Do not take Lariam Tablets if you have or have previously experienced:

• an allergy to mefloquine or any of the other ingredients of this medicine (see section 6 “Contents of the pack and other information”) or to similar medicines such as quinine or quinidine
• depression, thoughts about suicide and self-endangering behaviour
• any other mental problem, including anxiety disorder, schizophrenia or psychosis (losing touch with reality)
• fits (seizures or convulsions)
• severe liver problems
• blackwater fever (a complication of malaria that affects the blood and kidneys)

If any of the above applies to you, make sure your doctor knows, so that your doctor can prescribe a different medicine for prevention or treatment of malaria.

Also, consult your doctor immediately if you are already being treated with halofantrine, or you have been prescribed a course of halofantrine. Halofantrine (which is used to treat malaria) and Lariam taken at the same time can slow the heartbeat to a dangerous level. Therefore, to help avoid the possibility of a dangerous alteration in heart rhythm, you must not take halofantrine if you are already taking, or have taken Lariam within the last 15 weeks.

Warnings and precautions

Lariam may cause serious mental problems in some people. Tell your doctor immediately if you experience any of the following while taking Lariam:

• suicidal thoughts
• self-endangering behaviour
• severe anxiety
• feelings of mistrust towards others (paranoia)
• seeing or hearing things that are not there (hallucinations)
• nightmares / abnormal dreams
• insomnia
• depression
• feeling restless
• unusual behaviour
• feeling confused

Please seek medical help immediately if you experience serious mental problems while taking Lariam. Lariam should be stopped immediately and replaced with another medicine to prevent malaria.

Talk to your doctor, pharmacist, or nurse before taking Lariam if you have:

• epilepsy
• fits (seizures or convulsions)
• heart problems, especially changes in heart rhythm
• liver or kidney problems
• eye problems (e.g. loss of fine detail, colours seem faded, sudden loss of vision, poor vision at night)
• blood or lymphatic disorder (abnormal blood test showing a decrease or an increase in white blood cells, a decrease in red blood cells or platelets)
• neuropathy with signs of e.g. pins and needles, weakness, numbness, new or worsening clumsiness or unsteadiness on your feet, or shaking of the hands and fingers
• inflammation of the lungs, also known as pneumonitis. This is a serious, potentially life-threatening allergic reaction in the lungs which may cause fever, chills, cough, shortness of breath or chest pain.
• previously contracted malaria even though you were taking Lariam tablets for malaria prevention
• experienced a mild to serious potential life threatening allergic reaction to Lariam or any of its ingredients
• low blood glucose due to a pre-existing condition called congenital hyperinsulinemic hypoglycaemia

Some side effects may occur after you have stopped taking Lariam. In a small number of patients it has been shown that depression, dizziness or vertigo and loss of balance may persist for months or longer, even after you have stopped taking Lariam.

Children

Experience with Lariam in infants less than 3 months old or weighing less than 5 kg is limited.

Other medicines and Lariam

Before taking Lariam, make sure your doctor knows if you are taking other medicines (including those you have obtained without a prescription).

Tell your doctor, pharmacist, or nurse if you are taking, have recently taken or might take any other medicines including:

• halofantrine, or you have been prescribed a course of halofantrine (see section 2 “Things you should know before taking Lariam”)
• medicines such as quinine, quinidine, or chloroquine, used to treat or to prevent malaria
• medicines for any heart trouble, or high blood pressure, such as β-blocking agents, calcium channel blockers
• antihistamines for allergies
• medicines for some mental problems (psychiatric disorders). Anti-depressants such as tricyclic anti-depressants, selective serotonin reuptake inhibitors (SSRIs), bupropion or anti-psychotics such as phenothiazines.
• medicines used to treat epilepsy, such as sodium valproate, carbamazepine, phenobarbital, phenytoin
• ketoconazole (used to treat fungal infections) – you should also ask your doctor for advice before taking ketoconazole within 15 weeks after taking Lariam
• antibiotics used to treat bacterial infections for example rifampicin, penicillins, cephalosporins
• efavirenz (used to treat HIV infections)
• tramadol (used to treat severe pain)
• medicines for blood clotting disorders or diabetes, as your doctor may wish to monitor you before you travel

If you need an oral vaccine to help prevent you from catching typhoid, you should arrange to receive it at least 3 days before you need to start taking Lariam. Otherwise, Lariam may stop the vaccine from working properly.

Pregnancy and breast-feeding

Pregnant women should not normally take these tablets.

Due to the seriousness of malaria during pregnancy, it is recommended that you should not travel to an area where you could become infected with malaria if you are pregnant, think that you may be pregnant, or if you are planning to have a baby.

Lariam should be avoided by women who are breast-feeding.

If you are pregnant or breast-feeding, think that you may be pregnant, or planning to have a baby, ask your doctor for advice before taking this medicine, as he or she may decide that you should not use this medicine.

Driving and using machines

Take special care if you perform activities requiring alertness and coordination (accurate small movements) and spatial awareness (being aware of distances) such as driving, piloting an aircraft, operating machinery, cycling, and deep-sea diving as Lariam can cause dizziness, loss of balance and mental problems. If you are in any doubt about whether you can do a particular activity, talk to your doctor.

In a small number of patients it has been shown that dizziness, vertigo and loss of balance may persist for months or longer after stopping Lariam.

Lariam contains lactose

If you have been told by your doctor that you have an intolerance to some sugars, such as lactose or galactose, you should not take Lariam. Contact your doctor before taking this medicinal product.