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1139574

	registered interest
	date	16/07/2019
	answering body	Ministry of Defence
	answering dept id	11
	answering dept short name	Defence
	answering dept sort name	Defence
	hansard heading	Armed Forces: Mefloquine
	house id	2
	legislature	25277 pref label House of Lords
	question text	To ask Her Majesty's Government, further to the Written Answer by Baroness Blackwood of North Oxford on 10 July (HL16834), what steps the Ministry of Defence has taken to address the concerns of the European Medicines Agency Pharmacovigilance Assessment Committee 2014 report on the toxicity of mefloquine (Lariam); and if they have not taken any such steps, why not.
	tabling member printed	The Countess of Mar
	uin	HL17221
	answer	answer is ministerial correction date of answer 22/07/2019 answer text <p>Anti-malarial drugs are prescribed to Service personnel with the UK product information leaflet. For mefloquine, this reflects the recommendations of the Pharmacovigilance Risk Assessment Committee of the European Medicines Agency.</p><p>All anti-malarial drugs have contraindications and a side effect profile which can be found in the British National Formulary or online at the Electronic Medicines Compendium. It is Ministry of Defence policy that healthcare professionals undertake a health risk assessment and to warn patients of the possible side effects of any anti-malarial drug.</p> answering member printed Earl Howe question first answered 22/07/2019 16:22:24 answering member 2000 label Biography information for Earl Howe
	tabling member	1861 label Biography information for The Countess of Mar

971901

	registered interest
	date	11/09/2018
	answering body	Ministry of Defence
	answering dept id	11
	answering dept short name	Defence
	answering dept sort name	Defence
	hansard heading	Armed Forces: Mefloquine
	house id	2
	legislature	25277 pref label House of Lords
	question text	To ask Her Majesty's Government when they intend to publish the results of the research into the side effects of malaria chemo-prophylaxis referred to in their second and third six-monthly progress updates to the House of Commons Defence Committee on its report An acceptable risk? The use of Lariam for military personnel, published on 24 May 2016.
	tabling member printed	The Countess of Mar
	uin	HL10263
	answer	answer is ministerial correction date of answer 24/09/2018 answer text <p>Data collection for this research has been completed and data cleansing, analysis and production of a report is under way, with completion anticipated in 2019.</p> answering member printed Earl Howe question first answered 24/09/2018 13:49:15 answering member 2000 label Biography information for Earl Howe
	tabling member	1861 label Biography information for The Countess of Mar

825297

	registered interest
	date	17/01/2018
	answering body	Ministry of Defence
	answering dept id	11
	answering dept short name	Defence
	answering dept sort name	Defence
	hansard heading	Armed Forces: Mefloquine
	house id	2
	legislature	25277 pref label House of Lords
	question text	To ask Her Majesty's Government whether they intend that an addendum should be added to the Defence Mental Health and Wellbeing Strategy Report 2017–2022 in order to address the effects of neurotoxicity from mefloquine; if so, when it will be published; and if not, why not.
	tabling member printed	The Countess of Mar
	uin	HL4830
	answer	answer is ministerial correction date of answer 30/01/2018 answer text <p>Mefloquine is effective in the prevention and treatment of malaria and is licensed for use by the Medicines and Healthcare products Regulatory Agency, which regulates medication in the UK. Bodies such as the Advisory Committee on Malaria Prevention, the World Health Organization and the United States Centers for Disease Control and Prevention continue to include mefloquine as an option for malaria chemoprophylaxis.</p><p> </p><p>The current product information for mefloquine states that neuropsychiatric adverse reactions may occur during treatment and includes warnings and precautions to minimise these risks. It also states that such adverse reactions may persist for months, or longer, even after discontinuation of the drug. It has not been established, however, that such adverse reactions may be permanent.</p><p> </p><p>For these reasons, there are no plans to add an addendum to the Defence Mental Health and Wellbeing Strategy Report 2017-2022.</p> answering member printed Earl Howe grouped question UIN HL4829 question first answered 30/01/2018 16:55:22 answering member 2000 label Biography information for Earl Howe
	tabling member	1861 label Biography information for The Countess of Mar

