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What are the aims of this leaflet?
This leaflet has been written to help you understand more about
mepacrine. It tells you what it is, how it works, how it is used to
treat skin conditions, and where you can find out more about it.
What is mepacrine and how does it work?
Mepacrine (an unlicensed drug in the UK) was introduced as a treatment
for malaria and for certain other tropical infections. It is one of
several antimalarial drugs that have been found also to have
anti-inflammatory properties, which can help some skin conditions.
What does “unlicensed” mean in relation to a drug?
An unlicensed drug is one that has not been awarded a Market
Authorisation from the UK Medicines Healthcare Products Regulatory
Agency (MHRA). A drug may be licensed in other countries, but not in the
UK. Drug licenses in the UK are awarded following a rigorous process
of evaluation by the MHRA following an application by a pharmaceutical
company. Once awarded, the licensed drug can then be marketed and sold
in the UK.
In the absence of a license, the drug may still be prescribed in the
UK, provided there is funding available locally to pay for it.
Additionally, there must be a clear body of evidence to confirm that the
drug is effective for the condition in question and that safety
concerns have been adequately addressed. Even after such evidence has
been supplied it is still a matter for the local formulary group (a
multidisciplinary group who make decisions on the prescribing of
medicinal drugs at a local level) to make a final decision on a
case-by-case basis.
Mepacrine is widely used for lupus in many countries including the UK
and North America but remains unlicensed and has to be obtained from a
‘Specials’ pharmaceutical manufacturer. It is listed as a treatment for
discoid lupus erythematosus in the British National Formulary.
Which skin conditions are treated with mepacrine?
Mepacrine is used particularly to treat discoid lupus erythematosus and for subacute cutaneous lupus erythematosus. Mepacrine has also been used in the treatment of erythema multiforme, sarcoidosis and dermatomyositis (please see the relevant BAD Patient Information Leaflets).
What dose of mepacrine should I take?
Your doctor will advise you about this. For skin conditions, the dose
may be as small as 50 mg (half a 100 mg tablet) taken three times a
week. A maximum dose would be 100 mg, taken three times a day. The dose
for children is 2 mg per kg bodyweight, given as a split dosage three
times a day (to a maximum of 300 mg daily). It may take several weeks to
reach its full effect.
What are the possible side effects of mepacrine?
Mepacrine is well tolerated at the low doses used in dermatology. However, it can have some undesirable side effects:
- Yellow discoloration of the skin and urine may occur during long-term treatment or with large doses. This is common but quite harmless, and should not be a cause for concern as it goes away when you stop the drug. Similarly, the palate, nails and eyes may be discoloured blue or black, which also resolve when you stop taking the drug.
- Mepacrine can cause dizziness, particularly when you get up from sitting or lying down. Getting up slowly should help to reduce this side effect.
- Other possible side effects include stomach upsets, headaches, nausea and vomiting, rashes (occasionally severe), and changes in mood or behaviour. Fits may occur with overdosing. Liver inflammation and alterations in the blood count can occur but are rare.
Mepacrine should be used with caution in:
- patients with porphyria
- elderly patients
- the presence of liver disease
Mepacrine is best avoided by patients with psoriasis as it can
make this condition worse. It should also be avoided in myasthenia
gravis and by patients with a history of the severe forms of mental
illness called psychoses.
How will I be monitored for the side effects of mepacrine treatment?
Blood tests are usually performed twice a year to check your blood count and liver function.
Can I have vaccinations while I am on mepacrine?
Yes. This should not be a problem. If you are travelling to a place
where malaria occurs, mepacrine alone will not provide adequate
protection against it and you must see your GP to be prescribed
additional antimalarial treatment which may be taken at the same time as
mepacrine.
Does mepacrine affect fertility or pregnancy?
There are no data on the use of this drug in pregnancy and breastfeeding.
Consequently, it is recommended that you should avoid taking it if you
are pregnant or planning a pregnancy, or if you are breast feeding.
May I drink alcohol while I am taking mepacrine?
Mepacrine has been reported to produce a mild flushing reaction when
taken with alcohol. There may be symptoms such as a racing heartbeat,
dizziness, headache, shortness of breath, and sickness. If you
experience these symptoms it is advisable to avoid alcohol.
Can I take other medicines at the same time as mepacrine?
Mepacrine is often used in conjunction with hydroxychloroquine
for additional benefits. This is safe, however, some drugs do interact
with mepacrine. For example, mepacrine may increase the blood level of
primaquine (a medication used in the treatment of malaria), resulting in
a higher risk of toxicity, and it has been recommended that these two
drugs should not be used together
You should always let any doctors who are treating you know that you are taking mepacrine.
Where can I find out more about mepacrine?
If you want to know more about mepacrine, or if you are worried about
your treatment, you should speak to your doctor or pharmacist. This
information sheet does not list all of the side effects of mepacrine.
For fuller details, look at the medicine information sheet which comes
as an insert with your prescription for mepacrine.
Web links to detailed leaflets:
