Intended for healthcare professionals


Comparison of adverse events associated with use of mefloquine and combination of chloroquine and proguanil as antimalarial prophylaxis: postal and telephone survey of travellers

BMJ 1996; 313 doi: (Published 31 August 1996) Cite this as: BMJ 1996;313:525

How bad is the insomnia caused by mefloquine?

What, I wonder, is the pattern of the insomnia that is associated
with mefloquine? I'm interested because I seem to have it. The experience
has helped me understand the inadequacy of the information made available
by medical authorities and the need for better information by patients for

At 2.30 in the morning last night I started by reading the patient
product information for mefloquine. It gives a list of "most common
unwanted effects" and includes "sleep problems." It gives no information
on how commonly they occur, how severe they are, and what is likely to
happen to a patient who has them. The BNF told me nothing more. Clinical
Evidence told me a little more: the evidence on side effects is not good
but insomnia may occur in 15% of patients. I then searched, which
gave me access to some original studies on side effects, but they didn't
tell me any more than Clinical Evidence.

What I want to know is:
1. Will this insomnia pass or will it happen every night for the six weeks
I expect to be taking the drug?
2. How long each night am I likely to be unable to sleep?
3. If I stopped taking the drug how quickly would the insomnia fade?
4. If I take the drug again will I get insomnia again?
5. As I have the insomnia does it mean that I'm more likely to get the
other side effects, some of which are very serious?
6. Is there anything I can do to treat the insomnia?
7. Is it worth it? I'm going to Calabar in Nigeria for a few days.

Sadly, none of my sources of information help me with these
questions, but I wish I could access a systematic account of patients'
experiences. DIPEX already does this for some conditions but not yet
malaria prophylaxis.

Richard Smith, Editor, BMJ

1 Herxheimer A, McPherson A, Miller R, Shepperd S, Yaphe J, Ziebland
S. Database of patients' experiences (DIPEx): a multi-media approach to
sharing experiences and information. Lancet. 2000;355:1540-3.

Competing interest: As well as being the editor of the BMJ I'm the
chief executive of the BMJ Publishing Group which owns Clinical Evidence
and co-owns the BNF.

Competing interests: No competing interests

20 April 2002
Richard Smith