a-t 2016; 47: 31

Quiet end to the anti-malarial drug mefloquine (LARIAM): In February 2016 Roche AG renounced the authorisation of the anti-malarial drug mefloquine (LARIAM) in Germany (1) and Denmark (2) - because of "decreased demand brought about by intense competition due to changes in treatment recommendations" (2), the company informed us. In Switzerland, where the group is based, and in the USA, Roche has already ceased marketing the drug; the end of sales in Ireland (3) has been announced for mid-2016. In Germany wholesalers and pharmacies can continue to sell existing supplies of LARIAM for up to two years (§ 31 [4] Medicinal Products Act, AMG). If remaining stock is exhausted, the compound may only be obtained on the basis of individual imports from abroad (§ 73 [3] AMG) (1), for example currently from Austria. We see the main reason for renouncing the authorisation and cessation of marketing as being the numerous indications of serious adverse effects that potentially last for months or are irreversible. Cataracts, retinal disorders and optic neuropathy can occur following treatment, sometimes with a delay, and they may resolve only very slowly or persist (a-t 2014; 45: 24) (4). In addition, neurological side effects such as dizziness, impaired balance or tinnitus can last for years or remain permanently. Anxiety, depression, hallucinations, panic attacks, psychosis and suicide (suicidal thoughts; a t 2013; 44: 72) as well as impaired fine motor co-ordination or spatial orientation (a t 1994; no. 6: 54) have long been recognised as undesirable effects. We consider adverse effects of this kind, which significantly impair quality of life and may last permanently, to be unacceptable for largely healthy travellers taking the anti-malarial drug as prophylaxis. However, there are not many alternatives: the possibilities are atovaquone plus proguanil (MALARONE, generics) as well as the inexpensive but potentially phototoxic doxycycline (DOXY-CT, generics); although the latter has been stated to be an alternative by the WHO, the German Society for Tropical Medicine and International Health (DTG) and others, in Germany it has to be prescribed off label because it lacks approval for malaria prophylaxis.