825296

	registered interest
	date	17/01/2018
	answering body	Ministry of Defence
	answering dept id	11
	answering dept short name	Defence
	answering dept sort name	Defence
	hansard heading	Armed Forces: Mefloquine
	house id	2
	legislature	25277 pref label House of Lords
	question text	To ask Her Majesty's Government whether the Surgeon General of Her Majesty’s Armed Forces recognises the chronic neurotoxic effects on members of the Armed Forces and Veterans from the administration of mefloquine (Lariam); and whether they will be addressing the problems caused by those effects in the near future.
	tabling member printed	The Countess of Mar
	uin	HL4829
	answer	answer is ministerial correction date of answer 30/01/2018 answer text <p>Mefloquine is effective in the prevention and treatment of malaria and is licensed for use by the Medicines and Healthcare products Regulatory Agency, which regulates medication in the UK. Bodies such as the Advisory Committee on Malaria Prevention, the World Health Organization and the United States Centers for Disease Control and Prevention continue to include mefloquine as an option for malaria chemoprophylaxis.</p><p> </p><p>The current product information for mefloquine states that neuropsychiatric adverse reactions may occur during treatment and includes warnings and precautions to minimise these risks. It also states that such adverse reactions may persist for months, or longer, even after discontinuation of the drug. It has not been established, however, that such adverse reactions may be permanent.</p><p> </p><p>For these reasons, there are no plans to add an addendum to the Defence Mental Health and Wellbeing Strategy Report 2017-2022.</p> answering member printed Earl Howe grouped question UIN HL4830 question first answered 30/01/2018 16:55:22 answering member 2000 label Biography information for Earl Howe
	tabling member	1861 label Biography information for The Countess of Mar

788907

	registered interest
	date	14/11/2017
	answering body	Ministry of Defence
	answering dept id	11
	answering dept short name	Defence
	answering dept sort name	Defence
	hansard heading	Armed Forces: Mefloquine
	house id	2
	legislature	25277 pref label House of Lords
	question text	To ask Her Majesty's Government whether Lariam is restricted in its use by military personnel only to those who are unable to tolerate available alternatives.
	tabling member printed	Lord Hunt of Kings Heath
	uin	HL3216
	answer	answer is ministerial correction date of answer 27/11/2017 answer text <p>In June 2017, the Government updated its policy on Preventing Malaria in UK Armed Forces Personnel (Joint Service Publication 950, Part 1, Leaflet 3-3-1). The leaflet includes guidance on antimalarial drug use, requiring that drugs only be supplied after a face-to-face malaria health risk assessment, following the Defence Medical Information Capability Programme antimalarial protocol.</p><p>The recommended drug regime is determined by the sensitivity of malaria parasites to antimalarial drugs in different parts of the world, based on Public Health England guidance. For areas without drug resistance the recommendation is that individuals are offered chloroquine on its own. If chloroquine is not suitable then proguanil is the preferred alternative. For areas of little chloroquine resistance, it is recommended that individuals are offered both chloroquine and proguanil. If chloroquine and proguanil are not suitable and the patient can tolerate proguanil then the patient should normally be offered atovaquone and proguanil.</p><p>For areas where malarial parasites are known to be resistant to chloroquine it is recommended that individuals are offered atovaquone and proguanil. If atovaquone and proguanil is not suitable they are to be reviewed in order to determine which alternative drug is most appropriate. The second choice drug will normally be doxycycline but may be modified in accordance with the disease profile of the country to be visited. If doxycycline is unsuitable then mefloquine may be prescribed but only after the individual has been reviewed by a doctor.</p> answering member printed Earl Howe grouped question UIN HL3102 HL3215 question first answered 27/11/2017 15:45:31 answering member 2000 label Biography information for Earl Howe
	tabling member	2024 label Biography information for Lord Hunt of Kings Heath

