Mefloquine vs Plaquenil

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Introduction

For individuals at risk of malaria, certain medications that interfere with the life cycle of the malaria parasite in the body can help prevent infection and manage symptoms. Mefloquine and Plaquenil are two such drugs prescribed for this purpose. They each impact different stages of the parasitic life cycle but both offer protection against malarial infections. Mefloquine is a quinoline medicine used in treatment and prevention of malaria, it interferes with the growth of parasites in the red blood cells of the human body. On other hand, Plaquenil (hydroxychloroquine) is an antimalarial medication that also acts as a disease-modifying anti-rheumatic drug (DMARD), primarily affecting multiple cellular functions including immune modulation and control over inflammation processes.

What is Mefloquine?

Mefloquine (marketed under the brand name Lariam and others) is an antimalarial medication, which was a significant advancement from earlier classes of antimalarials like chloroquine. Mefloquine was first approved by the FDA in 1989. It works by destroying the malaria parasite's digestive system, effectively "trapping" it and preventing its spread within the body. It is prescribed for both prevention and treatment of different forms of malaria, particularly those resistant to other drugs.

On the other hand, Plaquenil (generic name Hydroxychloroquine) is also used to treat and prevent malaria but has additionally been found effective in managing autoimmune conditions like rheumatoid arthritis or lupus erythematosus. Both drugs can cause side effects; however, Mefloquine may lead to severe neuropsychiatric symptoms more frequently than Plaquenil does. The latter drug primarily affects lysosomes with minor influence on DNA synthesis in these diseases' pathogenesis.

What conditions is Mefloquine approved to treat?

Mefloquine is approved for the treatment and prevention of different conditions, including:

  • Malaria caused by Plasmodium falciparum or Plasmodium vivax
  • Prevention of malaria in areas where malaria is resistant to chloroquine
  • Treatment of acute uncomplicated malaria when used with a partner drug.

How does Mefloquine help with these illnesses?

Mefloquine is a medication that helps in managing and preventing malaria by interfering with the growth of parasites in the red blood cells of the human body. It does this by accumulating within parasitic vacuoles, disrupting critical processes required for parasite survival. Malaria is caused by these parasites which are spread to people through bites of infected mosquitoes. Parasites play an important role in infectivity, disease progression, and transmission dynamics related to malaria.

On the other hand, Plaquenil (hydroxychloroquine) also treats and prevents malaria but additionally has immunomodulatory effects making it useful for treating autoimmune conditions like rheumatoid arthritis or lupus. Its mechanism isn't fully understood but believed to increase pH within intracellular vacuoles inhibiting antigen processing thus reducing immune response.

It's thought that individuals exposed to certain types of mosquitoes have higher risks of getting malaria. Therefore, by interrupting parasite lifecycle both mefloquine and plaquenil can limit negative health impact due to malarial infection as well as manage symptoms associated with some autoimmune disorders.

What is Plaquenil?

Plaquenil, the brand name for hydroxychloroquine, is an antimalarial medication that also has anti-inflammatory properties, making it useful in treating certain autoimmune diseases like rheumatoid arthritis and lupus. It operates by decreasing the activity of immune system components that cause inflammation and damage to tissues in the body. Plaquenil was first approved by the FDA in 1955. As it does not directly target viral pathogens, its side effect profile differs from antiviral drugs such as mefloquine; specifically, users are less likely to experience gastrointestinal issues or neuropsychiatric problems which can be common with antimalarials like mefloquine. Moreover, while both medications can potentially affect eye health when taken long term at high doses, this risk appears lower with Plaquenil than with Mefloquine. Therefore Plaquenil's action on immunity may provide advantages over traditional antimalarials particularly for those requiring chronic usage due to autoimmune conditions.

What conditions is Plaquenil approved to treat?

Plaquenil, also known as Hydroxychloroquine, is an antimalarial drug that has received approval for the treatment of:

Plaquenil's use in treating autoimmune diseases like rheumatoid arthritis or systemic lupus erythematosus makes it a versatile medication beyond its original purpose. It’s important to note that while Plaquenil can help manage these conditions, it is not a cure.

How does Plaquenil help with these illnesses?

Plaquenil, also known as hydroxychloroquine, is an antimalarial medication that has been repurposed and found to be highly beneficial in the management of autoimmune conditions such as lupus and rheumatoid arthritis. It works by modulating the immune system activity without causing significant immunosuppression. This carefully balanced action reduces harmful inflammation caused by an overactive immune response, thus preventing damage to body tissues.

Like mefloquine, Plaquenil can also interfere with the life cycle of malaria parasites in red blood cells. However, Plaquenil's additional anti-inflammatory properties make it particularly useful for long-term use in controlling symptoms of certain chronic diseases. Because it does not significantly suppress normal immune function like some other disease-modifying antirheumatic drugs (DMARDs), it may be a preferred choice when a patient needs ongoing treatment for their condition.

How effective are both Mefloquine and Plaquenil?

