Adverse neuropsychiatric effects of antimalarial drugs

ABSTRACT

Introduction: Antimalarial drugs are the primary weapon to treat parasite infection, save lives, and curtail further transmission. Accumulating data have indicated that at least some antimalarial drugs may contribute to severe neurological and/or psychiatric side effects which further complicates their use and limits the pool of available medications.

Areas covered: In this review article, we summarize published scientific studies in search of evidence of the neuropsychiatric effects that may be attributed to the commonly used antimalarial drugs administered alone or in combination. Each individual drug was used as a search term in addition to keywords such as neuropsychiatric, adverse events, and neurotoxicity.

Expert opinion: Accumulating data based on published reports over several decades have suggested that among the major commonly used antimalarial drugs, only mefloquine exhibited clear indications of serious neurological and/or psychiatric side effects. A more systematic approach to assess the neuropsychiatric adverse effects of new or repurposed antimalarial drugs on their safety, tolerability and efficacy phases of clinical studies and in post-marketing surveillance, is needed to ensure that these life-saving tools remain available and can be prescribed with appropriate caution and medical judgment.

KEYWORDS:

• Antimalarials
• neurotoxicity
• psychiatric adverse events

Article highlights

• Malaria affects nearly 200 million individuals across the globe, causing 584,000 deaths in 2013.

• Without effective vaccines, antimalarial drugs are the most powerful tools for combating clinical illness and preventing disease transmission.

• The availability of many effective antimalarials are being limited due to the rise of malaria strains resistant to treatment with these drugs.

• Accumulating evidence suggests that some antimalarials are associated with the development of neuropsychiatric adverse effects, potentially separate from the pathogenesis of severe malaria, particularly cerebral malaria.

• To maximize the efficacy of our antimalarial arsenal and minimize patient risk, medications must be appropriately prescribed with full understanding of the relevant safety profiles.

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Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.