788906

	registered interest
	date	14/11/2017
	answering body	Ministry of Defence
	answering dept id	11
	answering dept short name	Defence
	answering dept sort name	Defence
	hansard heading	Armed Forces: Mefloquine
	house id	2
	legislature	25277 pref label House of Lords
	question text	To ask Her Majesty's Government whether they have developed guidelines about the use of Lariam and other antimalarial drugs, specific to their use by military personnel.
	tabling member printed	Lord Hunt of Kings Heath
	uin	HL3215
	answer	answer is ministerial correction date of answer 27/11/2017 answer text <p>In June 2017, the Government updated its policy on Preventing Malaria in UK Armed Forces Personnel (Joint Service Publication 950, Part 1, Leaflet 3-3-1). The leaflet includes guidance on antimalarial drug use, requiring that drugs only be supplied after a face-to-face malaria health risk assessment, following the Defence Medical Information Capability Programme antimalarial protocol.</p><p>The recommended drug regime is determined by the sensitivity of malaria parasites to antimalarial drugs in different parts of the world, based on Public Health England guidance. For areas without drug resistance the recommendation is that individuals are offered chloroquine on its own. If chloroquine is not suitable then proguanil is the preferred alternative. For areas of little chloroquine resistance, it is recommended that individuals are offered both chloroquine and proguanil. If chloroquine and proguanil are not suitable and the patient can tolerate proguanil then the patient should normally be offered atovaquone and proguanil.</p><p>For areas where malarial parasites are known to be resistant to chloroquine it is recommended that individuals are offered atovaquone and proguanil. If atovaquone and proguanil is not suitable they are to be reviewed in order to determine which alternative drug is most appropriate. The second choice drug will normally be doxycycline but may be modified in accordance with the disease profile of the country to be visited. If doxycycline is unsuitable then mefloquine may be prescribed but only after the individual has been reviewed by a doctor.</p> answering member printed Earl Howe grouped question UIN HL3102 HL3216 question first answered 27/11/2017 15:45:31 answering member 2000 label Biography information for Earl Howe
	tabling member	2024 label Biography information for Lord Hunt of Kings Heath

788310

	registered interest
	date	13/11/2017
	answering body	Ministry of Defence
	answering dept id	11
	answering dept short name	Defence
	answering dept sort name	Defence
	hansard heading	Armed Forces: Mefloquine
	house id	2
	legislature	25277 pref label House of Lords
	question text	To ask Her Majesty's Government in what circumstances it is considered suitable to prescribe the antimalarial drug mefloquine to members of the Armed Forces.
	tabling member printed	Lord Hunt of Kings Heath
	uin	HL3102
	answer	answer is ministerial correction date of answer 27/11/2017 answer text <p>In June 2017, the Government updated its policy on Preventing Malaria in UK Armed Forces Personnel (Joint Service Publication 950, Part 1, Leaflet 3-3-1). The leaflet includes guidance on antimalarial drug use, requiring that drugs only be supplied after a face-to-face malaria health risk assessment, following the Defence Medical Information Capability Programme antimalarial protocol.</p><p>The recommended drug regime is determined by the sensitivity of malaria parasites to antimalarial drugs in different parts of the world, based on Public Health England guidance. For areas without drug resistance the recommendation is that individuals are offered chloroquine on its own. If chloroquine is not suitable then proguanil is the preferred alternative. For areas of little chloroquine resistance, it is recommended that individuals are offered both chloroquine and proguanil. If chloroquine and proguanil are not suitable and the patient can tolerate proguanil then the patient should normally be offered atovaquone and proguanil.</p><p>For areas where malarial parasites are known to be resistant to chloroquine it is recommended that individuals are offered atovaquone and proguanil. If atovaquone and proguanil is not suitable they are to be reviewed in order to determine which alternative drug is most appropriate. The second choice drug will normally be doxycycline but may be modified in accordance with the disease profile of the country to be visited. If doxycycline is unsuitable then mefloquine may be prescribed but only after the individual has been reviewed by a doctor.</p> answering member printed Earl Howe grouped question UIN HL3215 HL3216 question first answered 27/11/2017 15:45:31 answering member 2000 label Biography information for Earl Howe
	tabling member	2024 label Biography information for Lord Hunt of Kings Heath

788920

	registered interest
	date	14/11/2017
	answering body	Ministry of Defence
	answering dept id	11
	answering dept short name	Defence
	answering dept sort name	Defence
	hansard heading	Armed Forces: Mefloquine
	house id	2
	legislature	25277 pref label House of Lords
	question text	To ask Her Majesty's Government what assessment they have made of neurotoxicity resulting from the administration of mefloquine to military personnel; and what steps they have taken to ensure that veterans suffering from mental health problems are not given drugs that may exacerbate their illness due to a reaction with mefloquine.
	tabling member printed	The Countess of Mar
	uin	HL3229
	answer	answer is ministerial correction date of answer 22/11/2017 answer text <p>There is no established evidence of prophylactic drugs having long-term side effects causing mental health issues.</p><p>The Royal College of Psychiatrists' 'Good Psychiatric Practice' report states clinicians must &quot;be competent in obtaining a full and relevant history that incorporates developmental, psychological, social, cultural and physical factors&quot;. This includes the consideration and assessment of the effect of medication and the circumstances in which it is being prescribed.</p> answering member printed Earl Howe question first answered 22/11/2017 16:15:55 answering member 2000 label Biography information for Earl Howe
	tabling member	1861 label Biography information for The Countess of Mar

