How to Help Your Patients Find Mefloquine in Stock: A Provider's Guide

When a patient calls your office unable to fill their mefloquine prescription, the burden of problem-solving often falls on your care team. The mefloquine supply shortage — which has been documented since May 2024 and affects Teva Pharmaceuticals' 250 mg tablets — has created a recurring scenario in travel medicine and primary care practices: patients with imminent international travel and no antimalarial in hand.

This guide is designed to help you and your staff efficiently navigate the shortage — finding supply when it exists, switching appropriately when it doesn't, and giving patients tools to help themselves.

Why Is Mefloquine Hard to Source Right Now?

Teva Pharmaceuticals USA is the primary generic manufacturer of mefloquine hydrochloride 250 mg in the United States. When Teva reported limited supply beginning in May 2024, the market — which has minimal manufacturer redundancy — immediately felt the impact. The ASHP maintained an active drug shortage bulletin from October 2024 through at least September 2025.

The brand-name Lariam was pulled from the U.S. market by Roche in 2009, leaving only generics. With low overall demand (mefloquine's serious neuropsychiatric side effects profile has reduced its prescribing rates), there is little commercial incentive for new manufacturers to enter the market. This structural fragility means that any production disruption quickly translates to a national shortage.

Step 1: Proactively Screen Upcoming Travel Patients

The most effective intervention is early screening. For patients with upcoming international travel to malaria-endemic regions, initiate the antimalarial prescribing and sourcing process at least 6-8 weeks before departure — not at the last pre-travel visit. This lead time allows:

Sufficient time to locate mefloquine if preferred, without the pressure of imminent departure

Time to switch to an alternative with proper prophylaxis lead time (doxycycline: 1-2 days before; atovaquone-proguanil: 1-2 days before; mefloquine: 1-3 weeks before)

Opportunity to assess tolerability of mefloquine by starting 2-3 weeks before departure to observe side effects before the trip begins

Step 2: Issue Dual Prescriptions When Appropriate

When prescribing mefloquine, consider issuing a backup prescription for your preferred alternative antimalarial simultaneously — especially when the patient faces a shortage situation. For example, write a prescription for mefloquine 250 mg with a note to fill first, and a separate prescription for atovaquone-proguanil labeled "fill only if mefloquine is unavailable within 5 business days." This gives patients agency without requiring a return visit or phone call to get an alternative.

Step 3: Know Where to Source Mefloquine

Retail pharmacies are the most commonly checked but least likely to have stock during a shortage. Prioritize these alternative channels:

Travel health clinics: The best source during shortages. Clinics staffed for international travel specifically maintain antimalarial inventory, including mefloquine.

Hospital outpatient pharmacies: Often carry broader formularies and may be able to source from specialty wholesalers.

Specialty wholesalers: Have your pharmacy team check McKesson, AmerisourceBergen, or Cardinal Health for current mefloquine availability through alternative distributors.

medfinder: Direct your patients to medfinder.com, which calls pharmacies on their behalf to check mefloquine inventory and reports results via text. This eliminates the call-cascade burden from your office staff and empowers patients to find their own medication efficiently.

Step 4: Counsel Patients on Timing Implications

Whichever antimalarial you prescribe, patients must understand the start date implications:

Mefloquine: Must begin 1-3 weeks before entering the endemic area. Starting 2-3 weeks early also allows time to observe for neuropsychiatric side effects before departure.

Atovaquone-proguanil: Can be started just 1-2 days before travel, providing more flexibility if sourcing delays occur.

Doxycycline: Start 1-2 days before travel; continue 4 weeks after return.

Step 5: Document the Clinical Rationale

When substituting for mefloquine due to shortage, document:

The reason for the substitution (drug shortage, documented unavailability)

The alternative prescribed and its evidence base for the patient's destination

Patient counseling provided, including start date, dosing, and side effect monitoring

Any special population considerations (pregnancy, G6PD status, psychiatric history)

Helpful Resources for Providers

CDC Malaria Consultation: 770-488-7788 (M-F 9am-5pm EST); after hours: 770-488-7100

ASHP Drug Shortage Bulletin: ashp.org/drug-shortages — current mefloquine shortage status

CDC Yellow Book (Travelers' Health): cdc.gov/travel — destination-specific malaria chemoprophylaxis recommendations

For providers who routinely help patients navigate drug shortages, medfinder for providers is a resource that allows patients to search for their prescription without burdening your office team. See also: Mefloquine Shortage: What Providers Need to Know in 2026.