The federal Department of National Defence (DND) and the Canadian Armed Forces (CAF) have published the results of a recent Surgeon General review on using the drug mefloquine to prevent malaria in the military. According to a June 1 news release from the DND, the military will now recommend mefloquine only if a CAF member requests it or if there are contraindications to prescriptions for other anti-malarial drugs for the member.
Although the CAF has been using mefloquine as medication to prevent the disease for more than two decades, concerns have been raised about the drug’s effects on users with mental-health disorders. Health Canada has placed monographs on mefloquine packages warning about “neuropsychiatric adverse reactions” and “psychiatric or neurologic symptoms” during prophylactic use, according to the report, titled Surgeon General Task Force Report on Mefloquine.
“We are recommending mefloquine as a second-line drug only, because of the unique operational environment that we work in,” said Brigadier-General Colin MacKay, the federal Surgeon General, in a press statement upon the report’s release. “This direction should not be applied to a nonmilitary environment.
“We will continue to monitor and review all relevant scientific literature on mefloquine,” Brig.-Gen. MacKay added.
General Jonathan Vance, Chief of the Defence Staff, said in a statement that he was confident that Brig.-Gen. MacKay’s recommendations would ensure the overall health of Canadian military members.
“The health and well-being of our people is directly linked to the operational effectiveness of the Canadian Armed Forces,” said Gen. Vance. “Because of this, I have a duty to ensure everyone under my command has access to the best options for medical care currently available.”
The review examined previously published studies on mefloquine and its use in military settings. It found no evidence, based on its inclusion criteria, that mefloquine has potential long-term adverse effects on one’s physical health. There is also no evidence that mefloquine is consistently associated with inability to perform occupational duties, according to the report.
But Brig.-Gen. MacKay recommended that the CAF use the drug with caution, due to the difficulty of screening members for contraindications sufficiently within short periods of time. In addition, the review speculated that the short-term side effects of mefloquine could be mistaken for typical responses to operational military situations, complicating the management of its adverse effects.
“The current CAF approach to use of [malaria medication] is consistent with international and national clinical-practice guidelines,” the report read. “We recommend that mefloquine be viewed as a less preferred agent that may be considered… when alternatives are considered unsuitable… [or] for persons who have previously tolerated, indicate a preference for and do not have contraindications to use of mefloquine.”
Surgeon General Task Force Report on Mefloquine is available online at http://www.forces.gc.ca/en/about-reports-pubs-health/surg-gen-rpt-mefloquine.page.