Saturday, February 25, 2012

Mefloquin Misery

Common side effects of Mefloquin:
Vivid, violent dreams
Insomnia
Memory loss
Mood swings
Depression
Bouts of explosive anger
Hair loss
Hallucinations
Heart beat irregularities
Note: Mefloquin can lay dormant in your system, so if you do not experience side effects immediately, not to worry, you still have a chance a few years down the line.

Mefloquin is the prophylaxis drug of choice of Peace Corps. It is a potent anti-malarial taken once per week. It has never been tested for use over 6 months. It was commonly used in the Vietnam War by US troops but later found that it had a high correlation with suicide rates among said troops. It’s now also on the “drugs to not give to people” list in the U.S. Why is it the drug of choice? Because it’s cheap. And we’re not IN the U.S.

Most people end up switching off it at some point in their service. My buddy, Sol, switched after a few months when he started having violent hallucinations of killing people in his village. Another guy I know saw rats running up his curtains and people in his house. Most people who switch have sleeping problems and depression. I fall into the category of “most people”.

I hadn’t really had a strong reaction to Mef until recently, after a year of being on it. Around October/November I started having these horribly disturbing dreams filled with gore and ghosts and stress in vivid colors, usually neon green or bright red. I’ve been really upset these last few months about everything with very angry but suppressed mood swings. I won’t go into detail on here, but it was like a seething anger. I couldn’t see anyone I didn’t consider a legitimate personal friend without wanting to yell at them. Most of the people I see are Malawians, so it really didn’t bode well for them my impression of Malawi during these swings (and even still, I’m trying to undo this annoyance I’ve built up toward them now that I’ve calmed down a bit).

So this had been going on for some time and I still hadn’t really made the connection between my depression, dreams, and mefloquin. I kept my mood pretty much to myself, I only ever shared my stand-out dreams with a friend or two, who just thought of them as cool stories written by my subconscious brought on by eating too much before bed, and mefloquin never really came up. Until one night about four weeks ago, I found myself bawling in bed about how sad and lonely I will be when my future husband dies before me and leaves me very old, alone without my other half, with grown children who don’t want me, to await death by myself. Granted, I’d just finished rereading Water for Elephants, which is told from the point of view of an old man in such a situation, but I was surprised at how acutely I felt this non-existent future husband’s loss. I told my mom about it the next day, I think I freaked her out. Something was definitely not right with my head.

The Peace Corps Doc has since switched me to Malarone, which is just as potent but has minimal side effects and is much more expensive. After three weeks, Mef is out of my system and the results are obvious. It’s like I’ve detached an anchor from my insides that was dragging me down that I didn’t realize was there. It’s still a little soon to test out the dream thing and the angry mood swings, and I’m still not entirely happy (I AM still in the 11-15 month sophomore slump period of my service), but I’m not a mess. I was, decidedly, a mess a month ago. I can go to school without dread of being in a room full of teenage Malawians who don’t want to be in school any more than any other teenager in the world. I can have visitors at my house without wanting to tell them to get the f*** out. I can endure cat calls in town without seeing red. Doug can eat my lunch off the counter and I won’t have serious fantasies of animal abuse. I can smile walking through my village when I greet people (I couldn’t fake it before, my face literally wouldn’t let me, permanent scowl). Yeah, a month ago it was really bad. It’s made all the difference getting off of it, thank god. My service has had a complete turn around and I can’t imagine it being that bad again (let’s hope).

Now I’m telling everyone to get off it asap, side effects or not. It’s just something that should never be in our systems. Peace Corps shouldn’t put us on it in the first place, and then make it a med sep (short for medical separation from Peace Corps, essentially a forced ET, or early termination of service) offence if you don’t take it and get Malaria. My sitemate, Alan, says he’d rather get Malaria than be on Mef. He’s on Doxycyclin now, the second choice of Peace Corps (I was on it for a day, actually, right when I got to country, but had a bad reaction to it almost immediately. Among other side effects, it makes your skin more sensitive to the sun and I had the worst sunburn of my life within hours of taking it). He says he still would rather not be on something as crazy as these prophylaxis drugs for two years and part of him would still prefer Malaria, but at least it’s not Mef, and at least he’s still here. So far I’ve gotten at least Robert to convert, he’s also on Doxy as of yesterday. He hasn’t shown any symptoms of side effects of Mef but I’m interested to know if he notices any differences regardless.

