Explaining about possible adverse events may reduce problems

BMJ 1996; 313 doi: http://dx.doi.org/10.1136/bmj.313.7071.1553b (Published 14 December 1996) Cite this as: BMJ 1996;313:1553
  1. Ron Behrens
  1. Consultant in tropical and travel medicine Travel Clinic, 4 St Pancras Way, London NW1 0PE

    EDITOR,—The adverse events reported by P J Barrett and colleagues in travellers taking mefloquine, who were recruited to the study when seeking telephone advice,1 were subjectively much more severe and disabling than those described in a study from Swiss, Swedish, and American researchers published around the same time2.

    Schlagenhauf et al's study reports a similar incidence of adverse events that interfered with travellers' normal activities (11.9% compared with Barrett and colleagues' 9.2%) and a not dissimilar proportion of neuropsychiatric events.2 Schlagenhauf et al followed up travellers recruited in a specialist travel clinic, where the neurobehavioural status, psychomotor function, performance deficit, and mood profile of people with adverse events and matched controls were examined. No significant differences were found between the groups, and none of the subjects with adverse events associated with mefloquine required medical attention or admission to hospital.

    The discrepancy in the severity of events between these two studies is therefore striking, and one possible explanation could be the method of recruiting subjects. Travellers advised in a specialist clinic would be forewarned of side effects and therefore might respond to adverse events with less anxiety and fear than people who had not been made aware, or had not been adequately informed, of the risks and events associated with prophylaxis with mefloquine. Awareness may increase the anxiety threshold and thereby reduce the severity of neuropsychiatric adverse events. Good prescribing, which includes explanations of possible adverse events as recommended by the Committee on Safety of Medicines,3 may be the best way of reducing disabling side effects.


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