Written questions and answers

Written questions allow Members of Parliament to ask government ministers for information on the work, policy and activities of government departments.

Historical written answers can be found in Hansard.

Find the latest written questions and answers for the 2017-19 session below. We welcome your feedback on this service.

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Unique Identifying Number – Every written question in the House of Commons has a UIN per Parliament. In the House of Lords each written questions has a UIN per parliamentary session.
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Q
Asked on: 16 July 2019
Ministry of Defence
Armed Forces: Mefloquine
Lords
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.
Q
Asked on: 01 July 2019
Department of Health and Social Care
Mefloquine
Lords
To ask Her Majesty's Government what assessment they have made of the European Medicines Agency Pharmacovigilance Risk Assessment Committee’s 2014 report on the toxicity of mefloquine (Larium).
Answered on: 10 July 2019

At its meeting in February 2014, the Pharmacovigilance Risk Assessment Committee (PRAC) of the European Medicines Agency recommended that the product information for mefloquine (Lariam) be amended to state that neuropsychiatric adverse reactions may persist for months, or longer, even after discontinuation of the drug. The Medicines and Healthcare products Regulatory Agency (MHRA) accepted the recommendations and implemented the advice of the PRAC, which is reflected in the United Kingdom product information for mefloquine. In addition, the MHRA has since taken further action to ensure that these risks are adequately conveyed to UK prescribers and patients in the form of improved checklists for healthcare professionals and a patient alert card.

Q
Asked by Dr David Drew
(Stroud)
[N]
Close

Named Day

'Named day' questions only occur in the House of Commons. The MP tabling the question specifies the date on which they should receive an answer. MPs may not table more than five named day questions on a single day.

Asked on: 14 January 2019
Ministry of Defence
Armed Forces: Mefloquine
Commons
To ask the Secretary of State for Defence, when he plans to reach a final conclusion on the effect on veterans' health of the issuing of Larium to them while they were in the Armed Forces.
A
Answered by: Mr Tobias Ellwood
Answered on: 17 January 2019

Mefloquine (commercially known as Lariam) 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. 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.

Notwithstanding, in September 2016, the Ministry of Defence (MOD) established the mefloquine Single Point of Contact (SPOC) email and telephone line, for both current and former Service personnel who have concerns about their experience of mefloquine. Up to 15 January 2019, the mefloquine SPOC has received the following number of enquiries.

Year

Enquiries from Serving Personnel

Enquiries from Veterans

Enquiries from Others

Total Number of Enquiries

2016

24

33

22

79

2017

3

10

5

18

2018

4

7

6

17

2019

0

1

0

1

Individuals can be referred to the SPOC in a number of different ways, including by Service charities. The MOD does not maintain a record of all such referrals.

Grouped Questions: 208187
Q
Asked by Dr David Drew
(Stroud)
[N]
Close

Named Day

'Named day' questions only occur in the House of Commons. The MP tabling the question specifies the date on which they should receive an answer. MPs may not table more than five named day questions on a single day.

Asked on: 14 January 2019
Ministry of Defence
Armed Forces: Mefloquine
Commons
To ask the Secretary of State for Defence, how many (a) service personnel and (b) veterans his Department has referred to the Mefloquine Single Point of Contact in each year since it’s inception.
A
Answered by: Mr Tobias Ellwood
Answered on: 17 January 2019

Mefloquine (commercially known as Lariam) 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. 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.

Notwithstanding, in September 2016, the Ministry of Defence (MOD) established the mefloquine Single Point of Contact (SPOC) email and telephone line, for both current and former Service personnel who have concerns about their experience of mefloquine. Up to 15 January 2019, the mefloquine SPOC has received the following number of enquiries.

Year

Enquiries from Serving Personnel

Enquiries from Veterans

Enquiries from Others

Total Number of Enquiries

2016

24

33

22

79

2017

3

10

5

18

2018

4

7

6

17

2019

0

1

0

1

Individuals can be referred to the SPOC in a number of different ways, including by Service charities. The MOD does not maintain a record of all such referrals.

Grouped Questions: 208186
Q
Asked by Gareth Thomas
(Harrow West)
[N]
Close

Named Day

'Named day' questions only occur in the House of Commons. The MP tabling the question specifies the date on which they should receive an answer. MPs may not table more than five named day questions on a single day.

