TL;DR
- Lariam is the brand name for mefloquine, an antimalarial used for prevention and treatment.
- Standard prophylaxis is one 250mg tablet weekly, starting 1‑2 weeks before travel and continuing 4 weeks after leaving the area.
- Common side effects include nausea, dizziness, vivid dreams and, in rare cases, neuro‑psychiatric reactions.
- Never use Lariam if you have a history of seizures, serious mental health issues, or are pregnant without medical advice.
- If symptoms persist or worsen, contact a healthcare professional immediately.
What is Lariam and When Should You Consider It?
Lariam is the trade name for the drug mefloquine. It belongs to a class called quinolines and works by killing the malaria parasite while it’s still in the liver. Health authorities in the UK, US and many other countries approve it for two main purposes:
- Pre‑exposure prophylaxis - taking the pill before, during and after a trip to a malaria‑risk zone.
- Treatment of acute malaria - usually when the infection is caused by Plasmodium falciparum or vivax and the patient can’t take other medicines.
Travelers heading to parts of sub‑Saharan Africa, Southeast Asia or the Amazon often get a prescription for Lariam because it’s a once‑a‑week regimen - a big convenience compared with daily pills like doxycycline.
However, the drug isn’t a one‑size‑fits‑all solution. The World Health Organization flags it as a second‑line choice for people with a known psychiatric history or epilepsy. In short, you need a medical check‑up to see if Lariam is safe for you.
How to Use Lariam Safely: Dosage, Timing and Contra‑indications
Getting the timing right is crucial. A missed dose can leave you vulnerable to malaria, while an extra dose raises the risk of side effects.
| Scenario |
When to Start |
Weekly Dose |
When to Stop |
| Standard prophylaxis |
7‑14 days before entering malaria zone |
One 250mg tablet (or two 125mg tablets) taken with food |
4 weeks after leaving the area |
| Short‑term travel (<7 days) |
1‑2 weeks before departure (if possible) |
Same as above |
4 weeks after return |
| Treatment of confirmed malaria |
Immediately after diagnosis |
Initial dose 1250mg (5 tablets) on day 1, then 750mg (3 tablets) daily for 2‑3 days |
End of treatment course |
Key safety pointers:
- Take the tablet with a large meal or a snack; food helps reduce stomach upset.
- If you miss a dose, take it as soon as you remember-unless it’s less than 8hours before the next scheduled dose. In that case, skip the missed one and resume the regular schedule.
- Store Lariam at room temperature, away from direct sunlight.
- Never combine Lariam with other antimalarials unless a doctor explicitly says so.
- Pregnant women should avoid Lariam unless the benefits outweigh the risks; alternative prophylaxis is usually recommended.
People with the following conditions should discuss alternatives with their doctor:
- History of seizures or epilepsy.
- Severe psychiatric disorders (e.g., depression, anxiety, psychosis).
- Heart rhythm problems (QT prolongation).
- Severe liver disease.
Even if you’re cleared to use Lariam, keep a symptom diary. Note any changes in mood, sleep patterns or vision, because early detection can prevent more serious complications.
Common Side Effects, Rare Risks and What to Do About Them
Most travelers report mild issues that pass within a few days. The most frequently noted reactions are:
- Nausea or stomach cramps.
- Dizziness or light‑headedness.
- Vivid, sometimes unsettling dreams.
- Headache.
These can often be eased by taking the pill with food, staying hydrated, and getting enough rest.
What raises eyebrows are the neuro‑psychiatric side effects. They’re uncommon-affecting roughly 1 in 10000 users-but they can be serious. Symptoms to watch for include:
- Persistent anxiety or panic attacks.
- Hallucinations or feeling detached from reality.
- Severe depression, thoughts of self‑harm, or suicidal ideation.
- Unexplained motor weakness or coordination loss.
If any of these appear, stop the medication immediately and seek medical help. A doctor may switch you to an alternative prophylactic such as atovaquone‑proguanil (Malarone) or doxycycline.
Other rare but documented risks:
- Skin rashes that could indicate an allergic reaction.
- Visual disturbances like blurred vision or double vision.
- Heart rhythm changes detectable on an ECG.
When you experience a rash or vision change, call a healthcare provider right away. For heart‑related concerns, an ECG before starting Lariam helps assess baseline risk.
Practical tips to minimise discomfort:
- Start the medication early-this gives your body time to adapt before you hit the malaria zone.
- Take the pill at the same time each week to create a routine.
- Consider a short break of a day or two if you experience intense nightmares; discuss this with a doctor before adjusting the schedule.
- Maintain a balanced diet; avoid excessive caffeine or alcohol, which can worsen anxiety.
- Carry a copy of your prescription and a brief note on the dosing schedule in case you need medical help abroad.
Remember, the benefits of preventing malaria far outweigh most side effects for most travelers. Malaria can be fatal if untreated, while Lariam‑related complications are usually manageable when caught early.
Quick FAQ for Travelers Considering Lariam
- Can I drink alcohol while on Lariam? Occasional moderate alcohol is unlikely to cause problems, but heavy drinking can amplify dizziness and nausea.
- Do I need a blood test before starting? A basic liver function test and, if you have a cardiac history, an ECG are advisable.
- What if I forget a weekly dose? Take it as soon as you remember unless it’s within 8hours of the next dose; then skip and continue as scheduled.
- Is Lariam safe for children? It’s approved for kids weighing at least 40kg. Dosage is weight‑based, so a pediatric prescription is essential.
- How does Lariam compare to Malarone? Malarone is taken daily, has fewer neuro‑psychiatric warnings, but can be pricier. Lariam’s weekly schedule suits those who dislike daily pills.
Next Steps If You Decide to Use Lariam
1. Book an appointment with a travel clinic or your GP at least 2weeks before departure.
2. Bring a list of current medications and any past psychiatric or seizure history.
3. Ask for a printed schedule and a short briefing on what to watch for.
4. Set a weekly reminder on your phone to keep the dosing consistent.
5. Keep emergency contact numbers (local health services, embassy) handy.
Following these steps helps you stay protected against malaria while keeping the side‑effect risk low. Safe travels!
