Mefloquine is not recommended for severe malaria infections, particularly infections from "P. falciparum", which should be treated with intravenous antimalarials. Mefloquine does not eliminate parasites in the liver phase of the disease, and people with "P. vivax" malaria should be treated with a second drug that is effective for the liver phase, such as primaquine. Mefloquine is widely used for the treatment of malaria in pregnancy. Limited data suggests that it is safe for this purpose. Resistance to mefloquine is now common around the west border in Cambodia and other parts of Southeast Asia. The mechanism of resistance is by increase
Mefloquine clearance is through the liver, and the primary means of excretion is through the bile and feces, as opposed to only 4% to 9% excreted through the urine. During long-term use, the plasma half-life remains unchanged. Liver function tests should be performed during long-term administration of mefloquine. Alcohol use should be avoided during treatment with mefloquine. Mefloquine is a chiral molecule with two asymmetric carbon centres, which means it has four different stereoisomers. The drug is currently manufactured and sold as a racemate of the ("R","S")- and ("S","R")-enantiomers by Hoffman-LaRoche, a Swiss pharmaceutical company. Essentially, it is two drugs in