Asked on: 31 October 2018
Ministry of Defence
Ministry of Defence: Drugs
Commons
To ask the Secretary of State for Defence, if she will publish the top 10 drugs by purchased by his Department in each of the last five years; and if he will make a statement.
A
Answered by: Mr Tobias Ellwood
Answered on: 05 November 2018

The top 10 drugs purchased by the Ministry of Defence in each of the last five years by value is as follows:

2017-18

Description

RABIES VACCINE BP SINGLE DOSE VIAL WITH DILUENT WATER FOR INJ 1ML SYRINGE (RAB/VAC) 1 X PK 'RABIPUR'

PROGUANIL HYDROCHLORIDE 100MG ATOVAQUONE 250MG F/C TABLETS 1 X 12 PACK

MENINGOCOCCAL POLYSACCHARIDE VACCINE GROUPS A,C,Y AND W-135 COMBINED
POWDER AND SOLUTION FOR INJECTION INTRAMUSCULAR USE 1 X VIAL WITH 1 X VIAL DILUENT 'MENVEO'

YELLOW FEVER VACCINE (LIVE) SINGLE DOSE VIAL POWDER FOR INJECTION WITH
0.5ML NACL INJECTION IN SYRINGE 1 X PACK 'STAMARIL'

OVER-LABELLED - 12 PROGUANIL/ATOVAQUONE 100/250mg TABLETS-GENERIC

ENCEPHALITIS TICK-BORNE VACCINE INACTIVATED 1 X 0.5ML PRELOADED SYRINGE

TYPHOID VACCINE POLYSACCARIDE 50MCG/ML SINGLE DOSE 0.5ML PREFILLED
SYRINGE 1 X 10 PACK

ADALIMUMAB 40MG SOLUTION FOR INJECTION IN 0.4ML PRE-FILLED PEN PACK OF
2 PENS 'HUMIRA'

DIPHTHERIA, TETANUS AND PERTUSSIS TOXOID (ACELLULAR) AND HEPATITIS B,
POLIOVIRUS AND HAEMOPHILUS TYPE B (HIB) VACCINE PRE-FILLED SYRINGE '
INFANRIX HEXA'

RABIES VACCINE BP POWDER AND SOLVENT FOR SUSPENSION FOR INJECTION
PACK OF 1 VIAL AND 1 PREFILLED SYRINGE 'RABIES BP'

2016-17

Description

PROGUANIL HYDROCHLORIDE 100MG ATOVAQUONE 250MG F/C TABLETS 1 X 12 PACK

MENINGOCOCCAL POLYSACCHARIDE VACCINE GROUPS A,C,Y AND W-135 COMBINED POWDER AND SOLUTION FOR INJECTION INTRAMUSCULAR USE 1 X VIAL WITH 1 X VIAL DILUENT 'MENVEO'

ENCEPHALITIS TICK-BORNE VACCINE INACTIVATED 1 X 0.5ML PRELOADED SYRINGE

YELLOW FEVER VACCINE (LIVE) SINGLE DOSE VIAL POWDER FOR INJECTION WITH 0.5ML NACL INJECTION IN SYRINGE 1 X PACK 'STAMARIL'

RABIES VACCINE BP SINGLE DOSE VIAL WITH DILUENT WATER FOR INJ 1ML SYRINGE (RAB/VAC) 1 X PK 'RABIPUR'

HEPATITIS B RECOMBINANT VACCINE ADSORBED 'ENGERIX' 20MCG/ML SUSPENSION FOR INJECTION 1ML PRE-FILLED SYRINGE PACK OF 10

ETANERCEPT 50MG PRE-FILLED PEN PACK OF 4

FENTANYL CITRATE;LOZENGE;800mcg;LOZENGE w/INTEGRAL OROMUCOSAL APPLICATOR; 1x3

HEPATITIS A VIRUS VACCINE INACTIVATED 1ML PFS PACK OF 10 'HAVRIX'

