Mefloquine Benefits Update

Not all nightmares among veterans are the result of PTSD.  Chronic nightmares, as well as anxiety and insomnia, may be the result of a disease called quinism, caused by poisoning by mefloquine and related antimalarial drugs.

Mefloquine is an antimalarial drug that was developed during the Vietnam War by the Walter Reed Army Institute of Research. It was approved for usage by the FDA in the late 180s under the name Lariam and recommended for U.S. military usage.  

The original drug label stated neuropsychiatric reactions could be possible with usage.  In 2013, a mandated label change by the FDA included a black box warning that stated side effects could persist long after discounting usage.   Side effects include anxiety, depression, restlessness, confusion, terrifying nightmares with technicolor clarity, irritability, anger, moodiness, insomnia and concentration problems.”  

In 1992, the use of Mefloquine was used during U.S. military operations in Somalia.  Many service members report that they received Mefloquine under command directed and directly observed administration.  Rob (a veteran whose last name is omitted for confidentiality) was in the Marine Corps and served in Somalia 1992 and 1993 stated: “My corpsman told me and my fellow marines not to take the drug… it has bad side effects!”.  Rob took the drug for a two-week period and still suffers side effects to this day.   After using the drug and suffering from a mental breakdown, he was directed to get back into the firefight.  “Nobody cleared me as safe to resume back normal operations. I felt like I had a fog over my brain.” 

While Mefloquine usage was widespread in Afghanistan in 2001 and 2003, the FDA requires all Mefloquine prescriptions to be accompanied by a patient medication guide to include the warning of the drug label that users seek medical attention if “possible signs of more serious mental problems” develop.    According to a vast number of service members, they were never informed of these warnings or verbal instructions of the same.  In 2013, another label change clarified that neurologic and psychiatric effects from Mefloquine could “persist after Mefloquine has been discontinued”  

It is estimated that over 100,000 service members were exposed to Mefloquine.  In 2004, the Veterans Health Administration (VHA) had issued an information letter (IL 10-2004-007) to its clinicians warning of the possibility of long-term effects from mefloquine, but this letter was allowed to lapse and is now unavailable.  In 2013, Dr. Jonathan Woodson, the Assistant Secretary of Defense for Health Affairs, acknowledged many military service members were dispensed mefloquine without proper medical and the VA must develop a procedure to adjudicate such claims, even in the absence of proof of prescribing.  

The VA is now recognizing the service connection for these conditions, but medical opinion is needed to be successful.  This is where Dr. Remington Nevin comes in.  He is a former U.S. Army Major and Preventative Medicine Officer with extensive travel medicine and policy experience. Dr. Nevin was the first to publish a clinical description of quinism, the permanent disorder of brain and brainstem dysfunction caused by the use of mefloquine and related quinoline drugs.

Dr. Nevin has assisted many veterans by reviewing their military medical records and civilian medical records in order to form a medical opinion.  

If you believe you were affected by this drug, please contact the Grand Traverse County Dept. of Veterans Affairs for more information or for assistance in filing a claim. 

This article originally featured in our January issue of GATHER Veterans