The review comes six weeks after the Pentagon announced its own study of whether the drug, called Lariam, has caused mental illness and suicide. The two studies suggest the government's concern about possible effects of the drug is quickening after years of defending it as safe.
"There has been a lot of attention to possible long-term health problems, including the possibility of an association with suicide and violent behavior among service members," VA spokeswoman Karen E. Fedele told United Press International.
A VA "white paper" on Lariam provided by Fedele says the department "will need to develop a well-grounded response to concerns among veterans, their families, Congress, the media and others about possible long-term health effects among Operation Iraqi Freedom and Operation Enduring Freedom veterans from taking the antimalarial drug mefloquine (Lariam)."
UPI reported in May 2002 that mounting evidence suggests the drug, known generically as mefloquine, has triggered such severe mental illness that in a number of cases it has led to suicide. In an ongoing investigation, UPI quoted soldiers who served in Somalia and elsewhere beginning in the early 1990s who said the drug had caused long-term problems.
Jeanne Lese of Lariam Action, an activist group, said: "Somalia vets have been contacting us for years, saying they're not the same since the war."
"They talk of outbursts of rage, anxiety, paranoia, depression, and many have overwhelming suicidal urges. All of them had at least one friend commit suicide in Somalia or after. But when they ask if the drug could be making them sick, they are told Lariam is 'approved by the Food and Drug Administration' so it can't be at fault. The patient is the problem, not the drug."
The FDA last year ordered that anyone prescribed the drug be given a written warning that it can cause depression, psychosis, aggression, hallucinations, paranoia and thoughts of suicide, and that problems may continue "after Lariam is stopped." The FDA also cited rare reports of suicide among people taking the drug but said it doesn't know if the drug was responsible.
Pentagon officials have said over the past several months that use of Lariam in Iraq is limited and that the drug does not cause suicide.
"I can tell you we are using almost no Lariam there," Virginia Stephanakis, a spokeswoman for the Army Surgeon General's office, told UPI in November.
"We don't believe there is any connection between Lariam and suicide," Army spokeswoman Martha Rudd said in January. "There is nothing to indicate that is a factor."
But after a Special Forces soldier who took the drug in Iraq committed suicide after returning to Fort Carson, Colo., last month, a medical official told the Colorado Springs Gazette that "we had 80,000 people (in Iraq) on it and only had a few problems." Separately, the paper also reported that in the year ending this past October, 45,000 U.S. service members worldwide were prescribed Lariam by the military.
In December, the Pentagon revised their Lariam warning for military clinicians to say that "rare instances of suicide" have been reported but that no statistical association has been established, and that "symptoms may continue long after mefloquine use has been stopped." In February, the Pentagon announced it would launch its own scientific study of whether Lariam has in fact triggered mental illness and suicides among troops.
The VA white paper said the department "should review the literature on mefloquine relative to long-term health effects, with an emphasis on any effects that may persist after the drug is stopped." It said a Lariam working group should include the department's directors of surgery and neurology and "identify experts and recommend how to proceed."
Lariam was invented by the Army to help it fight in parts of the world where malaria is rampant, and has been taken by tens of thousands of soldiers and a total of 5 million Americans since it was approved for use in the United States in 1989.
The VA white paper noted that the Pentagon "has widely prescribed mefloquine for U.S. service members in Southwest Asia to protect against endemic malaria." In the summer of 2002, several soldiers who took the drug while serving in Afghanistan killed their wives and committed suicide at Fort Bragg, N.C. UPI reported that they showed signs of Lariam toxicity, but the Army concluded the drug was not responsible in that cluster of deaths.
Veterans' advocate Steve Robinson, a former Army Ranger, said the VA review was necessary.
"We are pleased that the VA will raise its awareness of the link between Lariam, its deleterious side effects and the psychological injuries coming out of the war in Iraq," said Robinson, executive director of the National Gulf War Resource Center. "The VA should make available the most current scientific tests if veterans believe they have suffered as a result of taking this drug."
Robinson pointed to the case of former Navy Lt. Cmdr. William Manofsky, who served during Operation Iraqi Freedom and says taking Lariam caused brain damage including violent shaking that continues a year after he stopped taking it. Manofsky recently retired on disability, and the Navy acknowledged that was partly due to Lariam.
In an e-mail exchange with Manofsky last week, the VA's Mark A. Brown, the official in charge of reviewing health threats to soldiers, said he agreed that "this is an issue that clearly needs to be looked into."
He said the VA is "concerned that so many veterans took this drug. ... If there are any serious long-term health effects that persist even after the drug is stopped, then this would affect a lot of veterans."
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