dr. Andrew Fuller: "I still have prescribed lariam, mefloquine, in recent times, although I must admit I probably prefer to prescribe doxycycline or cholorquine and proguanil because of my experience."
Dr. Tony Gherardin: "I personally have a preference to steer towards doxycycline."
BUT FOR EVERY DOCTOR WHO KNOWS AND UNDERSTANDS THE RISKS OF LARIAM USE, THERE ARE MANY MORE WHO DON'T...
Dr. Bernie Hudson: "There's probably pockets of doctors out there and members of the public who are very well aware of the adverse reaction to lariam and the caution that should be used, and others who maybe aren't as aware."
GEORGINA COLE SAYS SHE DEFINITELY WASN'T AS AWARE AS SHE SHOULD HAVE BEEN. SHE WAS OVERSEAS WHEN WE STARTED RESEARCHING THIS STORY, AND ARRIVED HOME JUST A COUPLE OF WEEKS AGO...
Georgina Cole: "I went to South America, Ecuador, Bolivia, Peru, Chile and Argentina, 24 of us altogether and three of us were taking lariam."
SO WHAT ADVICE WAS SHE GIVEN BEFORE SHE LEFT?
Georgina Cole: "None. No information whatsoever, they just simply asked had we taken it before, did you have any problems, and that was it."
DEEP IN THE JUNGLES OF ECUADOR, AND ALONG THE TRIBUTARIES OF THE AMAZON, GEORGINA EXPEREIENCED THE FAMILIAR SIDE EFFECTS OF LARIAM...
Georgina Cole: "Lack of sleep, a few hours a night sleep, mood swings, depression, hallucination, and I personally developed a real fear of heights, I was very paranoid and I had never experienced that before."
HER FRIENDS WERE MORE BADLY AFFECTED. ONE BEGAN CRYING UNCONTROLLABLY, THE OTHER HAD DREAMS AND HALLUCINATIONS..
.Georgina Cole: "She was staying in a room that had a cross with Jesus on it, and she woke up in the middle of the night quite scared that Jesus had jumped off this cross and was madly attacking her, and was quite petrified."
FORTUNATELY, THE LOCAL TOUR GUIDES HAD SEEN IT ALL BEFORE, AND WERE QUICK TO ADVISE THEM TO STOP TAKING THE DRUG...
Georgina Cole: "There was three crew on the trip, none of them actually took any anti-malarial drugs at all, and when we first arrived at the trip, we were asked hands up who's taking lariam, and they had experienced strange things with passengers before."
REMEMBER, THAT WAS JUST WEEKS AGO. IT SUGGESTS THAT TOO MANY AUSTRALIANS ARE STILL BEING PRESCRIBED LARIAM AND HEADING OVERSEAS WITH INSUFFICIENT INFORMATION AND ADVICE.ONE OF THE WORST CASES INSIGHT HAS HEARD HAPPENED LATE LAST YEAR. AN AUSTRALIAN MAN TRAVELLING OVERSEAS ON HOLIDAY WAS PRESCRIBED LARIAM. AFTER TAKING THE DRUG, HE HAD A SEVERE PSYCHOTIC REACTION AND ATTACKED HIMSELF WITH A KNIFE , SUSTAINING LIFE-THREATENING INJURIES. HE IS STILL RECOVERING...
Dr. Fuller: "If you're in a foreign country and you get sick, you're going to be in trouble, and if you're paranoid and you think you're Jesus Christ you're in huge trouble."
Sheree Yeomans: "I don't feel enough information was given. As well as something in writing, something verbally should have been said as well, and certainly stating the effects a lot more widely, occur a lot more widely than stated in the leaflets as well."
Lesley Gidding: "I wasn't told enough. I thought that I researched it enough, I sat down with my doctor and we talked long and hard and he was really dismissive of it.""I was told, if you don't get it in the first two weeks, you're fine. I wasn't warned that it was something that could effect you years later."
RECENT RESEARCH SUGGESTS THAT WE SHOULDN'T BE SURPRISED BY THIS AT ALL. A SURVEY CARRIED OUT AT MONASH UNIVERSITY MORE THAN A YEAR AGO TESTED THE PRE-TRAVEL HEALTH ADVICE PROVIDED BY GENERAL PRACTITIONERS. IT FOUND THAT TEN PER CENT DIDN'T RECOMMEND APPROPRIATE ANTI-MALARIA DRUGS. 20% RECOMMENDED DRUGS WHEN THEY WEREN'T NECESSARY, AND 80% DIDN'T RECOMMEND APPROPRIATE IMMUNISATIONS.THE CONCLUSIONS? DOCTORS' TRAVEL ADVICE WAS INCONSISTENT, AND MUCH COULD BE CONSIDERED INADEQUATE...
Dr. Gherardin: "It is not a simple drug to be prescribing, and I think the onus is very much on doctors to be informed about the issues of mefloquine, and often our travellers are better informed than many of the GP's."
SO WHAT'S THE LONG-TERM SOLUTION TO THE PROBLEM OF LARIAM SIDE-EFFECTS? WELL, RESEARCHERS SAY NEW DRUGS ARE BEING INVESTIGATED ALL THE TIME, AND IT MAY NOT BE LONG BEFORE SOMETHING SAFER COMES ALONG...
Dr. Gherardin: "I think what you're highlighting is the need for better drugs, maybe safer drugs, but more effective drugs, to fight what is in fact an increasing disease."
BUT UNTIL THAT HAPPENS, IT SEEMS THAT TOO MANY AUSTRALIANS WILL BE RELYING ON WORD OF MOUTH AND ON BITTER EXPERIENCE, TO ALERT THEM TO A SIGNIFICANT HEALTH RISK...
Sheldon Johnston: "To take an unknown drug was just like a bungee jump, you know, just to think what the hell, throw yourself to the elements and you'll come out alive at the end, you'll be right, you know."
Georgina Cole: "I think that its still the best anti-malarial drug to take, but I would rather not take it."
Lesley Gidding: "And I don't remember when I came out of that dark period, but I did, and I'm out of it, and I'm not going back."

