title: Antimalarial chemoprophylaxis and the risk of neuropsychiatric disorders.
abstract: BACKGROUND
  Case reports and epidemiological studies have associated the use of mefloquine with neuropsychiatric adverse events.
  
  
  METHODS
  We used the General Practice Research Database to conduct a follow-up study with a nested case-control analysis. We assessed the risk of developing first-time anxiety, stress-related disorders/psychosis, depression, epilepsy or peripheral neuropathies in patients using mefloquine, chloroquine and/or proguanil, or atovaquone/proguanil for malaria chemoprophylaxis, as compared to unexposed travelers.
  
  
  RESULTS
  Compared to non-users of antimalarials, the adjusted odds ratio in the nested case-control analysis for users of mefloquine, chloroquine and/or proguanil, or atovaquone/proguanil were 0.71 (95% CI 0.56-0.90), 1.04 (95% CI 0.74-1.46), and 0.73 (95% CI 0.61-0.86) for anxiety or stress-related disorders combined, 0.54 (95% CI 0.41-0.71), 1.06 (95% CI 0.71-1.59), and 0.75 (95% CI 0.62-0.91) for depression, 0.69 (95% CI 0.35-1.36), 1.41 (95% CI 0.54-3.67), and 0.75 (95% CI 0.42-1.36) for epilepsy, and 1.22 (95% CI 0.50-2.99), 1.59 (95% CI 0.41-6.15), and 1.05 (95% CI 0.54-2.03) for neuropathies, respectively. The risk of all outcomes was higher in females than in males across all exposure categories.
  
  
  CONCLUSIONS
  The risk of neuropsychiatric disorders was similar for users and for non-users of anti-malarial chemoprophylaxis, with evidence for elevated risks in some subgroups.
authors.affiliation: Basel Pharmacoepidemiology Unit, Division of Clinical Pharmacy and Epidemiology, Department of Pharmaceutical Sciences, University Basel, Basel, Switzerland. schneiderc@uhbs.ch
authors.forename: Cornelia
authors.initials: C
authors.lastname: Schneider
authors.forename: Miriam
authors.initials: M
authors.lastname: Adamcova
authors.forename: Susan S
authors.initials: SS
authors.lastname: Jick
authors.forename: Patricia
authors.initials: P
authors.lastname: Schlagenhauf
authors.forename: Mary K
authors.initials: MK
authors.lastname: Miller
authors.forename: Hans-Georg
authors.initials: HG
authors.lastname: Rhein
authors.forename: Christoph R
authors.initials: CR
authors.lastname: Meier
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000962:Antimalarials / Q000008:administration & dosage* / Q000009:adverse effects; D018890:Chemoprevention; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D008288:Malaria / Q000188:drug therapy / Q000517:prevention & control* / Q000523:psychology; D008297:Male; D001523:Mental Disorders / Q000139:chemically induced / Q000453:epidemiology*; D008875:Middle Aged; D016017:Odds Ratio; D012306:Risk; D014195:Travel / Q000706:statistics & numerical data*; D006113:United Kingdom / Q000453:epidemiology
chemical_list: D000962:Antimalarials