Therapeutics & Drug Brief
Magic Mushrooms and Mefloquine
Source: ISTM Physicians ([email protected]); March 19-20, 2001.
Physicians on the International Travel Medicine (ISTM) chat line reviewed a case of an 18-year-old student traveling in Southeast Asia and India as part of a class "project" who developed an acute reaction following an ingestion of raw "magic mushrooms" in Thailand. He presented several days later to a physician in Calcutta complaining of nausea, sweats, palpitations, and intermittent attacks of confusion, anxiety, and, according to friends, possible paranoia. He was also experiencing bad dreams.
He was also receiving mefloquine for malaria prophylaxis.
He consumed the mushrooms—also known as LSG/ecstasy mushrooms—and some possible marijuana, along with several friends, none of whom had a similar reaction. Such mushrooms have been popular with certain travelers looking for a "natural" (someone said the word—organic?) high since the 1960s and are apparently available at clubs and resorts in Southeast Asia.
Whether this young man’s symptoms were secondary to the mushrooms, the mefloquine, or both is uncertain. However, retrospective data suggest that up to 11.3% of travelers, none with previously identified psychiatric problems, report some kind of neuropsychiatric symptoms while receiving mefloquine, including sleep disturbances, vivid dreams, and fatigue in about one-half to frank depression in 0.5% (see Kemper CA. Infectious Disease Alert 2000;19:112). About 1.2% report prolonged symptoms lasting longer than 2 months.
Critics of these data argue that good prospective data identifying a significant risk of neuropsychiatric problems in persons receiving mefloquine is lacking. Mefloquine remains an important prophylactic antimalarial agent for many travelers. Since a major complaint of some patients appears to be a perception of a lack of adequate warning regarding potential side effects, travel medicine clinics may find a simple handout outlining potential problems helpful. It seems reasonable to add that patients should probably not take psychoactive substances with their mefloquine.
The Therapeutics & Drug Brief was written by Carol A. Kemper, MD, Clinical Associate Professor of Medicine, Stanford University, Division of Infectious Diseases; Santa Clara Valley Medical Center, Santa Clara, Calif.
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