Central Anticholinergic Syndrome with the Antimalarial Drug Mefloquine

To the Editor: The neuropsychiatric side effects of the antimalarial drug mefloquine are well documented1,2. They include anxiety, depression, hallucinations, acute psychosis, and seizures. The incidence of these side effects is 1 in 13,000 with prophylactic use and 1 in 250 with therapeutic use2. The mechanism of action is unknown1. A 47-year-old, previously healthy Japanese tourist was admitted to our hospital because of severe falciparum malaria with parasitemia of 24 percent after a trip to Zaire without any antimalarial chemoprophylaxis. Treatment consisted of 750 mg of quinine per day and 450 mg of clindamycin three times . . .