Chicago Tribune
TRAVELERS' DILEMMA

Column:
TAKE ANTI-MALARIA DRUGS, BUT GET ALL OF THE FACTS FIRST
Alfred Borcover
Sunday, June 4, 2000
Travelers to malaria-ridden parts of our world face a dilemma. It's not a matter of taking a drug or not taking a drug, but deciding which drug to take. Only the foolhardy would journey to places like India, the Solomon Islands, sub-Sahara Africa and most of Southeast Asia without protecting themselves against malaria, a serious, sometimes fatal disease transmitted by the bite of a
parasite-carrying mosquito.

The problem is this: In the U.S., there are three drugs commonly used to prevent malaria -- chloroquine, doxycycline and mefloquine. Chloroquine (sold as Aralen and taken orally once a week) is ineffective in severe malaria areas, but is often used for travel to Central America, Haiti and certain parts of the Mediterranean. Doxycycline, effective in severe malaria areas, must be taken orally every day. And the third drug, mefloquine, sold as Lariam, effective in the worst malaria areas and taken orally once a week, is a bit controversial. Because Lariam has to be taken only once a week, it generally is the drug of choice. But Lariam, like most drugs, has side effects ranging from mild nausea, dizziness and vivid dreams to rarer hallucinations and severe anxiety attacks.

It is the more severe side effects that have brought notoriety to Lariam, although several studies conclude that only about 20 percent of the takers experience any side effects at all. What appears to be a side issue of Lariam is that doctors often prescribe Lariam as the drug of choice without adequately explaining the side effects and offering travelers a choice between Lariam and doxycycline, which has its own set of side effects.

Lariam, produced by Hoffman-La Roche, a Swiss firm, was first introduced in Europe in 1984 but was not approved by the U.S. until 1989. Its product information sheet was updated in 1994, and then vastly expanded last year, greatly elaborating the section on side effects.

A case in point came from a physician in Michigan, who requested not to be identified further. In January 1999, the doctor traveled to India to visit his daughter, who was attending school there. He gave me this account in a phone interview:
"I went to a travel nurse consultant for a large family practice medical group. She took a history, updated my shots and prescribed a malarial prophylaxis. To the best of my recollection, only one drug was mentioned, Lariam. I didn't make a big deal of it. I got my prescription filled at a local pharmacy and was given five individually packaged pills. There was no package information sheet, just instructions to take one pill a week before leaving, one a week there and the remainder upon returning.

"I started taking the pills. I thought I was OK. When I was in India, I never slept at night. I didn't make too much of it. I've always had a difficult time sleeping, but not to the point where I couldn't get to sleep. I might drift off at 3 or 4 o'clock and wake up at 6. I also remember being a little edgy while I was there. "But things really didn't get bad until I got home. It culminated one night when I was alone at home and my wife was out of town. I had such depression, paranoia, an inability to act and function. I almost got to the point where I couldn't decide whether to stand up or sit down."

The doctor's "incredible, profound anxiety" caused him to take leave of his practice because he couldn't function. He said he could hardly drive his car and had his wife drive them to Detroit to see a specialist about a very fine tremor he had (unrelated to the Lariam reaction). "While in the doctor's office, my wife looked up Lariam in the `Physicians' Desk Reference' and found the drug could produce neurotoxic symptoms in less than 1 in 1,000 cases," the Michigan doctor said.

