MEDICATIONS - Medicine for Mountaineering and Other Wilderness Activities - page 523

Administration: The cream should be gently massaged into the affected and surround-
ing skin twice a day, in the morning and evening. Improvement with relief of itching usu-
ally occurs within the first week of treatment.
ANTIMALARIAL AGENTS
Various antimalarial drugs are available. Chloroquine, mefloquine, and malarone are used
most commonly. Travelers to malaria-endemic areas should consult a travel medicine spe-
cialist because recommendations for drugs for specific areas change so frequently.
Chloroquine
Chloroquine is highly effective for both prevention and treatment for chloroquine-sens-
itive malaria. Unfortunately, chloroquine-resistant falciparum malaria is widespread. As a
result, mefloquine (Lariam®) or atovaquone/proguanil (Malarone®) are the prophylactic
agents of choice for travel to most malarious areas. Chloroquine is also effective to some
extent in the treatment of amebiasis.
Precautions: In the dosages used for preventing or treating malaria, chloroquine has
few serious side effects. Therapeutic doses may cause minor gastrointestinal disturbances.
Skin rashes or itching occur occasionally. However, these symptoms often do not require
interruption of therapy or prophylaxis and rapidly disappear when administration is ended.
Dose: 0.5gmorallyonceweeklyonthesamedayoftheweek,startingoneweekbefore
entering a malaria endemic area and continuing for four weeks after leaving.
Mefloquine
Mefloquine (Lariam®) is administered for preventing or treating chloroquine-resistant
falciparum malaria.
Precautions: Individuals allergic to mefloquine or related agents, particularly quinine
or quinidine, should not take this drug.
Because dizziness occasionally followsmefloquine ingestion, individuals takingitmust
be careful with activities such as driving a car, piloting an aircraft, or using machinery in
which injury could occur.
Psychiatric reactions such as anxiety, depression, restlessness, hallucinations, or confu-
sion occur occasionally with mefloquine, and the drug should be stopped if these appear.
Persons with significant, preexisting psychiatric illness, particularly those on psychiatric
medication, should take mefloquine with caution, preferably after consulting a physician.
Animal studies have shown serious complications from mefloquine taken during preg-
nancy. There are no studies of the safety of mefloquine in pregnant women. The drug
should only be taken by pregnant women if the potential benefits justify the potential risk
to the fetus.