381711

	registered interest
	date	17/06/2015
	answering body	Ministry of Defence
	answering dept id	11
	answering dept short name	Defence
	answering dept sort name	Defence
	hansard heading	Armed Forces: Mefloquine
	house id	2
	legislature	25277 pref label House of Lords
	question text	To ask Her Majesty’s Government how many service men and women who were deployed to Afghanistan between 2007 and 2014, and were required to take Lariam (mefloquine), subsequently required mental health treatment.
	tabling member printed	Baroness Corston
	uin	HL564
	answer	answer is ministerial correction date of answer 25/06/2015 answer text <p>Between 1 April 2007 and 31 December 2014, 16,473 UK Regular Armed Forces personnel were prescribed mefloquine (commercial name Lariam). Up to 31 March 2015, 1,066 (6 per cent) were assessed as having a mental health disorder at their initial assessment at an MOD Department for Community Mental Health (DCMH) or on admission to an MOD in-patient provider. It is not possible from centrally-held data to identify whether an assessment is associated with a patient having taken mefloquine.</p><p> </p><p>Former Service men and women are treated by the NHS and their status as a veteran is not always recorded on their NHS medical records. It is therefore not possible to say how many former Service personnel have required psychiatric treatment after taking mefloquine.</p><p> </p><p>Between 1 April 2007 and 31 December 2014, 536 UK Armed Forces personnel were prescribed mefloquine prior to or whilst on deployment to Afghanistan. Up to 31 March 2015, 43 (8 per cent) were assessed as having a mental health disorder at their initial assessment at an MOD DCMH or on admission to an MOD in-patient provider.</p><p> </p><p> </p><p> </p> answering member printed Earl Howe grouped question UIN HL563 question first answered 25/06/2015 15:20:29 answering member 2000 label Biography information for Earl Howe
	tabling member	215 label Biography information for Baroness Corston

381710

	registered interest
	date	17/06/2015
	answering body	Ministry of Defence
	answering dept id	11
	answering dept short name	Defence
	answering dept sort name	Defence
	hansard heading	Armed Forces: Mefloquine
	house id	2
	legislature	25277 pref label House of Lords
	question text	To ask Her Majesty’s Government how many (1) serving and (2) former service men and women have required psychiatric treatment after taking Lariam (mefloquine).
	tabling member printed	Baroness Corston
	uin	HL563
	answer	answer is ministerial correction date of answer 25/06/2015 answer text <p>Between 1 April 2007 and 31 December 2014, 16,473 UK Regular Armed Forces personnel were prescribed mefloquine (commercial name Lariam). Up to 31 March 2015, 1,066 (6 per cent) were assessed as having a mental health disorder at their initial assessment at an MOD Department for Community Mental Health (DCMH) or on admission to an MOD in-patient provider. It is not possible from centrally-held data to identify whether an assessment is associated with a patient having taken mefloquine.</p><p> </p><p>Former Service men and women are treated by the NHS and their status as a veteran is not always recorded on their NHS medical records. It is therefore not possible to say how many former Service personnel have required psychiatric treatment after taking mefloquine.</p><p> </p><p>Between 1 April 2007 and 31 December 2014, 536 UK Armed Forces personnel were prescribed mefloquine prior to or whilst on deployment to Afghanistan. Up to 31 March 2015, 43 (8 per cent) were assessed as having a mental health disorder at their initial assessment at an MOD DCMH or on admission to an MOD in-patient provider.</p><p> </p><p> </p><p> </p> answering member printed Earl Howe grouped question UIN HL564 question first answered 25/06/2015 15:20:29 answering member 2000 label Biography information for Earl Howe
	tabling member	215 label Biography information for Baroness Corston