PNEUMOCOCCAL POLYSACCHARIDE CONJUGATE VACCINE (13-VALENT ADSORBED) SUSP FOR INJ IN 0.5ML PRE-FILLED SYRINGE PK OF 10 'PREVENAR 13'

2015-16

Description

YELLOW FEVER VACCINE (LIVE) SINGLE DOSE VIAL POWDER FOR INJECTION WITH 0.5ML NACL INJECTION IN SYRINGE 1 X PACK 'STAMARIL'

HEPATITIS B RECOMBINANT VACCINE ADSORBED 'ENGERIX' 20MCG/ML SUSPENSION FOR INJECTION 1ML PRE-FILLED SYRINGE PACK OF 10

MENINGOCOCCAL POLYSACCHARIDE VACCINE GROUPS A,C,Y AND W-135 COMBINED POWDER AND SOLUTION FOR INJECTION INTRAMUSCULAR USE 1 X VIAL WITH 1 X VIAL DILUENT 'MENVEO'

PROGUANIL HYDROCHLORIDE 100MG ATOVAQUONE 250MG F/C TABLETS 1 X 12 PACK

RABIES VACCINE BP SINGLE DOSE VIAL WITH DILUENT WATER FOR INJ 1ML SYRINGE (RAB/VAC) 1 X PK 'RABIPUR'

TYPHOID VACCINE POLYSACCARIDE 50MCG/ML SINGLE DOSE 0.5ML PREFILLED SYRINGE 1 X 10 PACK

FENTANYL CITRATE;LOZENGE;800mcg;LOZENGE w/INTEGRAL OROMUCOSAL APPLICATOR; 1x3

JAPANESE ENCEPHALITIS VACCINE (INACTIVATED, ADSORBED) SUSPENSION FOR INJECTION IN 0.5ML PRE-FILLED SYRINGE IXIARO

ETANERCEPT 50MG PRE-FILLED PEN PACK OF 4

ENCEPHALITIS TICK-BORNE VACCINE INACTIVATED 1 X 0.5ML PRELOADED SYRINGE

2014-15

Description

PROGUANIL HYDROCHLORIDE 100MG ATOVAQUONE 250MG F/C TABLETS 1 X 12 PACK

YELLOW FEVER VACCINE (LIVE) SINGLE DOSE VIAL POWDER FOR INJECTION WITH 0.5ML NACL INJECTION IN SYRINGE 1 X PACK 'STAMARIL'

HEPATITIS B RECOMBINANT VACCINE ADSORBED 'ENGERIX' 20MCG/ML SUSPENSION FOR INJECTION 1ML PRE-FILLED SYRINGE PACK OF 10

YELLOW FEVER VACCINE 'STAMARIL' (LIVE) UNLICENSED 10 DOSE VIAL PACK OF 10 VIALS (100 DOSE TOTAL)

MEFLOQUINE HYDROCHLORIDE 250MG TABLET 1 X 8 PACK

RABIES VACCINE BP SINGLE DOSE VIAL WITH DILUENT WATER FOR INJ 1ML SYRINGE (RAB/VAC) 1 X PK 'RABIPUR'

MENINGOCOCCAL POLYSACCHARIDE VACCINE GROUPS A,C,Y AND W-135 COMBINED POWDER AND SOLUTION FOR INJECTION INTRAMUSCULAR USE 1 X VIAL WITH 1 X VIAL DILUENT 'MENVEO'

PNEUMOCOCCAL POLYSACCHARIDE CONJUGATE VACCINE (13-VALENT ADSORBED) SUSP FOR INJ IN 0.5ML PRE-FILLED SYRINGE PK OF 10 'PREVENAR 13'

HEPATITIS A VIRUS VACCINE INACTIVATED 1ML PFS PACK OF 10 'HAVRIX'

JAPANESE ENCEPHALITIS VACCINE (INACTIVATED, ADSORBED) SUSPENSION FOR INJECTION IN 0.5ML PRE-FILLED SYRINGE IXIARO

2013-14

Description

YELLOW FEVER VACCINE (LIVE) SINGLE DOSE VIAL POWDER FOR INJECTION WITH 0.5ML NACL INJECTION IN SYRINGE 1 X PACK 'STAMARIL'

