Lariam (mefloquine hydrochloride), the anti malarial drug produced by Hoffman-La Roche, has rarely been out of the news since its introduction in the 1980s.

The flames of controversy were fanned once again recently with the first reported death from the drug. A six year old girl died in an English hospital after returning from a holiday in Nigeria. She suffered a severe reaction, known as toxic epidermal necrolysis, and died after 19 days in hospital from a heart attack.

This follows on from a class action suit against the Swiss manufacturer by 300 Britons who are all claiming severe and long term effects after taking the drug. They are still suffering hallucinations, anxiety attacks, seizures and severe mood swings, they say.

Many travellers are refusing to take the drug, and British Airways last year issued a warning to all staff about Lariam.

Lariam is considered to be the most powerful of all the anti malarials, and is designed as a preventative against and as treatment for resistant strains of malaria caught in sub Sahara Africa, such as P falciparum and Plasmodium vivax.

Because it is taken just once a week, Lariam tends to stay in the system for a long time. This means there can be a rapid build up and adverse reactions can be experienced quite early on.

Hoffman-La Roche says that the effects of the drug on patients suffering from malaria are indistinguishable from the disease itself. As a preventative (prophylaxis), reactions can include vomiting, dizziness, nausea, fever, headache, chills, skin rash, tinnitus, hair loss, emotional problems and seizures. One patient suffered a heart attack after taking just one tablet.

To that long list must now be added another: death.