Mefloquine cannot be recommended as an alternative drug to prevent malaria in women who are pregnant, whether they harbor HIV or not, according to 2 large randomized controlled trials conducted in Africa.
Because pregnant women and their unborn children living in Africa are at high risk of complications and death due to malaria infection during pregnancy, the World Health Organization recommends intermittent preventive treatment during pregnancy (IPTp) with sulphadoxine-pyrimethamine for women who are HIV-negative. Finding an alternative to sulphadoxine-pyrimethamine has become a concern because of an increase in malaria parasite resistance to sulphadoxine-pyrimethamine. In addition, sulphadoxine-pyrimethamine is contraindicated in women who are HIV-positive because it interacts negatively with the HIV drug cotrimoxazole. Mefloquine has been proposed as an alternative candidate for IPTp.
Friedrich MJ. Mefloquine Not an Alternative for Treating Malaria in Pregnant Women. JAMA. 2014;312(19):1961. doi:10.1001/jama.2014.15533