HEPATITIS B RECOMBINANT VACCINE ADSORBED 'ENGERIX' 20MCG/ML SUSPENSION FOR INJECTION 1ML PRE-FILLED SYRINGE PACK OF 10

PROGUANIL HYDROCHLORIDE 100MG ATOVAQUONE 250MG F/C TABLETS 1 X 12 PACK

PROGUANIL HYDROCHLORIDE 100MG TABLETS X 98 AND CHLOROQUINE PHOSPHATE 250MG TABLETS X 14 1 X 112 TABLET TRAVEL PACK

MEFLOQUINE HYDROCHLORIDE 250MG TABLET 1 X 8 PACK

HEPATITIS A&B VACCINE 'TWINRIX'

HEPATITIS B VACCINE 20MCG/ML ADSORBED 1 X 1ML PRE-FILLED SYRINGE

HEPATITIS A VACCINE INACTIVATED 1 X PREFILLED SYRINGE

MENINGOCOCCAL POLYSACCHARIDE VACCINE GROUPS A,C,Y AND W-135 COMBINED POWDER AND SOLUTION FOR INJECTION INTRAMUSCULAR USE 1 X VIAL WITH 1 X VIAL DILUENT 'MENVEO'

YELLOW FEVER VACCINE 'STAMARIL' (LIVE) UNLICENSED 10 DOSE VIAL PACK OF 10 VIALS (100 DOSE TOTAL)

Q
Asked on: 11 September 2018
Ministry of Defence
Armed Forces: Mefloquine
Lords
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.
A
Answered by: Earl Howe
Answered on: 24 September 2018

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.

Q
Asked on: 07 March 2018
Department of Health and Social Care
Mefloquine
Lords
To ask Her Majesty's Government, further to the Written Answer by Lord O'Shaughnessy on 18 January (HL4484), whether they consider the completed "cases of suicide", listed in the current mefloquine product information leaflet as reported psychiatric adverse reactions to the drug, to be permanent.
A
Answered by: Lord O'Shaughnessy
Answered on: 21 March 2018

In the context of an adverse reaction to a medicine, suicide is a possible outcome of suicidal ideation, rather than necessarily an adverse reaction to treatment. For mefloquine, the current assessment, as recommended by the European Medicines Agency's Pharmacovigilance Risk Assessment Committee, is that whilst psychiatric side effects, including suicidal ideation, may persist after stopping treatment, current evidence does not support that these may be permanent after stopping treatment.

Q
Asked on: 17 January 2018
Ministry of Defence
Armed Forces: Mefloquine
Lords
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.
A
Answered by: Earl Howe
Answered on: 30 January 2018

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.

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.

For these reasons, there are no plans to add an addendum to the Defence Mental Health and Wellbeing Strategy Report 2017-2022.

Grouped Questions: HL4830
Q
Asked on: 17 January 2018
Ministry of Defence
Armed Forces: Mefloquine
Lords
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.
A
Answered by: Earl Howe
Answered on: 30 January 2018

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.

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.

For these reasons, there are no plans to add an addendum to the Defence Mental Health and Wellbeing Strategy Report 2017-2022.

Grouped Questions: HL4829
Q
Asked on: 16 January 2018
Department of Health and Social Care
Mefloquine
Lords
To ask Her Majesty's Government, following the report in the Sunday Times on 14 January that the Ministry of Defence had stated that respected health bodies continued to recommend Lariam "as a safe and effective form of malaria prevention", which bodies provide such a recommendation.
A
Answered by: Lord O'Shaughnessy
Answered on: 25 January 2018

Mefloquine is effective in the prevention and treatment of malaria and is licensed for use by the Medicines and Healthcare products Regulatory Agency (MHRA), which regulates medication in the United Kingdom. As with all medicines, the MHRA keeps the safety of mefloquine under continual review.

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.

Q
Asked on: 08 January 2018
Department of Health
Mefloquine
Lords
To ask Her Majesty's Government, further to the Written Answer by Lord O'Shaughnessy on 22 December 2017 (HL4314), whether they consider suicide, as listed in the current mefloquine product information as a psychiatric adverse reaction, to be a permanent adverse reaction.
A
Answered by: Lord O'Shaughnessy
Answered on: 18 January 2018

Feeling suicidal, or the risk of suicide, would not be considered to be permanent adverse reactions.

