I propose to take Questions Nos. 25, 57 and 66 together.
I am advised by the military authorities that the Defence Forces personnel management system does not capture data on the number of suicides in the Defence Forces during a specific period. In this context, the information requested regarding the number of suicide victims who were either taking Lariam or who had taken Lariam prior to committing suicide is not available.
Lariam is authorised for use by the Irish Medicines Board, which is the statutory regulatory body charged with regulating the use of medicines to ensure the quality, safety and efficacy of medicines available in Ireland. Lariam was first authorised for use by the Irish Medicines Board in 1989. The authorised product information provides details to ensure the safe and effective use of this medicinal product. While certain risks associated with the use of the drug were highlighted in drug safety newsletters in 1996 and 2003, the Irish Medicines Board remained of the view that the benefit-risk profile for the product remained acceptable. The Irish Medicines Board continues to review the safety of this and all medicines on an ongoing basis and updates the product information as appropriate.
In accordance with best practice in prescribing this medication and taking account of the contraindications, warnings and side effects highlighted by the Irish Medicines Board, the Defence Forces screen all personnel for medical suitability. The screening system automatically rules out personnel from overseas service with certain conditions such as depression, anxiety, neurodegenerative disorders and so on which, as has been indicated by the Irish Medicines Board, are more likely to precipitate serious adverse reactions to Lariam. Pregnant personnel also are excluded.
In the case of overseas missions to malarious areas, the medical screening involves an assessment of the individual's suitability to be prescribed the selected anti-malarial agent in line with current Irish Medicines Board guidelines. This typically involves review of the individual's previous experience, if any, with the medication. The individual's medical history is also screened for those conditions which have been identified as precipitating serious side effects in association with the medication. In addition, blood tests are carried out to ensure that the liver is healthy, as liver disease is an accepted contraindication to the use of Lariam.
It is the policy of the Defence Forces Medical Corps that personnel who are found suitable for Lariam should commence their medication three to four weeks in advance of their travel. The purpose of this precaution is twofold. While it allows a slow build-up of the medication in the bloodstream, it also permits assessment by the person of his or her individual reaction to the medication while still in Ireland. During this probationary period, the individual can consult a medical officer on any adverse reaction, minor or major. Some minor reactions may be transient but if persistent or troublesome, the individual will be deemed to have sensitivity to the medication and will be found not medically suitable for the mission.
The Defence Forces take all necessary precautions in assessing the suitability of personnel before prescribing Lariam in accordance with the prescribing instructions and information provided by the Irish Medicines Board. Personnel are screened both before and after deployments and all necessary actions are taken to ensure that those with contraindications to Lariam use are deemed unsuitable for overseas service and are not prescribed the medication.