August 20, 2002

8:03 AM

A dangerous drug...Is it possible that the anti-malaria drug Lariam contributed to the recent series of murders at Fort Bragg? Three of the soldiers involved were on the drug, which has been known to cause aggression, paranoia, hallucinations, and thoughts of suicide. After identifying the potential side-effects, why are we still prescribing this drug to our troops?
posted by greengrl (20 comments total)

Good for Mrs. Flitcraft - keep up the good fight.
posted by Pressed Rat at 8:15 AM on August 20, 2002

from personal experience, i can tell you that this so- called "preventative medicine" and its side- effects are almost as bad as actually contracting malaria.

i was advised by guidebooks and my doctor to take it before a trip to belize this summer.

in any case, you take it ONE week before you leave for the region, then you take it with food the same day, same time while you are there, and then for at least THREE weeks after you get back.

all the while, you feel nauseous, can't sleep, have mood swings, can't walk straight, get stomach cramps, and numerous other digestive problems.

oh, did i mention that the pills are the size of frisbees and taste like chalk?

better living through chemistry!
posted by ronv at 8:15 AM on August 20, 2002

Why weren't they just drinking shitloads of Gin and Tonics?
posted by interrobang at 8:21 AM on August 20, 2002

It's been known for a while that Lariam can have some serious psychoactive side effects, including irritability (I can vouch personally), awful nightmares (know many who've had them), and, supposedly, some reactions so bad they require a padded room.

A study in the British Medical Journal (31 August 1996) showed "About 0.7% (1 in 140) travellers taking mefloquine can expect to have a neuropsychiatric adverse event unpleasant enough to temporarily prevent them from carrying out their day to day activities."

Damn. I'll risk malaria.
posted by gottabefunky at 8:32 AM on August 20, 2002

<>"After identifying the potential side-effects, why are we still prescribing this drug to our troops?"

because aggressive, paranoid, hallucinating troops are a goddamned american tradition, you commie bastard.
posted by jcterminal at 8:34 AM on August 20, 2002

jc's definitely off HIS meds.......
posted by Pressed Rat at 8:35 AM on August 20, 2002

My organization sends volunteers to malarial regions and we spend a lot of time talking about malaria prophylaxis options with our volunteers. Mefloquine works really well for some people - my wife takes it when we travel together and she has no side effects from it. I've taken it in the past and I experience paranoia, hallucinations and other debilitating symptoms. In 1993, on Mefloquine, I broke my foot by kicking a concrete wall during an intense Mefloquine-addled dream. Needless to say, I don't take the stuff anymore.

If there were a universally acceptable alternative to mefloquine, we'd advocate for it. But almost all the alternatives have problems associated with them. Doxycycline is effective, but is an antibiotic - women taking it often experience frequent yeast infections (a real drag in countries where bathrooms aren't always available or sanitary). Furthermore, taking doxy as a prophylaxis increases the probability of creating doxy-resistant bacteria. Chloroquine and paludrine together make a cocktail that's not quite as effective as mefloquine. It's a tough regimen to remember - one pill weekly, the other pill daily - and the drugs aren't available in the US.

I'm currently taking Malarone when in malarial regions. It's a combination of two drugs in a single pill, is taken daily and hasn't caused me to experience side effects. But it's expensive, and taking it as a prophylactic means that it's likely to (eventually) develop resistant strains and be less useful to folks who use it to respond to acute infections. So it's not perfect, either.

What's most fascinating about mefloquine is the fact that it's still widely available - and mandated if you're in the Peace Corps or other US government institutions - given the literature on adverse reactions. There's an astounding list of mefloquine-related papers at http://www.indiana.edu/~primate/larrefs.html and there have been at least two class action suits against the manufacturer for misrepresenting the risk levels associated with the drug.
posted by obruni at 8:36 AM on August 20, 2002

I took mefloquine (Larium) without ill effect for a 6 week trip to Africa in 1995. When the person I was traveling with came down with Malaria I was very glad I'd opted in. Nothing like seeing your buddy shaking and sweating uncontrollably and asking for more blankets even though it's 95 degrees out to give one an appreciation of western-made meds.
On the other hand, seeing a psychedelic rock band in Victoria Falls called "Larium Dreams" does make one wonder what those little pills are doing behind the scenes.
posted by alms at 8:47 AM on August 20, 2002

I have personal experience with Lariam and I would never take it again. The side effects mentioned in the article, however, do not affect everyone. The link to special forces folks is interesting though. I worked for a number of months in Indonesia with three students. One student had been a ranger in the US Army and worked behind the lines fighting Contras in Nicaragua. Of all of us, he was the most adversely effected by the Lariam – at times becoming unstable. It could easily be coincidence, but I wonder if the kind of person that joins special forces has a brain chemistry that is particularly vulnerable to the side effects of the drug?

Whether the drug is worse than the disease is an open question. Having had malaria a number of times, I can vouch for the fact that it is extremely unpleasant. One advantage of Lariam is that it is cheap – much cheaper than the new drug on the market - Malaron. Malaria kills millions. Depending on the person, the benefits of avoiding malaria may outweigh the possibility of going nuts. The Army may be making just that sort of calculation -- a few deaths versus millions more spent on expensive yet safer malaria prophylaxis
posted by ALvard at 8:48 AM on August 20, 2002

larium is a dangerous drug and i believe it has been implicated in at least one person's death.

from my experience i would say the effects listed above are accurate and unembellished. personally i think one in four/five have these symptoms.

interestingly, the drug should not be taken for more than 3 months - according to the manufacturer, but in Tanzania the US peace corps were given the drug for 2 years +. and..... the medical notes had been taken out of every packet.
posted by quarsan at 8:56 AM on August 20, 2002

I took larium for 4 months and I still got malaria.

shit.

