Report on controversial anti-malarial drug to remain secret

A report on the use of controversial anti-malarial drug Lariam received by Minister for Defence Alan Shatter is "legally privileged" and will not be published, the Department of Defence has said.

Administration of the drug to Defence Forces personnel travelling to malarial countries will continue. This is despite revised safety information from manufacturer Roche that the drug can cause serious neuropsychiatric disorders.

The disorders now listed by Roche as possible side effects include insomnia, anxiety and depression. The company also says hallucinations, psychosis, suicide, suicidal thoughts and self-endangering behaviour have been reported. It says that adverse reactions could persist up to several months after discontinuation.

Documents seen by The Irish Times indicate that soldiers on a mission to Chad in 2009 were told if they failed to take Lariam and caught malaria "by their own fault" the Defence Forces "are not liable".

They were required to take the drug under supervision and were warned not to take any other anti-malarial medicine as “only Lariam is effective in Chad”, though other drugs, such as atovaquone-proguanil (Malarone) and orartemether-lumefantrine (Coartem), are used by other countries, including the US. Alternative anti-malarial drugs found in the possession of any soldier would be considered contraband and soldiers would face disciplinary action if found with them, soldiers were told.

Blood test
If they did become sick with malaria, a blood test would reveal "the amount of Lariam in your system", soldiers were warned. They were also required to report any other soldier to an officer if they were aware he or she was not taking the drug.

Lariam, chemical name mefloquine, has been issued to Irish soldiers to combat malaria since 2001 when it was prescribed for those going to Eritrea. Since then, it has been the main drug used for Defence Forces missions to countries with malaria.

While it was also used widely in the US military, the Pentagon dropped it as the drug of choice in 2009 after concerns about side effects in some soldiers.

Advice given to Irish personnel going to Chad included that if they developed intolerable side effects, alternative medication could be prescribed, “but in the event of this happening, you will be considered unfit for future missions requiring Lariam”.

Additional measures were taken by the Defence Forces in 2004 to ensure personnel travelling to malarial countries took their medication. These included that all personnel be ordered to take their medication, to be administered once a week, unless ordered to cease under medical advice and those who failed to do so could be repatriated. Taking of the drug was also to be supervised.

Some serving and former members of the Defence Forces have since begun legal action against the State complaining of side effects including depression and suicidal ideation.

The report of the Working Group on Malaria Chemoprophylaxis, set up in 2009, examined the use of Lariam. The group reported to Mr Shatter over the summer.

Aware of side effects
In a statement the department said the report was "produced in the context of current and potential litigation and is legally privileged" and would not be published.

The Defence Forces were aware of the reported side effects “attaching to all anti-malarial medications”, including the latest patient safety information issued by Roche for Lariam, the statement noted. And “significant precautions” are being taken by the Medical Corps to assess the suitability of members to take Lariam or any other anti-malarial drugs.

"Lariam continues to be authorised by the Irish Medicines Board, the statutory body that regulates medicines available in Ireland, and the Defence Forces comply fully with IMB guidelines on the prescribing of all medicines including Lariam," it said.