USE OF MEFLOQUINE IN PREGNANCY

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(Date of issue: February 2019, Version: 3)

This is a UKTIS monograph for use by health care professionals. For case-specific advice please contact UKTIS on 0344 892 0909. To report an exposure please download and complete a pregnancy reporting form. Please encourage all women to complete an online reporting form.

A corresponding patient information leaflet on mefloquine use in pregnancy is available at www.medicinesinpregnancy.org.

Summary

Mefloquine is used primarily for malaria prophylaxis in regions of chloroquine/proguanil resistance and is recommended by the Royal College of Obstetricians and Gynaecologists as a first-line option for prophylaxis during the second and third trimester of pregnancy (in non-resistant regions). Due to increased mefloquine resistance in some locations and the risk of neuropsychiatric side effects, it is now rarely used to treat malaria in monotherapy but may still be used on occasion in combination with artemisinin-based therapies.

Travel to areas where malaria is endemic should be avoided during pregnancy wherever possible. If travel to such areas is unavoidable, insect repellents, bed nets, appropriate clothing to prevent mosquito bites and adequate chemoprophylaxis should be used.

Human pregnancy data concerning both prophylaxis and treatment with mefloquine provide no conclusive evidence of an increased risk of miscarriage, congenital malformation, stillbirth/IUD, low birth weight, prematurity, growth restriction, infant mortality or delayed neurodevelopment. However, data relating to first trimester exposure are limited; as such, increased risks of congenital malformation or miscarriage cannot currently be completely excluded.

Where mefloquine is clinically indicated, it should not be withheld on account of pregnancy as the known risks of maternal malaria infection are likely to be far greater than any potential risks to the fetus from the drug.

Exposure to mefloquine at any stage of pregnancy in the absence of maternal malaria infection would not usually be regarded as an indication for additional fetal monitoring. However, other risk factors may be present in individual cases which may independently increase the risk of adverse pregnancy outcome. Clinicians are reminded of the importance of consideration of such factors when performing case-specific risk assessments.

Current recommendations as to the appropriate antimalarials for specific regions are based on malarial resistance profiles and are available from a number of sources (e.g. BNF,[1] Fit For Travel,[2] NaTHNAC,[3] and TRAVAX[4]).

This document is regularly reviewed and updated. Only use full UKTIS monographs downloaded directly from TOXBASE.org to be sure you are using the most up-to-date version. The summaries of these monographs are openly available on UKTIS.org.

This is a summary of the full UKTIS monograph for health care professionals and should not be used in isolation. The full UKTIS monograph and access to any hyperlinked related documents is available to health care professionals at www.toxbase.org.

If you have a patient with exposure to a drug or chemical and require assistance in making a patient-specific risk assessment, please telephone UKTIS on 0344 892 0909 to discuss the case with a teratology specialist.

If you would like to report a pregnancy to UKTIS please click here to download our pregnancy reporting form. Please encourage all women to complete an online reporting form.

Disclaimer: Every effort has been made to ensure that this monograph was accurate and up-to-date at the time of writing, however it cannot cover every eventuality and the information providers cannot be held responsible for any adverse outcomes of the measures recommended. The final decision regarding which treatment is used for an individual patient remains the clinical responsibility of the prescriber. This material may be freely reproduced for education and not for profit purposes within the UK National Health Service, however no linking to this website or reproduction by or for commercial organisations is permitted without the express written permission of this service. This document is regularly reviewed and updated. Only use UKTIS monographs downloaded directly from TOXBASE.org or UKTIS.org to ensure you are using the most up-to-date version.