The larium dreams are real. Freaky that is.

The other side effects? I can't say for sure, those behaviors were par for the course for me back then.
posted by kremb at 9:02 AM on August 20, 2002

alms: About four years ago, I read an article (in a college magazine) about recreational Lariam use. The article doesn't exist online, as far as I can tell; but here's the gist of it, excerpted from a Dartmouth Review article that mentions it:

Lariam put the trip back into mountaineering trip. Lariam is a drug which wards off malaria with the added benefit of being a mild hallucinogen. It has the greatest effect on dreams, giving them incredible clarity and focus. Sometimes I would wake up and get my dreams confused with reality.

Still, with the possibility of psychotic episodes occurring (1 in 140, according to this page), it's not something that I'd want to play around with.

Back on topic, there's one thing I'd like to know: Were peacekeeping troops in Somalia given Lariam as well? If so, was there a similar incidence of violent acts among returning soldiers?
posted by Johnny Assay at 9:19 AM on August 20, 2002

Yeah, I'll second everything anyone has to say about Larium. I took it for two months while in Africa in 1999. The dreams were completely insane, I was never getting enough sleep and I really felt like I was going out of my mind. It reminded me of the episode of Star Trek the Next Generation where no one can reach REM sleep so they all start going insane (yes, I am geeky.)

Most of my Peace Corps friends have stopped taking Larium now, taking either alternative meds or nothing at all. I will only use Malarone now when travelling to malarial zones.
posted by pjgulliver at 9:37 AM on August 20, 2002

Malaria vaccine breakthrough

Why do the troops need anti-malarials? Read this outstanding tale of a place where malaria is one of life's major obstacles: Tropical Gangsters: One Man's Experience With Development and Decadence in Deepest Africa.

A Kuna acquaintance, whose culture is well-known for its practical experience with both malaria and the paranormal, suggested that one especially vivid nightmare might be the result of taking my weekly anti-malarial Chloroquin tablet right before bedtime. I started taking the tablet at breakfast instead and the bad dreams stopped. Perhaps this advice from the rainforest will help someone else here too.
posted by sheauga at 9:54 AM on August 20, 2002

Here is a good article about the effects of both malaria and levoquine from the writer's personal experience.
posted by TedW at 10:03 AM on August 20, 2002

I wonder if the kind of person that joins special forces has a brain chemistry that is particularly vulnerable to the side effects of the drug?

Interesting idea. Sounds like it might be right on the money, to me.

Consider this: to get into special forces, you have to succeed very well at following orders, and that whole mindset - you have to be a "good soldier", not even just an ordinary soldier.

During a psychotic episode, the feeling (at least in my experience) is quite akin to being given orders that you cannot refuse. People who are accustomed to following orders unquestioningly would likely be particularly vulnerable to this.

Plus add to the fact that those in special forces are likely more aggressive and physically powerful than average soldiers, and you've got a nasty, volatile combination.

Also, I wouldn't be surprised if the army were giving soldiers stronger doses than civilians get, maybe even experimenting on them to see what dose works best. But then I'm a cynic.

(I thank my lucky stars that I'm a nonviolent wuss - the worst thing I did during my own psychosis was poke my skin with a pen)
posted by beth at 10:26 AM on August 20, 2002

I did fine with Lariam, but I heard from fellow travelers how intensely bad it can be ... but ditto malaria.

My understanding is that only the U.S. and Canada prescribe Lariam as a prophylaxis -- the rest of the world keeps it on hand for when they get malaria. This seems like a wise course, especially when there's this cerebral form that kills in 8-24 hours...
posted by argybarg at 11:39 AM on August 20, 2002

beth: My understanding is that special forces are the complete opposite of what you describe; rather than the hurry-up-and-wait automatons who make up the bulk of our troops, they are the smartest, best trained, and most individualistic of soldiers, because their assignments require them to work in very small teams or even alone, exercising judgement in diverse and muddled situations. I can see how that mindset could also feed into a drug-induced paranoia, so I don't completely discount your point.

There seems to be quite a bit of patient empowerment regarding the drug right in this thread; one would think a similar process would develop among the military users.
posted by dhartung at 12:54 PM on August 20, 2002

Hmm, Another case of life imitating art ?
posted by BentPenguin at 12:59 PM on August 20, 2002

I recently came back from a trip to Thailand for which I was taking Lariam. I actually asked my doctor to prescribe Malarone, but let him convince me to take Lariam instead. (He had the idea that Lariam was more effective: ironic, as it turned out!)

Imagine my exasparation upon coming back and reading the notice from the CDC (look for the Special note: in the Malaria Risk by Country section) that some of the malaria bugs in Thailand are resistant to Lariam anyway!

I actually sort of enjoyed having strange vivid dreams, but the sleeplessness was a drag. I'm just glad my side effects were mild. A friend of mine in the foreign service apparently got hit with side effects pretty badly.
posted by steviehero at 1:08 PM on August 20, 2002