Mefloquine mania

malaria seems to be India's growing nemesis. In Rajasthan, 3,000 documented deaths were attributed to malaria last year. However, Vikas Rampal of the Delhi-based Lok Nayak Jayaprakash Narain Hospital cynically remarked, "Three thousand means 30,000! There is an official apathy to admit that there is a rise in the incidence of malaria." In such a situation, doctors and government officials are currently caught between the horns of a dilemma with respect to the emergence of a drug called mefloquine.

Malaria, of late, has become even more lethal due to its resistance to readily available medicines like chloroquine. Medicos are now looking up to the imported 'wonder drug' mefloquine to treat virulent cases of the disease. In Delhi, the drug is selling under the brand name Eloquine 250 (each tablet containing 250 mg of mefloquine) manufactured by Medochemie Ltd, based in Limassol, Cyprus.

One medical practitioner in Delhi remarked, "Mefloquine saved my dying patients overnight." Yet, despite glowing reports on the drug, there remains much confusion and a tangle of opinions regarding the drug's necessity and utility in India, which assumes importance only when chloroquine and metacalphine fail to respond in malaria positive patients.

Mefloquine, smoothly being smuggled into India, was being supplied by leading pharmacists in Delhi for reportedly Rs 450 a tablet few months ago; now a tablet sells for Rs 50 without any prescription. And government doctors, reportedly, often buy the drug on the sly and then recover the cost by making false prescriptions. Private clinics procure the drug illegally -- often through contacts with airline pilots -- and they levy the high costs on their patients. Obviously, most malaria victims, who are poor, cannot afford this expensive treatment.

Besides, there is a lack of consensus on mefloquine among malaria experts, research organisations and the Central Drug Standard Control Organisation regarding its legal status. While the assistant drug controller, S K Tandon states that prescribing mefloquine has not been okayed by the government, V P Sharma, director, New Delhi-based Malaria Research Centre (mrc), confidently maintains that the drug controller, P Dasgupta, "has given authorisation to mefloquine and it is legal in India now; so the question of smuggling the drug is an old story."

A number of sources -- D Banerjee of the Jawaharlal Nehru University's centre for social medicine and community health; Mira Shiva, director, Voluntary Health Association of India and others -- maintain that mefloquine has been conferred legal authorisation in the revised new drug policy's Operational Manual .

A leaflet enclosed with a pack of Eloquine 250 says that the tablet is effective in the treatment of malaria "due essentially to the destruction of the asexual blood forms of the malaria pathogens...( Plasmodium falciparum, P vivax, P malariae, P ovale )".

Neena Valeja, a pharmacologist at mrc, confirmed that despite its legal status, the drug is not being used in the centre's programme. Sharma feels that mefloquine is not really necessary in India for most cases and that traditional malarial drugs can do the job. Some practitioners even doubt its safety. Some believe that the drug develops rapid resistance and can cause neurological problems if used extensively.

In fact, the leaflet says: "patients with a history of psychiatric disturbances or convulsions should not be prescribed Eloquine prophylactically," and that "Experience is insufficient as yet to rule out the possibility of interactions with cardioactive agents, for example beta blockers."

Mira Shiva explains that the restriction on mefloquine is beneficial in the long run as haphazard or irresponsible use of the drug induces faster resistance. For the drug to retain its efficacy, mefloquine's dosage, the duration of use and frequency have to be carefully monitored. Shiva remarked, "It's not only a question of availability but also of implementation. You can't drink mefloquine like cough syrup or sell it like toffees." Rampal, however, subscribed against this view, "You cannot let a patient die because of restricted use."

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