Larimef

Introduction
Larimef is an antiparasitic medicine, used for the treatment of malaria. It works by killing the malaria causing parasite and stops the infection from spreading. Larimef should be used in the dose and duration as advised by your doctor. Take it with food to decrease the risk of stomach upset. Do not skip any doses and finish the full course of treatment even if you feel better. Some people may have stomach pain, abnormal dreams, chills, depression, and diarrhea, as side effects of this medicine. Please consult your doctor if these side effects persist for a longer duration. Inform your doctor if you ever had fits (seizures) or any problems with your kidney, heart or liver.

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Uses of Larimef
Malaria
Side effects of Larimef
Common
Abdominal pain
Abnormal dreams
Anxiety
Chills
Depression
Diarrhea
Dizziness
Fever
Headache
Atrial arrhythmias (altered heart rate)
Insomnia (difficulty in sleeping)
Itching
Loss of appetite
Muscle pain
Nausea
Rash
Ringing in ear
Vertigo
Visual impairment
Vomiting
Fatigue
How to use Larimef
Take this medicine in the dose and duration as advised by your doctor. Swallow it as a whole. Do not chew, crush or break it. Larimef is to be taken with food.
How Larimef works
Larimef is an antiparasitic medication which treats malaria. It works by increasing the levels of haeme in the blood, a substance toxic to the malarial parasite. This kills the parasite and stops the infection from spreading.
Quick Tips
Larimef should be taken with food to prevent a stomach upset.
Finish the prescribed course, even if you start to feel better. Stopping it early may make the infection come back and harder to treat.
Tips to reduce the chance of being bitten by mosquitoes:
It may cause dizziness or sleepiness. Do not drive or do anything that requires concentration until you know how it affects you.
Inform your doctor if you have kidney liver or heart disease.
Brief Description
Indication
Malaria
Administration
Should be taken with food. Best taken w/ meals & a full glass of water. Should be taken on the same day of each week.

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Adult Dose
Oral Acute Malaria Adult: 5 tablets (Total 1250 mg) as a single oral dose. OR 750 mg orally as initial dose, followed by 500 mg orally 6 to 12 hours after initial dose. Total dose 1,250 mg. Malaria prophylaxis 250 mg once weekly, taken 1-3 wk before exposure and continuing for 4 wk after leaving the endemic area. Dosing Considerations If a full-treatment course does not lead to improvement within 48-72 hr, mefloquine should not be used for retreatment; an alternative therapy should be used Similarly, if previous prophylaxis with mefloquine failed, mefloquine should not be used for curative treatment

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Child Dose
Oral Acute Malaria <6 months old: Safety and efficacy not established Child: >6 months: 20-25 mg/kg PO as single dose. Maximum total dose: 1250 mg. OR 15 mg/kg as initial dose, followed by 10 mg/kg po given 6-12 hours after initial dose. Total dose= 25 mg/kg Malaria prophylaxis Child: 5 to <10 kg: 31.25 mg (1/8 tablet) PO qWeek 10 to <20 kg: 62.5 mg (1/4 tablet) PO qWeek 20 to <30 kg: 125 mg (1/2 tablet) PO qWeek 30-45 kg: 187.5 mg (3/4 tablet) PO qWeek >45 kg: 250 mg (1 tablet) PO qWeek Start 1-2 weeks before arrival in endemic area; continue 4 weeks after leaving endemic area

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Contraindication
Hypersensitivity to related compounds (e.g. quinine and quinidine); history of blackwater fever;, prophylactic use in patients w/ history of psychiatric (including depression) or convulsive disorders; retreatment w/ mefloquine. Severe hepatic impairment. Concomitant use w/ halofantrine.
Mode of Action
Mefloquine is a 4-methanolquinine antimalarial agent and a blood schizontocide which acts by interfering w/ the parasite’s ability to metabolise and utilise erythrocyte Hb. It is active against most Plasmodium sp and is used for prophylaxis and treatment against malaria.
Precaution
Epilepsy; delay admin until at least 12 hr after the last dose of quinine/quinine-related compounds (monitoring of cardiac and neurological functions is warranted). Avoid driving or operating machines during and up to 3 wk after mefloquine use. Pregnancy, lactation; cardiac conduction disturbances; children <3 mth or 5 kg. Lactation: Minimally excreted in human breast milk; based on a study in a few subjects, low concentrations (3% to 4%) excreted; caution advised _ Side Effect 1-10% Anxiety,Difficulty concentrating,Headache,Insomnia,Lightheadedness,Vertigo,Vomiting,Diarrhea,Stomach pain,Nausea,Visual disturbances,Tinnitus Frequency Not Defined Suicidal depression,Psychiatric Sx,Pneumonitis,Seizure,Abnormal ECG Potentially Fatal: Seizures, thrombocytopenia, leucopenia, AV block, encephalopathy. _ Interaction Increased risk of ECG abnormalities w/ quinine or chloroquine, antihistamines, TCAs and phenothiazines. May increase risk of seizure w/ quinidine or quinine. Concomitant use w/ valproic acid, phenobarbital, carbamazepine and phenytoin may cause loss of seizure control and lower plasma levels of anticonvulsants. Increased risk of QT prolongation and arrhythmia w/ ketoconazole. Concomitant use w/ digoxin, Ca-channel blockers, antiarrhythmics and ?-blockers may increase the risk of cardiotoxicity. Increased risk of ventricular arrhythmias w/ amiodarone. Concomitant use w/ TCAs, SSRIs, buprion, antipsychotic, tramadol may increase the risk of convulsions. Increased plasma levels w/ metoclopromide. May compromise adequate immunisation by live typhoid vaccine. Vaccinations w/ attenuated live bacteria should be completed at least 3 days prior the 1st dose of mefloquine. Potentially Fatal: Avoid concomitant use w/ halofantrine as potentially fatal cardiac arrhythmias may occur. _