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!
neville grimshaw
September 21, 2025 AT 06:19Lariam? Oh sweet mercy, that’s the one that turns people into paranoid zombies who think their toaster is plotting against them, right? I took it in Cambodia and spent three days convinced the hotel staff were replacing my shampoo with mind-control gel. Never again. Also, why does everyone act like it’s just ‘vivid dreams’? Bro, I saw my dead cat give me a PowerPoint on global capitalism. Real talk.
Philip Crider
September 21, 2025 AT 23:19Bro, I get it - you wanna nap on a beach in Thailand without getting malaria. But have you ever stopped to ask who *really* profits from pushing Lariam? 🤔 Big Pharma’s got a monopoly on quinoline derivatives, and they’ve been burying the PTSD case studies since 2003. I mean, look at the VA’s own reports - over 12,000 vets prescribed Lariam now have chronic anxiety, derealization, even suicidal ideation. And yet? Still on the WHO’s ‘preferred’ list. Coincidence? Or just another chapter in the pharmaceutical colonization of global health? 🌍💊
Jackie Burton
September 22, 2025 AT 20:46Let’s not romanticize the ‘once-a-week convenience.’ Mefloquine’s half-life is 2–3 weeks. That means you’re essentially dosing yourself with a neurotoxin for 6+ weeks post-travel. The CDC’s ‘rare’ psychiatric events? That’s a statistical illusion - underreporting is rampant because docs don’t connect the dots. I’ve reviewed 47 case files from DoD deployments. 89% of patients who reported hallucinations or paranoia were told it was ‘stress.’ No one wants to admit their ‘safe’ prophylaxis is a chemical lobotomy.
Diana Sabillon
September 23, 2025 AT 08:50I just want to say I’m really sorry anyone had a bad experience with this. I took it once for a trip to Kenya and had the weirdest dreams - like, I was flying over the Serengeti on a giant mosquito - but it passed. I know it’s scary for some people, and I hope anyone struggling feels heard. Maybe there’s a better option out there for you.
Carl Gallagher
September 25, 2025 AT 04:15It’s fascinating how we treat prophylaxis like a one-size-fits-all solution when the human body is a wildly variable system. Lariam works for some, sure - but the pharmacokinetics vary drastically based on CYP2D6 metabolism, BMI, even gut microbiome composition. I’ve seen people on the same dose have zero side effects while others spiral into months of dissociation. The real issue isn’t the drug - it’s the medical system’s refusal to personalize. We need genetic screening before prescribing, not just a checkbox on a travel clinic form. And yes, I’ve written to the WHO about this. Twice.
bert wallace
September 26, 2025 AT 23:18My cousin took it for a trip to Ghana. Came back quiet. Like, really quiet. Didn’t talk for six months. Diagnosed with ‘adjustment disorder’ - until someone noticed the timeline matched the Lariam course. Now he’s on disability. They told him it was ‘rare.’ But if it happened to someone you love, would you still call it rare? Just… be careful.
Hamza Asghar
September 27, 2025 AT 18:12Oh wow, another one of you normies who thinks ‘vivid dreams’ is the worst that can happen? Lariam isn’t a drug - it’s a chemical weapon disguised as a vacation tool. The FDA knew about the neuropsych risks since 1999 and still let it stay on the market because it’s profitable. And now you’re all acting like it’s just a ‘side effect’? Please. This is institutional negligence wrapped in a travel brochure. If you’re dumb enough to take this, you deserve what you get. Also, doxycycline is cheaper, safer, and you don’t need to be a neurologist to use it. Grow up.
Neal Shaw
September 28, 2025 AT 14:44There’s a critical nuance missing here: Lariam’s risk profile is only dangerous in specific subpopulations - those with preexisting psychiatric conditions, CYP2D6 poor metabolizers, or a history of seizures. The real failure isn’t the drug, but the lack of pre-travel genetic and psychiatric screening. In clinical practice, I’ve reduced adverse events by 92% by implementing a simple algorithm: 1) Screen for psychiatric history, 2) Check CYP2D6 status if possible, 3) Offer alternatives (atovaquone-proguanil, doxycycline) as first-line. The WHO’s second-line designation is actually appropriate - it’s not about banning Lariam, it’s about *contextualizing* it. Misinformation is the real parasite here.