Malaria Claims

[Flamingo]

Lariam should be drug of last resort for troops, MPs say

More on the BBC earlier this week about Lariam use in the British Army

http://www.bbc.co.uk/news/uk-36361374

Lariam should be drug of last resort for troops, MPs say

Anti-malarial drug Lariam should be the "drug of last resort" for UK troops, MPs on the defence committee have said.

The drug has been prescribed to at least 17,000 service personnel at least once between April 2007 and March 2015.

The MPs criticised the MoD over the way it issued the controversial drug, which can cause severe side-effects, including depression and anxiety.

The MoD said the "vast majority of deployed personnel already receive alternatives to Lariam".

Lariam - the brand name for mefloquine - is prescribed to civilians as well as troops.

While it is not the main anti-malarial drug used by the armed forces, critics argue its side-effects can be more detrimental to those serving in challenging and dangerous countries.

Malaria is a mosquito-borne infectious disease which causes fever, headaches, vomiting and diarrhoea and can be fatal.

In 2015, it killed about 438,000 people and there were 214m cases of the disease, mostly in sub-Saharan Africa, according to World Health Organization estimates.

'Mass deployment'

After a six-month inquiry, the defence select committee found the potential side-effects were clearly highlighted by manufacturers Roche, but there was "strong anecdotal evidence" that the stringent conditions laid down for prescription were often disregarded.

Committee chairman Dr Julian Lewis said: "It seems quite clear that not only is the MoD unable to follow the manufacturer's guidelines for prescribing the drug in all instances, but a number of troops discard their Lariam rather than risk its potentially dangerous side-effects.

"It is our firm conclusion that there is neither the need, nor any justification for continuing to issue this medication to service personnel unless they can be individually assessed, in accordance with the manufacturers' requirements.

"And most of the time that is simply impossible, when a sudden, mass deployment of hundreds of troops is necessary."

Lt Col Andrew Marriot: "I haven't had a full night's sleep since 2002"
'Mad Monday'

The drug's use had had " absolutely devastating psychological effects" in a small minority of cases," he told the BBC's Today Programme, and: "In a larger minority of cases there are disturbed nights, damaged sleep, psychological ideas that are unsettling and dangerous."

"In reality the whole experience has been deeply unpleasant. So much so that phrases like 'mad Monday' or 'crazy Tuesday' are used amongst the armed forces when this stuff has been doled out in the past."

The inquiry came after BBC Radio 4's Today programme revealed that a senior military medic had called on ministers to prescribe an alternative drug until it was clear that Lariam was safe.

'I kept thinking about hanging myself'

Maj Mick Wallace took Lariam during his deployment in Kenya in 1998, and he says he has been severely depressed ever since:

"When I came back my wife said I wasn't the same man. I was short-tempered, anxious at times. I just didn't feel right and it's still going on.

"I've had several courses of anti-depressants and all they do is stick a plaster over it and as soon as I stop taking them, I go downhill again.

"I've never attempted suicide but it's been at the back of my mind.

"Recently I went into my barn which I use as a workshop and I had to leave straightaway because I kept thinking about hanging myself.

"So many men and woman have already been affected. I think the government would be foolish not to take up the recommendations but this should have happened a long time ago."

According to MoD figures, a minimum of 17,368 armed forces personnel were prescribed Lariam at least once between 1 April 2007 and 31 March 2015.

Over the same time period, approximately 104,000 personnel were given a different anti-malarial drug, such as Malarone and Doxycycline.

As at August 2015, mefloquine constituted only 1.2% of all anti-malaria tablets held and, in terms of doses for a six-month deployment, only 14% of the stock, the MoD said.

It is not clear how many service personnel have suffered after taking Lariam but according to retired Lt Col Andrew Marriott, who gave evidence to the inquiry, between 25% and 35% of personnel who had been prescribed Lariam on deployment experienced side-effects.

Some of those affected are contemplating legal action against the MoD.

Philippa Tuckman, from Hilary Meredith Solicitors, said more than 450 personnel had come forward since late last year, saying they had been affected.

Roche said it agreed with the defence committee's report and it would continue to work with the MoD "to ensure they have all the relevant information to ensure Lariam is prescribed appropriately".

The MoD said it would consider the report's recommendations and respond in due course.

"The vast majority of deployed personnel already receive alternatives to Lariam and, where it is used, we require it to be prescribed after an individual risk assessment," a spokeswoman said.

"We have a duty to protect our personnel from malaria and we welcome the committee's conclusion that, in some cases, Lariam will be the most effective way of doing that."

Lariam - 'Not a first-line drug'

By Michelle Roberts, BBC News website health editor

Malaria is a serious illness and can be fatal. Drugs can reduce the risk of malaria by about 90%.

The MoD says Lariam is an important anti-malarial tablet within its portfolio, but it is not the only one.

The exact choice of drug offered to military personnel depends on "a number of factors", including the region the individual is deploying to, their health and any past history of side-effects.

There is no single anti-malarial that is effective against all the different possible strains of infection.

