Low body mass index is associated with an increased risk of neuropsychiatric adverse events and concentration impairment in women on mefloquine

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Abstract
Aims: We performed a prospective cohort study to gain more insight into risk factors for neuropsychiatric effects of mefloquine among tourists travelling to tropical areas.Methods: We enrolled all patients who consulted the Travel Clinic of the Havenziekenhuis & Institute for Tropical Diseases Rotterdam for mefloquine prophylaxis during the period between 1 May 1999 and 7 March 2000. Each patient was followed from baseline (prior to starting mefloquine) up to 3 weeks after starting weekly intake of 250 mg mefloquine. We compared the intraindividual change in scores between baseline and follow‐up visit on the Dutch shortened Profile of Mood States, and on the Continuous Performance Test (CPT) which measures sustained attention.Results: The final cohort consisted of 151 subjects with a mean age of 38 years. In this population, a significant impairment of mood state was observed in those with a body mass index (BMI) ≤ 20 kg m−2. Stratification for gender showed that the total mood disturbance in females in the lowest BMI category significantly increased by 8.42 points [95% confidence interval (CI) 3.33, 13.50], whereas BMI did not affect the risk in males. Stratification for history of use of mefloquine showed that the risks were highest in first‐time users. Analyses of the CPT showed that reaction time in women with a BMI ≤ 20 kg m−2 increased significantly by 22.5 ms (95% CI 7.80, 37.20), whereas reaction time in men showed a slight and nonsignificant decrease.Conclusion: Risk factors for mefloquine‐associated neuropsychiatric adverse events and concentration impairment are female gender, low BMI, and first‐time use. The frequency of neuropsychiatric effects is highest in women with a BMI ≤ 20 kg m−2.