Lariam should be 'drug of last resort' for troops

Defence Committee Press Notice – 24 May 2016

Lariam, the anti-malarial drug sometimes prescribed to British troops, should be considered only as a drug of last resort, says the Defence Committee, in its report on the MoD’s use of the drug.

Overview

Lariam (also known as mefloquine) has a high-risk profile and a minority of users experience severe side-effects. These side-effects are clearly highlighted by Roche, the manufacturer of Lariam, who rightly lay down stringent conditions which must be met if it is to be prescribed safely. But there is very strong anecdotal evidence that such conditions have often been disregarded in dispensing it to large numbers of troops about to be deployed.  

Danger of side effects

The danger of severe side-effects from using Lariam has been highlighted by both Roche and other witnesses to the Inquiry. The evidence received has emphasised the specific risks that such side-effects can place on military personnel when deployed and the belief that the military environment has the potential to exacerbate those side-effects. While most users will not experience the most adverse reactions, the Committee does not believe Lariam, with its significant risk profile, is compatible with the duties required of military personnel on operations.

Strong anecdotal evidence suggests that a body of current and former Service personnel have been adversely affected by the use of Lariam. The MoD acknowledges its duty of care to support them, but the current arrangements for doing so appear to be inadequate. 

Recommendations

The Committee concludes that any future prescribing of Lariam to Service personnel must be restricted:

·         Only to those who are unable to tolerate any of the available alternatives

·         Only after a face-to-face Individual Risk Assessment has been conducted

·         Only after the patient has been made aware of the alternatives and has been given the choice between Lariam and another suitable anti-malarial drug.

The report recommends that the MoD should establish a single point of contact for all current and former Service personnel who have concerns about their experience of Lariam. This point of contact should be publicised widely though the Chain of Command, veterans organisations, the MoD website, and armed forces magazines and publications. Discussions should also be held with the Department of Heath on possible ways of advising GPs of potential risks to veterans who may previously have been prescribed Lariam.

Chairman's comments

Chairman of the Committee, Dr Julian Lewis MP, said:

"It seems quite clear that not only is the MoD unable to follow the manufacturer’s guidelines for prescribing the drug in all instances, but a number of troops discard their Lariam rather than risk its potentially dangerous side-effects. It is our firm conclusion that there is neither the need, nor any justification for continuing to issue this medication to Service personnel unless they can be individually assessed, in accordance with the manufacturers’ requirements. And – most of the time – that is simply impossible, when a sudden, mass deployment of hundreds of troops is necessary." 

[To read the full report, click here.]

[The Government's response to the report can be read here.]

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REPORT SUMMARY

Lariam is one of a number of anti-malarials used by the Ministry of Defence to protect military personnel against malaria. It is not the most widely used anti-malarial drug, but the MoD believes it to be an important part of the defence against malaria for Armed Forces posted to particular locations overseas.

Lariam has a high risk profile and a minority of users experience severe side-effects. These side-effects are clearly highlighted by Roche, the manufacturer of Lariam. Our inquiry considered whether those risks outweigh the benefits of Lariam when other anti-malarial drugs, with a lower risk profile, are available to the MoD.

The evidence we received highlighted some severe examples of the possible side-effects of Lariam in a military setting. While they may be in the minority, we do not believe that the risk and severity of these side-effects are acceptable for our military personnel on operations overseas. We understand that in very limited instances the prescription of Lariam may be unavoidable. However we believe that it should be considered as a ‘drug of last resort’ and be prescribed only to those who are unable to take any of the available alternatives.

We also believe that if the MoD continues to prescribe Lariam, this must take place only after a face-to-face Individual Risk Assessment has been conducted. As part of that assessment we believe that each serviceman should be made aware of alternative anti-malarial drugs and be given the choice between Lariam and another suitable antimalarial drug.

The MoD relies on advice from the Advisory Committee on Malarial Prevention (ACMP), but the ACMP does not tailor its advice for use in a military setting. We consider this to be inadequate and recommend that military specific advice be provided. We are also concerned about the lack of up-to-date research on the impact of the use of Lariam by military personnel, and we expect the MoD to rectify this.

The Minister opened his evidence to us with a clear statement of support to those members of the Armed Forces who believe that they have been affected by the inappropriate prescription of Lariam. We welcome the Minister’s statement and look forward to a similar level of engagement by the Government with this Report.