Dosing & Uses
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
Interactions
Interaction Checker
No Results
Contraindicated
Serious - Use Alternative
Significant - Monitor Closely
Minor
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 (132)
- 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.
- fingolimod
fingolimod and mefloquine both increase QTc interval. Use Caution/Monitor.
- 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.
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
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
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.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)
Images
| BRAND | FORM. | UNIT PRICE | PILL IMAGE |
|---|---|---|---|
| mefloquine oral - | 250 mg tablet |  | |
| mefloquine oral - | 250 mg tablet |  |
Copyright © 2010 First DataBank, Inc.
Patient Handout
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.
Formulary
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