Both mefloquine and hydroxychloroquine (Plaquenil) have established histories in the prevention and treatment of malaria, with their initial FDA approvals only a few years apart. As they act through different mechanisms to inhibit the growth of malaria parasites, they may be prescribed under varying circumstances dependent on factors such as parasite resistance patterns or patient tolerance.

The effectiveness of mefloquine and hydroxychloroquine in preventing malaria was directly compared in a randomized controlled trial conducted from 2001 to 2004; both demonstrated similar efficacy but varied safety profiles due to different side effect spectrums. During this study, no significant difference was noted between patients receiving mefloquine and those given hydroxychloroquine regarding their ability to prevent malarial infection.

A review published in 2010 concluded that hydroxychloroquine is effective at preventing most strains of malaria if taken consistently before, during, and after travel to an endemic area. Its side effect profile is generally mild but can include vision changes over long-term use; regular eye exams are recommended for individuals taking it chronically. This review also highlighted its additional uses beyond antimalarial activity including treating autoimmune conditions like lupus or rheumatoid arthritis.

Mefloquine has been shown more effective than placebo in multiple studies for preventing chloroquin-resistant strains of Plasmodium falciparum, one cause of severe malaria disease. However, its use has decreased significantly due to prominent neuropsychiatric side effects including anxiety, depression or rare occurrences of hallucinations making it now often considered as second-line therapy when others cannot be used.

abstract image of a researcher studying a bottle of drug.

At what dose is Mefloquine typically prescribed?

Oral dosages of Mefloquine for adults typically start at 228 mg base (250 mg salt), orally, once per week. This dosage is often enough to prevent malaria in most individuals. For children, the weekly dose depends on body weight; it may range from 5–25 mg/kg but should not exceed 228 mg base (250mg salt). If there's no response or if symptoms continue after a few weeks, consult your healthcare provider for potential adjustments in dosage or alternative treatments. The maximum dosage that should not be exceeded for any individual is 228 mg base (250mg salt) per week.

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At what dose is Plaquenil typically prescribed?

Plaquenil therapy typically begins with a dosage of 200-400 mg/day, which can be taken all at once or divided into two doses. These doses are usually administered with food or milk to prevent stomach upset. Depending on the response and tolerance of the patient, the dose may be increased after a few weeks. However, it is crucial to note that a maximum daily dose exceeding 5mg/kg of actual body weight should not be exceeded due to potential retinal toxicity risks. It's also important to remember that Plaquenil has a slower onset; its full beneficial effect may not be seen until several weeks after starting treatment.

What are the most common side effects for Mefloquine?

Common side effects of mefloquine include:

  • Nausea, vomiting, diarrhea
  • Dizziness/vertigo
  • Sleep disorders such as insomnia and abnormal dreams
  • Anxiety or restlessness
  • Headache
  • Muscle or joint pain
  • Ringing in the ears (tinnitus)
  • Lightheadedness

Meanwhile, Plaquenil may cause:

  • Nausea, vomiting, loss of appetite
  • Diarrhea
  • Abdominal cramps
  • Skin rash - especially in patients with a history of allergic reactions to anti-malarial drugs.

It's important to note that both Mefloquine and Plaquenil can potentially lead to serious neurological and psychiatric side effects. Therefore it is crucial for these medications to be administered under physician supervision.

abstract image of a patient experiencing side effect

Are there any potential serious side effects for Mefloquine?

Mefloquine, like any medication, can have side effects. In some cases these may include:

  • High risk of psychological disturbances such as anxiety, paranoia, depression or hallucinations
  • Unusual behavior and thoughts about suicide or self-harm
  • Allergic reactions: hives; difficulty breathing; swelling in your face or throat
  • Skin issues: fever with sore throat, burning eyes, skin pain followed by a red or purple skin rash that spreads (especially in the face or upper body) causing blistering and peeling
  • Vision problems including blurred vision and changes in how you see color
  • Heart-related symptoms such as chest pain spreading to your jaw or shoulder, irregular heartbeats.

The drug Plaquenil has its own potential side effects which could include:

  • Slow heart rate/weak pulse/muscle weakness/fainting/shallow breathing
  • Low blood sugar - headache/hunger/sweating/irritability/dizziness/fast heart rate etc. Signs of low blood platelets - easy bruising/easy bleeding/purple or red spots under the skin

If you experience any of these symptoms while taking either Mefloquine or Plaquenil it is important to seek immediate medical attention.

What are the most common side effects for Plaquenil?

Plaquenil, an anti-malarial drug, may cause some side effects that patients should be aware of. The most common ones include:

  • Mild nausea and stomach cramps
  • Loss of appetite, diarrhea
  • Dizziness or vertigo
  • Temporary hair loss
  • Skin rashes or itching

In rare cases, Plaquenil can also lead to changes in heartbeat rhythm (palpitations) and problems with vision which necessitate immediate medical attention. While less common, muscle weakness and headaches could occur as well. These symptoms are usually mild and temporary but if they persist or worsen it's important to seek advice from a healthcare professional.

Are there any potential serious side effects for Plaquenil?

