title: Mefloquine safety and tolerability in pregnancy: a systematic literature review.
abstract: BACKGROUND
  Control of malaria in pregnant women is still a major challenge as it constitutes an important cause of maternal and neonatal mortality. Mefloquine (MQ) has been used for malaria chemoprophylaxis in non-immune travellers for several decades and it constitutes a potential candidate for intermittent preventive treatment in pregnant women (IPTp).
  
  
  METHODS
  The safety of MQ, including its safety in pregnancy, is controversial and a continuing subject of debate. Published studies which evaluated the use of MQ for malaria prevention or treatment in pregnant women and which reported data on drug tolerability and/or pregnancy outcomes have been reviewed systematically.
  
  
  RESULTS
  Eighteen articles fitted the inclusion criteria, only one study was double-blind and placebo controlled. No differences were found in the risk of adverse pregnancy outcomes in women exposed to MQ compared to those exposed to other anti-malarials or to the general population. MQ combined with artesunate seems to be better tolerated than standard quinine therapy for treatment of non-severe falciparum malaria, but a MQ loading dose (10 mg/kg) is associated with more dizziness compared with placebo. When used for IPTp, MQ (15 mg/kg) may have more side effects than sulphadoxine- pyrimethamine.
  
  
  CONCLUSIONS
  In the published literature there are no indications that MQ use during pregnancy carries an increased risk for the foetus. Ideally, the use of MQ to prevent malaria should be based on a risk-benefit analysis of adverse effects against the risk of acquiring the infection. For this purpose double-blinded randomized controlled trials in African pregnant women are much needed.
authors.affiliation: Barcelona Centre for International Heath Research (CRESIB, Hospital Clínic- Universitat de Barcelona), Rosselló 132, 4-2, Barcelona E-08036, Spain. Raquel.gonzalez@cresib.cat.
authors.forename: Raquel
authors.initials: R
authors.lastname: González
authors.forename: Urban
authors.initials: U
authors.lastname: Hellgren
authors.forename: Brian
authors.initials: B
authors.lastname: Greenwood
authors.forename: Clara
authors.initials: C
authors.lastname: Menéndez
mesh_terms: D000962:Antimalarials / Q000009:adverse effects* / Q000627:therapeutic use; D018890:Chemoprevention / Q000009:adverse effects / Q000379:methods; D005260:Female; D006801:Humans; D008288:Malaria / Q000188:drug therapy* / Q000517:prevention & control*; D015767:Mefloquine / Q000009:adverse effects* / Q000627:therapeutic use; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy* / Q000517:prevention & control*
chemical_list: D000962:Antimalarials; D015767:Mefloquine