Mefloquine is effective in the prevention and treatment of malaria and is approved by the Medicines and Healthcare products Regulatory Agency (MHRA), which regulates medication in the United Kingdom. As with all medicines, the MHRA keeps the safety of mefloquine under continual review. Mefloquine continues to be recommended as a safe and effective form of malaria prevention by the Advisory Committee on Malaria Prevention, the World Health Organization and other respected organisations who take account of the body of global evidence.

Q
Asked on: 19 December 2017
Department of Health
Mefloquine
Lords
To ask Her Majesty's Government, further to the Written Answer by Lord O'Shaughnessy on 19 December (HL3942), whether they consider (1) suicide, and (2) the “irreversible” neurological condition described in the current mefloquine product information to be permanent adverse reactions.
A
Answered by: Lord O'Shaughnessy
Answered on: 22 December 2017

The product information refers to irreversible neuropathic conditions, which are conditions affecting the nervous system.

The product information states that neuropsychiatric adverse reactions, such as mood disturbances, psychosis and vestibular disorders, may occur during treatment and includes warnings and precautions to minimise these risks. Some of these reactions may persist, but it has not been established whether these are permanent.

Mefloquine is effective in the prevention and treatment of malaria and is approved by the Medicines and Health products Regulatory Agency (MHRA), which regulates medication in the United Kingdom. As with all medicines, the MHRA keeps the safety of mefloquine under continual review. Mefloquine continues to be recommended as a safe and effective form of malaria prevention by the Advisory Committee on Malaria Prevention, the World Health Organization and other respected organisations who take account of the body of global evidence.

Q
Asked on: 06 December 2017
Department of Health
Mefloquine
Lords
To ask Her Majesty's Government, further to the Written Answers by Lord O'Shaughnessy on 5 December (HL3532) and 27 November (HL3227), whether they have seen the unclassified order of the US Surgeon General’s Office of the Army Special Command of 13 September 2013; whether there is any difference between the drug of the same name administered to US troops and that issued to British troops; and why it is necessary to demonstrate that the neurological damage caused by the administration of mefloquine is permanent before acknowledging the persistence of the neurotoxic effects of the drug.
A
Answered by: Lord O'Shaughnessy
Answered on: 19 December 2017

We have considered this order.

There is no difference in the anti-malarial drug Mefloquine (under the brand name Lariam) currently provided to the United Kingdom and United States armed forces.

Mefloquine is effective in the prevention and treatment of malaria. Approved by the Medicines and Health products Regulatory Agency, the current product information states that neuropsychiatric adverse reactions may occur during treatment and includes warnings and precautions to minimise these risks. Some of these reactions may persist, but it has not been established whether these are permanent.

Mefloquine continues to be recommended as a safe and effective form of malaria prevention by the Advisory Committee on Malaria Prevention, the World Health Organization and other respected organisations who take account of the body of global evidence.

Q
Asked by Lord Stirrup
Asked on: 28 November 2017
Department of Health
Mefloquine: Veterans
Lords
To ask Her Majesty's Government what steps they are taking to (1) identify, (2) monitor, and (3) assist, those veterans who were prescribed mefloquine while in the military before the introduction of recent safeguards.
A
Answered by: Lord O'Shaughnessy
Answered on: 12 December 2017

Any veteran presenting to his or her National Health Service general practitioner (GP) with side effects of any medication will receive care in line with national guidelines.

In making a clinical judgement about any patient, the GP will consider a number of factors, including relevant medical history, and will be treated appropriately. GP registration forms include a section to complete if a patient has served in the armed forces. Armed forces’ medical records can be accessed by NHS clinicians.