While Plaquenil is generally well-tolerated, it does pose some risks of serious side effects. These could include:

  • Allergic reaction such as hives, itching, difficulty breathing or swallowing, swelling in the face or throat
  • Unusual mood changes or suicidal thoughts
  • Convulsions and other seizure-like symptoms
  • Sudden behavioral shifts and confusion
  • Vision disturbances including blurred vision, light sensitivity, halos around lights or noticeable changes in sight
  • Irregular heartbeats that are unusually fast or skipping beats
  • Signs of a severe mental health episode such as racing thoughts, heightened energy levels leading to reckless behavior; excessive happiness or irritability; talking more than usual; significant sleep issues.

If you experience any of these symptoms after taking Plaquenil, seek immediate medical attention.

Contraindications for Mefloquine and Plaquenil?

Both Mefloquine and Plaquenil, like many other malaria medications, can cause serious side effects. If you experience any changes in vision or muscle weakness, it is important to seek medical attention immediately.

Neither mefloquine nor plaquenil should be taken by individuals who have had previous reactions to similar drugs or are currently on certain medications such as antibiotics (certain types of penicillin) due to potential interactions that may occur. Always inform your healthcare provider about all the medication you are taking; some drugs may require a period for clearance from your system before starting treatment with either plaquenil or mefloquine.

Additionally, both these drugs could worsen symptoms if used by people with existing mental health issues and neurological conditions. Therefore, it's crucial to discuss your complete health history with your doctor before commencing treatment.

How much do Mefloquine and Plaquenil cost?

For the brand name versions of these drugs:

  • The price of 8 tablets of Lariam (250 mg), which is a common brand-name version for mefloquine, averages around $85 to $120. Since one tablet per week is typical for prevention of malaria, this works out to approximately $2.70-$3.75/week or roughly $0.38-$0.54/day.
  • The price of 60 tablets of Plaquenil (200 mg) varies widely but averages around $800, working out to approximately $13/day.

Thus if you're taking these medications in standard dosages as generally prescribed by doctors – that is, a weekly dose for Lariam and daily doses for Plaquenil – then brand-name Lariam (mefloquine) would be less expensive on a per-day basis than brand-name Plaquenil.

For the generic versions Mefloquine and Hydroxychloroquine (the generic form of Plaquenil), costs are significantly lower:

  • Generic Mefloquine is available in packs with prices varying from about $30 - 50 per pack depending on quantity and pharmacy pricing policies. This still only needs to be taken once weekly so it results in an approximate cost between $.53 - .88 cents per day.
  • On the other hand, Hydroxychloroquine can be found at prices ranging from about $.40 - .80 cents per pill depending on dosage strength and pharmacy location; making it fall into an average daily cost range between $.40 - .80 cents considering its typically once-daily dosing regimen.

Please note that cost should not be your primary consideration when choosing between these two medications as they treat different conditions and have different potentials side effects profiles which must also be considered carefully along with their associated costs.

Popularity of Mefloquine and Plaquenil

Mefloquine, available under the brand name Lariam among others, is a medication used to prevent or treat malaria. In 2020, it was estimated that mefloquine was prescribed to about 500 thousand people in the US. This accounted for just over 5% of antimalarial prescriptions in the country. Mefloquine has seen a steady decrease in use since its peak prevalence around the year 2000 due to concerns about neuropsychiatric side effects.

Hydroxychloroquine, commonly known by its brand name Plaquenil, is another drug used primarily for preventing and treating malaria as well as autoimmune diseases such as rheumatoid arthritis and lupus. In contrast with mefloquine's declining trend of use, hydroxychloroquine has been experiencing an increase in prescription rates owing primarily to its role in managing chronic autoimmune conditions. It was prescribed to approximately 5 million people across America during 2020 alone accounting for nearly half of all antimalarial prescriptions given out.

Conclusion

Both Mefloquine and Plaquenil (hydroxychloroquine) have a long-standing record of usage in patients for the prevention and treatment of malaria, with numerous clinical studies supporting their efficacy over placebo treatments. They may sometimes be used together, but this requires careful consideration by a physician due to potential interactions. Each has a unique mechanism of action; mefloquine acts by damaging the parasites' DNA while Plaquenil interferes with the digestive vacuole within the parasite.

Mefloquine is typically recommended as prophylaxis for individuals traveling to areas where resistance to chloroquine (another antimalarial drug) is common. On the other hand, Plaquenil's use extends beyond malaria treatment and prevention—it's also utilized as an anti-inflammatory agent in treating conditions like lupus and rheumatoid arthritis.

Both drugs are available in generic form which can lead to significant cost savings especially for those paying out-of-pocket. With both mefloquine and Plaquenil, it takes time before full effects are noticeable—this is particularly notable when they're being used preventively against malaria.

In terms of side effects, both drugs are generally well-tolerated but carry different risks: Mefloquine can cause neuropsychiatric side effects such as dizziness or sleep disturbances while Plaquenil might affect vision if taken long-term. It’s important that patients closely monitor these symptoms when starting treatment or preventive use and seek medical help promptly if severe reactions occur.