Q. I will be traveling to Kenya and will need to take anti-malaria medication. I've heard conflicting information regarding side effects of Lariam. Some authorities state that this medicine has a low level of side effects. But I have also heard testimonials from people who have had panic attacks after taking this drug. Do you have any information on this? Is there any alternative?
A. Lariam (mefloquine) has made headlines because the Army is investigating the drug's possible connection to a series of domestic murders and suicides at Fort Bragg, N.C. The soldiers had taken Lariam to prevent malaria while on active duty.
Peace Corps volunteers have complained for years that Lariam causes weird psychological side effects. Medical experts acknowledge that it might cause confusion, nightmares, hallucinations, aggression, agitation, anxiety, depression or psychosis.
Public-health officials support the value of Lariam for people traveling to areas with resistant malaria. However, Malarone and doxycycline are effective alternatives.
Q. If I don't get a decent night's sleep, it leaves me irritable and makes it hard to focus. I have a lot of responsibility and cannot afford to be sluggish or groggy during the day.
When I am especially keyed up and afraid I won't be able to sleep, I take Tylenol PM. But I worry about taking it every night for fear it will lose its effectiveness.
I've seen ads for a drug called Ambien. Would it be compatible with my other medicines? I take Claritin-D, Toprol and Zoloft.
A. Before you ask your doctor about Ambien, you might want to discuss your other medications. They could all be contributing to your sleeping problems. The "D" in many allergy medicines is a decongestant that can be stimulating. Beta blockers like propranolol or metoprolol (Toprol) also affect sleep. So can antidepressants like Zoloft, Paxil or Prozac.
Ambien is a prescription sleeping pill with a fast onset. Zoloft might exaggerate its action, however. Side effects might include nausea, dizziness and daytime drowsiness.
Q. Are there any drugs for cholesterol that aren't statins? My doctor says, "Not really."
I know statins haven't been around all that long, and there had to be something doctors used previously to try to control high cholesterol. I can't tolerate statins and would welcome an alternative.
A. You're right that doctors used to prescribe other medicines for high cholesterol. Statin medications like Zocor, Pravachol and Lipitor are so effective at lowering cholesterol that many doctors stopped using drugs like Questran or Colestid.
But these medications, and a newer one that is similar, called WelChol, are options for people who can't tolerate statin drugs. Other possibilities include Lopid or Tricor.