Background: The adverse effects
of mefloquine and other quinoline antimalaria drugs can be severe and long-lasting. We believe that the trigger for these effects may be drug-induced
hepatocellular damage that causes, firstly, a spillage of retinoids into the circulation (and hence a direct toxic effect on the brain and other target
organs), and secondly, disruption of the liver-thyroid axis (and hence a
pattern of specific bipolar symptoms such as
is often seen in thyroid disease). Methods: We sought recently-published lay accounts of adverse effects
in users of quinoline antimalaria drugs, to test these lay descriptions
against our hypothesis on the likely pathogenesis of these effects. Results: We found six lay accounts that described four different experiences of adverse effects arising from the
prophylactic use ofquinoline antimalaria drugs. All four travellers were healthy, at the start of travel. Two
of the travellers experienced severe psychoses, and one had a mild psychosis. The
fourth traveller, a serving US soldier,
killed 16 unarmedAfghan civilians. Analysis of these accountsshows that,
based on our hypothesis, all four travellers had at least one risk factor (most commonly, concurrent alcohol use), for developing a severe reaction to
their quinoline antimalaria drug. Our hypothesis therefore predicted a severe
adverse drug reaction in each of these four
travellers. We also identified a hitherto unrecognized
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