The primary antimalarial for Central America continues to be chloroquine (not capitalized as it is a chemical, not a brand name) (e.g., Aralen®). The side effect profile of this drug typically is pretty benign.
As you suggest, mefloquine (e.g., Lariam®) indeed is another matter. Advice on it would include the following from my "Ask RSD" column in the Nov '99 issue of "Rodale's Scuba Diving":
"Lariam (mefloquine) is a very effective drug in preventing and treating malaria, but can give rise to unwanted side effects, including vivid & disquieting dreams, hallucinations, anxiety, depression, confusion and forgetfulness. The US package insert directs that "...caution should be exercised with regard to driving, piloting an airplane, and operating machinery as dizziness, a disturbed sense of balance, neurological or psychiatric reaction have been reported during and following the use of Lariam," and states that "dizziness, sensory & motor abnormalities, headache and fatigue have been recorded in patient's taking the drug." These cautions are consistent with suggestions by some in the medical and dive communities that mefloquine may produce side effects which mimic DCS. Interestingly, the German package insert adds it should not be used for "certain activities which have a need for full attention and undisturbed motor activity," with a specific direction that pilots should not use Lariam for the prevention of malaria during their work.
Of most concern to the diver are the positions of some medical professionals that the drug simply should not be taken for malaria prophylaxis by those who are actively diving. These sources include Rodale's Diving Doc," Dr. Samuel Shelanski, and the German Society for Tropical Diseases. This later group, whose policies can be used as a basis for professional and legal action in cases of harm resulting from a physician's failure to follow them, states that people with a special need for three-dimensional orientation, for example pilots, scuba divers and others, should not take mefloquine as prophylaxis. Similar advice regarding scuba diving is provided by Dr Bridget Farham, B.Sc (hons), Ph.D, MB.ChB., an expert on tropical medicines, and appears in the package insert accompanying mefloquine dispensed in South Africa.
The above information suggests it would be prudent to take this drug only after detailed discussion with a physician who is fully aware of its current status, and to closely monitor for any adverse reaction."
Yes, there are alternatives that are best discussed with a tropical medicine expert. Which one is preferred depends on where the travel is, intercurrent diseases one may have, drug sensitivities & other factors. Malarone
http://www.cdc.gov/travel/diseases/malaria/malarone.htm is a new drug that is sometimes prescribed in place of Lariam.
This is educational only and does not constitute or imply a doctor-patient relationship. It is not medical advice to you or any other individual, and should not be construed as such.
Best regards.
DocVikingo
