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What is Which antimalarial drug is known to cause neuropsychiatric adverse reaction? and explain in detail?
Ans. d (Mefloquine) (Ref. KDT 6th/pg. 787; Katzung 9th/pg. 871)Approximately 1 in every 10,000 recipients of mefloquine develops an acute reversible neuropsychiatric reaction manifested by confusion, psychosis, convulsions, or encephalopathy.MEFLOQUINE# Mefloquine (250 mg of salt weekly, adult dose) has been the antimalarial prophylactic agent of choice for much of the tropics because it is usually effective against multidrug-resistant falciparum malaria and is reasonably well tolerated.# S/E include:- Mild nausea,- dizziness,- fuzzy thinking,- disturbed sleep patterns,- vivid dreams, and- malaise# The role of mefloquine prophylaxis during pregnancy remains uncertain; in studies in Africa, mefloquine prophylaxis was found to be effective and safe during pregnancy.DRUGINDICATIONADVERSE EFFECTSINTERACTIONSMefloquineMalariaFrequent: light-headedness, nausea, headache. Occasional: confusion, nighmares, insomnia, visual disturbances, transient and clinically silent ECG abnormalities (including sinus bradycardia, sinus arrhythmia, first-degree AV block, prolongation of QTc interval, and abnormal T waves). Rare: psychosis, convulsions, hypotensionAdministration of halofrantine <3 weeks after mefloquine use may produce fatal QTc prolongation.Mefloquine may lower plasma levels of anticonvulsants. Mefloquine levels decreased and clearance accelerated by artesunateArtemisinin derivatesMalariaOccasional: neurotoxicity (ataxia, convulsions), nausea, vomiting, anorexia, contact dermatitisMefloquine levels decreased and clearance accelerated by artesunateQuinine and quinidineMalaria, babe- siosisFrequent: cinchonism (tinnitus, high-tone deafness, headache, dysphoria, nausea, vomiting, abdominal pain, visual disturbances, postural hypotension), hyperinsulinemia resulting in life-threatening hypoglycemia. Occasional: deafness, hemolytic anemia, arrhythmias, hypotension due to rapid intravenous infusionCarbonic-anhydrase inhibitors, thiazide diuretics: reduce renal elimination of quinidine: Amiodarone, cimetide: increase quinidine levels.Nifedipine: decreases quinidine levels; quinidine shows metabolism of nifedipine. Phenobarbital, phenytoin, rifampicin: accelerate hepatic elimination of quinidine Verapamil: reduces hepatic clearance of quinidine.Diltiazem: decreases clearance of quinidine