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Psychiatry · Psychopharmacology: mefloquine neuropsychiatric toxicity
Sample itemA traveller takes a weekly oral antimalarial for prophylaxis. After the third dose he reports vivid nightmares, anxiety, dizziness and suspicious thoughts about his companions. Which drug is the most likely cause?
Original practice item, not a recalled exam question. Nothing here is recorded.
The answer and the reasoning
A. Mefloquine
Mefloquine is associated with neuropsychiatric effects such as vivid dreams, insomnia, anxiety, depression, paranoia and psychosis, and is avoided in people with psychiatric histories. Stopping the drug is advised if such symptoms appear.
Option by option
A. Mefloquine (correct)
Correct. A weekly antimalarial with vivid dreams and paranoia fits mefloquine.
B. Artesunate
Artesunate is used to treat severe malaria and is not used as weekly prophylaxis.
C. Doxycycline
Doxycycline causes photosensitivity and oesophagitis and is taken daily.
D. Atovaquone-proguanil
Atovaquone-proguanil is taken daily and commonly causes gastrointestinal upset.
Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.
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