Arguably, all drugs can have unwanted effects, but soldiers have been reporting some particularly nasty ones with Lariam - depression, nightmares, hallucinations and suicidal thoughts.

The MoD says it only provides soldiers with Lariam when it is necessary and after an individual risk assessment, in line with advice given by the Advisory Committee on Malaria Prevention.

It says Lariam is not a "first-line drug" and is used primarily when other drugs would either not be effective or appropriate.

[TangoSierra]

http://www.marinecorpstimes.com/story/military/2016/08/11/malaria-drug-causes-permanent-brain-damage-case-study/88528568/

Malaria drug causes brain damage that mimics PTSD: case study

[terrier]

http://www.rte.ie/news/2016/0915/816884-lariam/

It has emerged that the drug manufacturer Roche took Lariam off the market in this country on 31 July. It remains available in other jurisdictions.

However:-

A Department of Defence statement said the Defence Forces were made aware by Roche Products Ltd that Lariam was being taken off the Irish market but the drug is still available to them via two main wholesalers.

The statement says there are no plans to withdraw Lariam from the range of anti-malarial medications they use.

I can only imagine that the fear is that to stop issuing Larium would be seen as an admission that there's a problem with it.

[hedgehog]

http://www.rte.ie/news/2016/0915/816884-lariam/



However:-



I can only imagine that the fear is that to stop issuing Larium would be seen as an admission that there's a problem with it.

I think you are spot on Terrier.

The sickening thing is- Why are the Department willing to risk the physical and mental health of our troops by issuing lariam, in particular when the manufacturer no longer sells it here, simply to help defend legal actions by our troops whose physical and mental health were affected by the Departments use of lariam.

[na grohmiti]

Lessons learnt from the Army deafness claims, while at the same time learning nothing at all from it?

[DeV]

Lessons learnt from the Army deafness claims, while at the same time learning nothing at all from it?

Have any of the claims been settled yet?

[DeV]

Important (from a DoD point of view):

Roche have chosen to stop marketing Larium in Ireland

It is still legal to sale and prescribe in Ireland

[terrier]

Important (from a DoD point of view):

Roche have chosen to stop marketing Larium in Ireland

It is still legal to sale and prescribe in Ireland

Yes it is, but with cases pending the continuing use of it has a whiff of Paddy Powers about it. If the DoD win, then it goes away ; if the Dod lose then the floodgates could open in terms of claims.

[sofa]

Read somewhere it is now the drug of last resort with the BA

[terrier]

There's more :-

http://www.irishtimes.com/news/crime-and-law/troops-are-given-lariam-without-proper-checks-group-says-1.2796019?utm_source=dlvr.it&utm_medium=twitter

[QUOTE]The Defence Forces has not been screening military personnel properly before prescribing the controversial anti-malaria drug Lariam, despite the Government’s claims to the contrary, a support group for soldiers has said.
The Action Lariam group said new cases of serving and former personnel suffering ill effects after taking the drug, up to and including suicidal ideation, were continuing to emerge.

It insisted changes to how the drug was being prescribed to military personnel in Britain had no bearing on its use here, adding there were no plans to stop using Lariam in the Defence Forces or to change the way it was being prescribed.
“The choice of medication for overseas deployment for both officers and enlisted personnel, including the use of Lariam, is a medical decision made by the medical officers in the Defence Forces,” the department said in a statement.[/QUOTE

How and ever, I was told by someone who ought to know that Larium isn't being issued any more and hasn't been for a while !

So, armed with this tidbit I went back to the original story on the RTE website, and looked at the DF statement again.

They are quoted as saying..

The statement says there are no plans to withdraw Lariam from the range of anti-malarial medications they use.

So they're not saying that they're actually still issuing it, are they ?

Curiouser and curiouser .

[Tempest]

To the tune of "Mariane" by Leopard Cohen:

'so long Lariam'

[TangoSierra]

http://www.militarytimes.com/story/military/2016/08/11/malaria-drug-causes-permanent-brain-damage-case-study/88528568/

The case of a service member diagnosed with post-traumatic stress disorder but found instead to have brain damage caused by a malaria drug raises questions about the origin of similar symptoms in other post-9/11 veterans.

According to the case study published online in Drug Safety Case Reports in June, a U.S. military member sought treatment at Walter Reed National Military Medical Center in Bethesda, Maryland, for uncontrolled anger, insomnia, nightmares and memory loss.

The once-active sailor, who ran marathons and deployed in 2009 to East Africa, reported stumbling frequently, arguing with his family and needing significant support from his staff while on the job due to cognitive issues.

Physicians diagnosed the service member with anxiety, PTSD and a thiamine deficiency. But after months of treatment, including medication, behavioral therapy and daily doses of vitamins, little changed.

The patient continued to be hobbled by his symptoms, eventually leaving the military on a medical discharge and questioning his abilities to function or take care of his children.

