Mefloquine – Defence Committee inquiry concludes British Armed Forces policy is wrong

On 24 May 2016, the House of Commons Defence Committee published its report into the use of anti-malarial drug, Lariam (also known as mefloquine), in the British Armed Forces. This followed an inquiry which heard evidence of the harmful side effects experienced by those in the armed forces.

The Defence Committee found there was very strong anecdotal evidence that the manufacturer’s stringent guidance on safe prescription of Lariam was often disregarded by the Armed Forces when dispensing the drug to a large number of troops. The inquiry heard evidence that the military environment has the potential to exacerbate the side effects of the drug which include psychosis, hallucinations and suicidal ideation. This evidence demonstrated that the drug’s significant risk profile is not compatible with the duties required of military personnel on operations.

The Defence Committee concluded that the Ministry of Defence (MoD) has a duty of care to ensure military personnel are adequately inoculated against disease but that in the case of malaria and the use of Lariam, MoD policy is wrong. Lariam should now be designated a drug of last resort and prescribing should be restricted by the following conditions:

• only to those who are unable to tolerate any of the available alternatives;
• only after a face to face individual risk assessment has been conducted; and
• only after the patient has been made aware of the alternatives and has been given the choice between Lariam and another suitable anti-malarial drug.

The Defence Committee stated in the report:

‘We welcome the Minister’s apology to former and current Service Personnel who believed that they were prescribed Lariam without the necessary individual risk assessments. This is a timely acknowledgment of the concerns raised about the use of Lariam. We look to the Minister to build on his opening statement by engaging positively with the recommendations we make in this Report. The prescription of a drug known to have ‘neuropsychiatric side effects and vestibular disorders’ without face to face interviews shows a lamentable weakness in the MoD’s Duty of Care towards Service Personnel’

I welcome the Defence Committee’s conclusions which recognises the duty of the care the MoD has to our soldiers’ mental health and that it should ensure the use of mefloquine is only permitted when absolutely necessary.