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Ciprofloxacin-induced psychosis
1Department of Psychiatry and Behavioral Sciences, University of Oklahoma College of Medicine-Tulsa 74129.
Objective:
To report a case of ciprofloxacin-induced psychosis and to discuss occurrence rates, risk factors, possible etiologies, preventive measures, and treatment courses for this adverse reaction.
Data Sources:
Case reports and review articles identified by MEDLINE.
Data Extraction:
Data from pertinent published sources were reviewed and abstracted.
Data Synthesis:
A 49-year-old man developed symptoms of severe psychosis concomitant with ciprofloxacin (250 mg bid) treatment. Central nervous system effects secondary to ciprofloxacin treatment are uncommon and usually consist only of minor dizziness or mild headache, although rare occurrences of seizures and hallucinations have been reported. The mechanism by which ciprofloxacin causes these adverse effects is not fully understood. It has been suggested that quinolones may produce an epileptogenic effect by inhibiting the binding of gamma-aminobutyric acid to its receptor sites in the brain. There is yet no explanation for the occurrence of hallucinations or psychosis.
Conclusions:
Caution should be exercised when using ciprofloxacin in the treatment of patients with personality abnormalities or symptoms of psychosis.
Insights
Ciprofloxacin can cause severe psychosis, a rare but serious central nervous system adverse effect. Healthcare providers should exercise caution when prescribing this antibiotic to patients with a history of psychosis.
Area of Science:
- Pharmacology
- Neuroscience
- Psychiatry
Background:
- Ciprofloxacin, a fluoroquinolone antibiotic, is widely prescribed.
- Central nervous system (CNS) adverse effects are uncommon but can occur.
- Psychiatric adverse events, including psychosis, are rare but documented.
Observation:
- A 49-year-old male developed severe psychosis during ciprofloxacin treatment (250 mg twice daily).
- This case highlights a rare but significant CNS adverse reaction to ciprofloxacin.
- Reported CNS effects typically include dizziness or headache, with seizures and hallucinations being infrequent.
Findings:
- The exact mechanism of ciprofloxacin-induced psychosis remains unclear.
- Quinolones may exert an epileptogenic effect by interfering with GABA receptor binding.
- Further research is needed to elucidate the pathways leading to hallucinations and psychosis.
Implications:
- Clinicians should exercise caution when prescribing ciprofloxacin to patients with pre-existing psychiatric conditions or personality abnormalities.
- Awareness of this potential adverse effect is crucial for early detection and management.
- This case underscores the importance of monitoring for neuropsychiatric symptoms during fluoroquinolone therapy.