This article aims to ascertain whether mefloquine (MQ) produces
electrocardiogram (ECG) changes that could be a risk for Torsades de
Pointe (TdP), a potentially malignant, ventricular tachyarrhythmia.
We measured the Fridericia-corrected QT (QTcF) intervals on 12 lead ECGs
on days (D) 0, 3, 7 in Plasmodium falciparum infected adults, treated
with oral artesunate (AS) and MQ as a new fixed dose (n = 25)
combination or loose tablets (n = 25) over 3 days. Target total doses
were 12 mg/kg of AS and 24–25 mg/kg of MQ. MQ concentrations ([MQ])
were measured by HPLC.
All ECG intervals were similar between drug arms and were combined for
analysis. Mean QTcF values were 389 (D0), 407 (D3) and 399 (D7) ms (Ps
greater than 0.003 vs. D0); corresponding heart rates and [MQ]s were
83, 67 and 73 beats/minute (Ps=0.0003 vs. D0) and 0, 3095 and 1721
ng/ml. One male patient (loose arm) had a D3 QTcF 504 ms (D0 406 ms, D7
433 ms). In the modelling of QTcF and JTcF from D0 to D7, significant
effects were observed individually for [MQ], temperature and heart
rate (HR). The MQ AUC0-8 was not a significant factor. Using a manual
descending, model building approach to select variables, the HR was the
only significant variable (P = 0.001) over time in the model that best
explained the changes in the QTcF and JTcF intervals.
Krudsood, S.; Looareesuwan, S.; Wilairatama, P.; Leowattana, W.;Tangpukdee, N.; Chalermrut, K.; Ramanathan, S.; Navaratnam, V.; Olliaro, P.; Vaillant, M.; Kiechel, J.R.;Taylor, W.R.J. Effect of artesunate and mefloquine in combination on the Fridericia corrected QT intervals in Plasmodium falciparum infected adults from Thailand. Tropical Medicine and International Health (2011) 16 (4) 458-465.
Effect of artesunate and mefloquine in combination on the Fridericia corrected QT intervals in Plasmodium falciparum infected adults from Thailand