Question to the Department of Health and Social Care:

To ask the Secretary of State for Health and Social Care, what steps he has taken with the Secretary of State for Defence to ensure that NHS practitioners are informed of the vulnerability to suicidal ideation of veterans impacted by Lariam; and what steps veterans can take with his Department to help improve awareness within the NHS of the nature and effects of mefloquine toxicity.

The Medicines and Healthcare products Regulatory Agency (MHRA) has updated its safety advice on mefloquine to reflect the risk of neuropsychiatric side effects, advising that it should not be used for chemoprophylaxis in individuals with a history of psychiatric disturbance.

National Institute for Health and Care Excellence guidance states that mefloquine should not be prescribed to people with current or past psychiatric disorders, suicidal ideation or behaviour, or with epilepsy or any form of convulsion.

The clinical management of suspected mefloquine intoxication has recently been reviewed with the NHS England Armed Forces Clinical Reference Group. This review advised that clinicians should assess patients individually and are expected to take a full drug and alcohol history, including any previous mefloquine use.

NHS England is considering adding screening for prior mefloquine use and any associated adverse events to initial Op COURAGE and Op RESTORE assessments. Additional clinical guidance on mefloquine and its potential adverse effects is being developed and through the Five Eyes partnership discussions are being arranged with the United States to support continuous learning and best practice in the management of suspected mefloquine intoxication.