So, here’s to Malarone, and here’s to not wanting to maim anyone anymore!

3 comments:

  1. Hey, I saw this post on PCJ...my invite is in the mail (should be here tomorrow, UPS is taking too long!) and I think I'm headed to Africa, so I've been researching malaria meds.

    Anyhow...Does PC let you choose what malaria medication you get to be on? Mefloquin scares me, and I don't really like the idea of taking an antibiotic for 27 months either.

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  2. Hi Sarah! Hope you've gotten your invite by now. PC doesn't really let you choose your profalaxis, but its easy to switch if you're having side-effects. If you don't want to be on mef my suggestion is that during training, report to your PCMO that you're experiencing insomnia and mood swings and that your vivid dreams won't go away, even if they're have and you're no experiencing side effects. They're used to people wanting to get off mef. They'll probably switch you to Doxy, which is better, but still not super great. If you want to get off Doxy, tell the med office that you're getting severe sunburns and sunscreen really isn't helping too much or that you're prone to yeast infections. Then they'll probably put you on malerone.

    Of course, you can always request to be put on malerone right at the start. Dunno if that'll work, but its worth a shot. Good luck!

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  3. IMPORTANT for EU (and in Parts also for the USA)! The German BfArM (comparable to the FDA in US) was the Rapporteur (Authority/Agency) who was responsible for the PSUR-WS Procedure Nr.: DE/H/0022/001 (Substance: Mefloquine). This Periodic Safety Update Report - Work Sharing (PSUR-WS) was implemented from 2006-2009 (3-Year PSUR). After a PSUR-WS is done, the responsible Agency (in this case the BfArM) has to carry out a new Core Safety Profile (CSP). In the Guidelines for this Drug Safety Procedure is written, that the whole Procedure had to be done within 110-135 Days. After that time a Final Assessement Report (FAR) and CSP had to carry out from the responsible P-RMS (Psur-Reference Member State). If further Information is required from the Manufacturer (within the Procedure), the Manufacturer have 14 Days to deliver this RFI (Request for Information). And now it comes: The BfArM (responsible as P-RMS for the Substance Mefloquine) had carry out the FAR/CSP for the PSUR-WS Nr.: DE/H/0022/001 in APRIL 2013. That was 4 Years !!! after the Data-Lock-Point (DLP) for this Procedure. Based on this new CSP also the FDA had carried out their "new" strengenthed Warnings (Block, Box, etc.) in JULY 2013. All other EU-Countries also then carried out the new CSP from BfArM. In Germany a "Dear Doctor Letter" came out in SEPTEMBER 2013. (Like you read before, the Manufacturer have normally 4 Month time to give out this Information to the Public. In this case (for Germany) it was more than 5 Months). Once again: All new warnings (WORLDWIDE) are based on the FAR/CSP from the BfArM dated 03.04.2013. 4 years!!! after the Drug Safety Procedure had normally to be done. For the USA: The Reason that ROCHE not continue the License in 2009 is, that they already knewed that a new CSP will carry out with new warnings after the PSUR-WS is done. In the "List of Substances under PSUR-WS" you can read that in 2009 there was an "Amended PAR" was carried out. Later (2011) you can read about a "Delay in the procedure" in this List. The whole PSUR-WS Procedure DE/H/PSUR/0022/001 stinks. The BfArM also wrote in Documents that they had recieved "confidential information" from the FDA for this PSUR-WS. Ask the FDA about this "confidential informations". Ask the FDA about the CSP/FAR from the BfArM from APRIL 2013 and ask the FDA why the P-RMS carried out this CSP/FAR after 4 Years the PSUR-WS had to be done already. You can ask the FDA also why they wait until the last Day to carry out this information on 29.07.2013 (remember: CSP came out 03. April 2013 and after that 4 Month time to give this to public would be 04.08.2013. The FDA carried it out on 29. July, but they knew about the new CSP already since APRIL 2013) For the EU: Same Questions to your Authorities and also the EMA. In a Document from the Irish Medicines Board you can also see that it took more than 1 Year after the BfArM ask for more Information (RFI) to the Manufacturer within this PSUR-WS (remember: the Manufacturer have 14 days to provide this information) that the Manufacturer give this Information. Related Documents and Screenshots can be found here: http://www.nebenwirkung-suizid.de/Documents/psur_ws_de_h_psur_0022_001.html (Documents are in English/ the german Text can be translated easy with google translate.) Thank you for your Attenton on this.

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