On the advice of an infectious disease specialist, the doctor finished off his anti-malarial treatment with doxycycline, but the Lariam remained in his system because the drug has a 21-day half life, which means that every 21 days, half of what is left in the system dissipates.

The doctor said he's fine now, but it wasn't until the end of the fourth month "that I started feeling whole again."

If you search the Internet, you'll find other Lariam horror stories What you won't find are comments from 80 percent of the takers (myself included) who had no problem with the drug.

The important thing for travelers heading for malaria areas is to make an informed choice.

"The first thing I would tell travelers is to go to the Centers for Disease Control Website (www.cdc.gov)," said Dr. John MacArthur, a family practice and preventive medicine specialist at the CDC in Atlanta. "Find the country you're traveling to and then see what the situation is with malaria as well as what vaccines or drugs are recommended. It's a good way for lay persons to educate themselves prior to seeing a primary-care physician."

MacArthur added: "What I usually tell a person who talks to me about not liking the side effects of either one of those drugs, I tell them the CDC gets anywhere from 1,000 to 1,500 cases of malaria reported annually from travelers importing the disease into this country. And certainly the disease is much worse than some of the side effects they're going to be experiencing."

But, MacArthur warned, nothing is 100 percent effective. When addressing the malaria issue, he said people have got to think about other things such as sleeping in a well-screened room or under a mosquito net, using a repellent that contains between 20 and 30 percent DEET and wearing long sleeve shirts and trousers, especially at dusk or evening time. "It's really from dusk to dawn that mosquitoes transmit malaria," said MacArthur. "It's not just popping a few pills and off we go. People have got to think about a number of different ways to keep healthy."

At Northwestern Memorial Hospital's Travel Immunization Center in Chicago, the first thing patients do is complete a medical history. "We always go over the medical history first," said Valerie Gongaware, a staff nurse at the center. "So we know ahead of time whether there are going to be reasons travelers can't take certain drugs. We review the patient's itinerary to decide whether there is a malaria risk. If there is a malaria risk, we go over the types of drugs that are available for that area of the world that they can take, and the possible side effects. If there is a choice we explain the differences in the drugs and how to take them. Based on their health history and travel plans, we help them decide which might be the better drug for them."

But, stressed Gongaware, "It's important for people to be truthful about their medical history. Why risk it. When you start talking about potential side effects, then people start fessing up -- `Oh, yes, I'm being treated for clinical depression,' which then would preclude them from taking Lariam."

Northwestern's Travel Immunization Center also provides each patient with a booklet that provides information on immunization vaccines, medications needed for travel and tips on disease prevention. Bonnie Ward, who runs the San Diego International Traveler's Medical Clinic, also stressed the need to screen patients to make certain there's no health history that would indicate a predisposition to having a reaction to medication. "Throughout our education process,
if a person feels a little uneasy with what we've stated, then we will go ahead and look at other options."

The bottom line: You have to take malaria seriously.
----------

Tilbage

Chicago Tribune, TRAVEL HOME section


Column: VOICE OF THE TRAVELER Letters

Sunday, June 25, 2000

LARIAM CRITIC

WESTFIELD, N.Y. -- As one who has had his life nearly wrecked by Lariam, I can tell you the degree and extent of the pain caused by Lariam is much more extensive than hinted at in Alfred Borcover's column ["Traveler's Dilemma"; June 4]. I wish he had contacted Lariam Action USA to learn the gravity of Lariam prior to writing this column.

-- John Ellison

Lariam Action USA was one of the sources Borcover used in researching his column. For more information: Lariam Action USA, PMB 248, 1563 Solano Ave., Berkeley, CA 94707; 510-663-5168; lariaminfo@yahoo.com; www.suggskelly.com/lariam

LARIAM AFTER-EFFECTS

IOWA CITY -- I graduated from Dartmouth College in 1992 and then went to Zimbabwe to play professional soccer later that year. I took Lariam for over three months and the drug built up toxic levels in my system. To make a very long story short, I became very sick from the drug and it ended my soccer career. I could not work or do much of anything for nine months. I went from being a professional athlete to not even being able to walk down the block. The problems continued for years, and some of the symptoms remain to this day, even eight years later. And the side effects I experienced were very serious. I experienced the side effects that you mentioned but I had many more as well, the most serious were problems with my heart -- murmurs, abnormal rhythms, tachycardia and an atrial flutter.

-- Jesse Bradley

RESEARCH NEEDED

MISSOURI CITY, Texas -- No wonder the physician [who suffered serious side effects from Lariam] requested not to be identified. I cannot believe that a health-care provider did not research his choices for anti-malaria drugs prior to visiting another health-care provider. Research is critical prior to any intervention!

-- Barbara J. Blue

Tilbage