Distribution of mefloquine in the blood of Thai patients with acute uncomplicated falciparum malaria following administration of therapeutic doses of artesunate.

PURPOSE

The study objectives to investigate the distribution of the antimalarial drug mefloquine (MQ) in cellular and fluid blood compartments when given at therapeutic dosage with artesunate and to investigate an eventual association with the occurrence of treatment-related adverse events in Thai patients with acute uncomplicated falciparum malaria.

METHODS

MQ distribution following administration of standard therapeutic doses (1,250 mg MQ in split dose) with artesunate to 20 Thai patients with acute uncomplicated falciparum malaria was assessed in whole blood, serum, plasma, red blood cells (RBC), white blood cells (WBC), and platelets using high -performance liquid chromatography.

RESULTS

All patients responded to treatment without reappearance of parasitemia during the 42-day follow-up period. There was no significant gender difference in MQ levels. The chronological change in MQ levels in all blood components, including ratios of plasma to serum, whole blood, RBC, platelets or WBC were similar and parallel in both genders. MQ concentrations at 14 and 168 h, in descending order, in both male and female patients were as follow: WBC > platelets > plasma > serum > whole blood > RBC. Gender-specific whole blood, serum, and RBC concentrations were similar at all time points, with median ratios of plasma:whole blood, plasma:serum, and plasma:RBC of 0.84:1.21, 1.09:1.64, and 1.59:3.79, respectively. Plasma vs whole blood and plasma vs RBC MQ concentrations showed a highly significant correlation, with r = 0.923 and 0.867, respectively. No association between occurrence of treatment-related adverse events and MQ concentrations in various blood components/fluids was observed in either gender.

CONCLUSIONS

Based on these observations, gender-specific therapeutic MQ dose adjustment is obviously not required.