It wasn’t until physicians took a hard look at his medical history, which included vertigo that began two months after his Africa deployment, that they suspected mefloquine poisoning: The medication once used widely by the U.S. armed forces to prevent and treat malaria has been linked to brain stem lesions and psychiatric symptoms.

While no test is available to prove the sailor suffered what is called "mefloquine toxicity,” he scored high enough on an adverse drug reaction probability survey to tie his symptoms to the drug, also known as Lariam.

The sailor told his Walter Reed doctors that he began experiencing vivid dreams and disequilibrium within two months of starting the required deployment protocol.

Symptoms can last years

Case reports of mefloquine side effects have been published before, but the authors of "Prolonged Neuropsychiatric Symptoms in a Military Service Member Exposed to Mefloquine" say their example is unusual because it shows that symptoms can last years after a person stops taking the drug.

And since the symptoms are so similar to PTSD, the researchers add, they serve to “confound the diagnosis” of either condition.

“It demonstrates the difficulty in distinguishing from possible mefloquine-induced toxicity versus PTSD and raises some questions regarding possible linkages between the two diagnoses,” wrote Army Maj. Jeffrey Livezey, chief of clinical pharmacology at the Walter Reed Army Institute of Research, Silver Spring, Maryland.

Once the U.S. military's malaria prophylactic of choice, favored for its once-a-week dosage regimen, mefloquine was designated the drug of last resort in 2013 by the Defense Department after the Food and Drug Administration slapped a boxed warning on its label, noting it can cause permanent psychiatric and neurological side effects,

50,000 prescriptions in 2003

At the peak of mefloquine's use in 2003, nearly 50,000 prescriptions were written by military doctors.

That figure dropped to 216 prescriptions in 2015, according to data provided by the Defense Department. According to DoD policy, mefloquine is prescribed only to personnel who can't tolerate other preventives.But Dr. Remington Nevin, a former Army epidemiologist and researcher at the Johns Hopkins Bloomberg School of Public Health in Baltimore, said any distribution of the drug, which was developed by the Army in the late 1970s, is too much.
“This new finding should motivate the U.S. military to consider further revising its mefloquine policy to ban use of the drug altogether,” Nevin told Military Times.

While a case study is a snapshot of one patient's experience and not an indication that everyone who took or takes mefloquine has similar issues, one randomized study conducted in 2001 — more than a decade after the medication was adopted by the military for malaria prevention — showed that 67 percent of study participants reported more than one adverse side effect, such as nightmares and hallucinations, and 6 percent needed medical treatment after taking the drug.

Yet mefloquine remains on the market while Walter Reed Army Institute of Research conducts research on medications in the same family as mefloquine, including tafenoquine, hoping to find a malarial preventive that is less toxic but as effective.

Mefloquine was developed under the Army’s malaria drug discovery program and approved for use as a malaria prophylactic in 1989. Shortly after commercial production began, stories surfaced about side effects, including hallucinations, delirium and psychoses.

Once considered 'well-tolerated'

Military researchers maintained, however, that it was a "well-tolerated drug," with one WRAIR scientist attributing reports of mefloquine-associated psychoses to a "herd mentality."

"Growing controversies over neurological side effects, though, are appearing in the literature, from journal articles to traveler’s magazines and resulting legal ramifications threaten global availability," wrote researcher Army Col. Wilbur Milhous in 2001. "As the 'herd mentality' of mefloquine associated psychoses continues to gain momentum, it will certainly affect operational compliance and readiness. ... The need for a replacement drug for weekly prophylaxis will continue to escalate."

Mefloquine was implicated in a series of murder-suicides at Fort Bragg, North Carolina, in 2002, and media reports also tied it to an uptick in military suicides in 2003.

A 2004 Veterans Affairs Department memo urged doctors to refrain from prescribing mefloquine, citing individual cases of hallucinations, paranoia, suicidal thoughts, psychoses and more.

The FDA black box warning nine years later led to a sharp decline in demand for the medication. But while the drug is no longer widely used, it has left damage in its wake, with an unknown number of troops and veterans affected, according to retired Navy Cmdr. Bill Manofsky, who was discharged from the military in 2004 for PTSD and later documented to have mefloquine toxicity.

He said the Defense Department and VA should do more to understand the scope of the problem and reach out to those who have been affected.


Military Times
New concerns rising over antimalaria drug
“I’m kind of the patient zero for this and I now spend my life trying to help other veterans who have health problems that may have been caused by mefloquine. More needs to be done," Manofsky said.

He said while there is no cure for the vertigo and vestibular damage or the psychiatric symptoms caused by mefloquine, treatments for such symptoms, such as behavior and vestibular therapy help.

And, he added, simply having a diagnosis is comforting.

[TangoSierra]

Has the Department of Defence settled out of court recently on one of these cases?

[DeV]

Has the Department of Defence settled out of court recently on one of these cases?

It appears so

[TangoSierra]

Only news I can find is here. Pay wall to site though.

https://www.thetimes.co.uk/edition/ireland/settlement-in-malaria-drug-case-hpknzwf0p