British authorities have issued an alert to healthcare professionals prescribing fluoroquinolone antibiotics (ciprofloxacin, delafloxacin, levofloxacin, moxifloxacin, ofloxacin), reminding them to be alert to the risk of psychiatric reactions, including depression and psychotic reactions, which may potentially lead to thoughts of suicide or suicide attempts.
Healthcare professionals are also reminded to advise patients to be alert to these risks, said the notice this week, MedicalBrief reports.
The Medical and Healthcare Products Regulatory Agency said it has received a coroner’s report following the death of a patient who died by suicide after being treated with ciprofloxacin. The patient had no previous history of depression or mental health problems. The coroner raised concerns about the potential risk of suicidal behaviour in patients taking ciprofloxacin, the potential for increased risk in patients with depression, and the need to highlight this to healthcare professionals.
Warnings on the potential for psychiatric adverse drug reactions to occur with ciprofloxacin and other fluoroquinolones are included in the product information. The Summary of Product Characteristics (SmPC) states that psychiatric reactions may occur with ciprofloxacin, including after the first dose. In rare cases, depression or psychosis can progress to suicidal ideation or suicide attempts. If this happens, ciprofloxacin should be discontinued immediately.
The Patient Information Leaflet (PIL) advises patients that they may experience psychiatric reactions. If patients suffer from depression or psychosis before being prescribed this medication, their symptoms may become worse under treatment with ciprofloxacin. In rare cases, depression or psychosis can progress to thoughts of suicide or suicide attempts. If this happens, patients are advised to contact their doctor immediately.
It is not possible from available data to indicate a frequency nor period of risk for these potential adverse reactions. Patients should be advised to seek medical attention for any psychiatric symptoms, even if it has been some time since they stopped taking the medication.
UK drug safety update – Fluoroquinolone antibiotics: suicidal thoughts and behaviour (Open access)
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