Q
Asked on: 23 November 2017
Department of Health
Mefloquine
Lords
To ask Her Majesty's Government, further to the Written Answer by Earl Howe on 22 November (HL3229), what assessment they have made of the conclusions of the Pharmacovigilance Risk Assessment Committee of the European Medicines Agency in 2014 that: “There is enough evidence … supporting a causal relationship between mefloquine and the occurrence of long lasting and even persistent neuropsychiatric side effects” and a “strong suspicion” that mefloquine can cause “permanent brain damage”.
A
Answered by: Lord O'Shaughnessy
Answered on: 05 December 2017

At its meeting in February 2014, the Pharmacovigilance Risk Assessment Committee (PRAC) of the European Medicines Agency recommended that the product information for mefloquine be amended to state that neuropsychiatric adverse reactions may persist for months, or longer, even after discontinuation of the drug. The PRAC did not recommend that such reactions should be listed as permanent. The United Kingdom product information for mefloquine reflects the final PRAC recommendation.

Asked on: 13 November 2017
Ministry of Defence
Armed Forces: Mefloquine
Lords
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.
A
Answered by: Earl Howe
Answered on: 27 November 2017

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.

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.

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.

Grouped Questions: HL3215 | HL3216
Asked on: 14 November 2017
Ministry of Defence
Armed Forces: Malaria
Lords
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.
A
Answered by: Earl Howe
Answered on: 27 November 2017

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.

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.

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.

Grouped Questions: HL3102 | HL3216
Asked on: 14 November 2017
Ministry of Defence
Armed Forces: Mefloquine
Lords
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.
A
Answered by: Earl Howe
Answered on: 27 November 2017

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.

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.

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.

Grouped Questions: HL3102 | HL3215
Q
Asked on: 14 November 2017
Department of Health
Mefloquine
Lords
To ask Her Majesty's Government, further to the answer by Lord O'Shaughnessy on 7 November (HL Deb, col 1689) that a link between mefloquine and severe and persistent psychiatric symptoms has not been established, what assessment they have made of Lariam’s inclusion in the British Medical Journal’s Visual Summary for Psychotic disorders list as a possible cause of psychotic symptoms and the warnings in the Roche patient information leaflet that Lariam may cause serious mental problems.
A
Answered by: Lord O'Shaughnessy
Answered on: 27 November 2017

As with all medicines, the Medicines and Healthcare products Regulatory Agency (MHRA) keeps the product information for mefloquine (which includes the patient information leaflet and the summary of product characteristics) under review. Mefloquine is effective in the prevention and treatment of malaria. The current product information 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.

The reference to mefloquine in the British Medical Journal article on 8 November 2017, entitled Early psychosis for the non-specialist doctor, is consistent with the possible adverse reactions included in the mefloquine product information.

Asked on: 14 November 2017
Ministry of Defence
Armed Forces: Malaria
Lords
To ask Her Majesty's Government, in the light of their response to the report by the House of Commons Defence Select Committee, The use of Lariam for military personnel (4th Report, Session 2015–16), whether they have now ensured that “all anti-malaria drugs are only supplied after a face-to-face travel health risk assessment performed by an appropriately trained and regulated healthcare professional”; and if not, when they expect to achieve 100 per cent compliance with that target.
A
Answered by: Earl Howe
Answered on: 22 November 2017

The Government's updated policy on Preventing Malaria in UK Armed Forces Personnel (Joint Service Publication 950, Part 1, Leaflet 3-3-1) makes it explicit that, if dispensed from a military source, all antimalarial drugs can only be prescribed after a face-to-face assessment with an appropriately trained and regulated healthcare professional has taken place.

The Official Statistic of 16 November 2017, Mefloquine Prescribing in the Armed Forces, shows that between 1 April and 30 September 2017, there were 40 prescriptions for mefloquine out of a total of 6,221 antimalarial prescriptions. Of those 40 prescriptions, 32 had an electronic coded entry on Defence Medical Information Capability Programme for a face-to-face assessment. However, this does not necessarily mean that 8 individuals did not have a face-to-face assessment. If the healthcare professional recorded it as free text rather than using a coded checkbox then it will not appear in the dataset. Of the 40 prescriptions, 28 had an electronic coded entry recording that an alternative antimalarial to mefloquine had been offered. Again, this does not necessarily mean that 12 individuals did not have an alternative offered, for the reasons previously stated.

Given healthcare professionals are permitted to record any part of a consultation in free text, it might be that a face-to-face assessment, or record of alternative antimalarials being offered, will not be recorded through an electronic coded entry in 100 per cent of cases.

Grouped Questions: HL3218
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