Levofloxacin induced hallucinations?

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Sparda29 said:
Has anyone here seen a patient who experienced hallucinations during the course of Levaquin therapy?
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Never see it bro but how long was the pt on it? it is usually used for a short period of time like a week or so but i have seen people taking it for whole month with refills...
sry i know i wasn't too useful but your question is making me curious.
 
Are they on any SSRIs or SNRIs?

What about serotonin syndrome? manifests like manic symptoms-- looks like bipolar disorder. I know there is a definite connection with linezolid and SSRIs...not sure about levaquin.
 
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rxlea said:
Are they on any SSRIs or SNRIs?

What about serotonin syndrome? manifests like manic symptoms-- looks like bipolar disorder. I know there is a definite connection with linezolid and SSRIs...not sure about levaquin.
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NOT serotonin syndrome, not unless its coupled with several other life-threatening signs and symptoms
 
Perhaps a search of Clinical Pharmacology would be good for you:

Convulsions and toxic psychosis have been reported in patients receiving quinolones. Quinolones may cause increased intracranial pressure and central nervous system stimulation which may lead to tremor, restlessness, anxiety, lightheadedness, confusion, hallucinations, paranoia, depression, nightmares, insomnia, and rarely, seizures (< 0.3%). These reactions can occur after the first dose of a fluoroquinolone; however, they are more common with elevated serum drug concentrations, especially in patients with substantial accumulation of the drug due to renal impairment. If these reactions occur in a patient receiving levofloxacin, the drug should be discontinued. As with other quinolones, levofloxacin should be used with caution in patients with a CNS disorder or in the presence of other risk factors that may predispose to seizures or lower the seizure threshold (see Precautions).

This was verbatim from Clinical Pharm.
So yes. It is possible.
 
not to mention that levaquin is known to have liver tox. Delirium is one of the results of liver failure.
 
Yes, I've seen a patient who experienced hallucinations on levofloxacin this year. Interesting, and my preceptors at a large academic medical center did not seem surprised.
 
/end thread.

Saw a guy on rotations go delerious after receiving ciprofloxacin eye drops.. of course, the order was for drops qhour or something and was never d/c'd. (d/c'd it and mental status returned to baseline)

Quiksilver said:
Perhaps a search of Clinical Pharmacology would be good for you:

Convulsions and toxic psychosis have been reported in patients receiving quinolones. Quinolones may cause increased intracranial pressure and central nervous system stimulation which may lead to tremor, restlessness, anxiety, lightheadedness, confusion, hallucinations, paranoia, depression, nightmares, insomnia, and rarely, seizures (< 0.3%). These reactions can occur after the first dose of a fluoroquinolone; however, they are more common with elevated serum drug concentrations, especially in patients with substantial accumulation of the drug due to renal impairment. If these reactions occur in a patient receiving levofloxacin, the drug should be discontinued. As with other quinolones, levofloxacin should be used with caution in patients with a CNS disorder or in the presence of other risk factors that may predispose to seizures or lower the seizure threshold (see Precautions).

This was verbatim from Clinical Pharm.
So yes. It is possible.
Click to expand...
 
rxlea said:
Are they on any SSRIs or SNRIs?

What about serotonin syndrome? manifests like manic symptoms-- looks like bipolar disorder. I know there is a definite connection with linezolid and SSRIs...not sure about levaquin.
Click to expand...

Not really, there are a whole slew of things that need to occur before serotonin syndrome should even be considered. Here's an excellent review of the topic: Boyer EW, Shannon M. The Serotonin Syndrome. NEJM 2005, 352:1112-20. http://content.nejm.org/cgi/content/extract/352/11/1112

To the OP: I have heard of quinolone-psychosis, especially with some of the older agents. As others have mentioned, they also have documented cases of it. So yes.
 
Praziquantel86 said:
Not really, there are a whole slew of things that need to occur before serotonin syndrome should even be considered. Here's an excellent review of the topic: Boyer EW, Shannon M. The Serotonin Syndrome. NEJM 2005, 352:1112-20. http://content.nejm.org/cgi/content/extract/352/11/1112

To the OP: I have heard of quinolone-psychosis, especially with some of the older agents. As others have mentioned, they also have documented cases of it. So yes.
Click to expand...

Cool! Thanks for the info :)
 
Another pharmacist at the hospital I work at had hallucinations while on Levaquin, said they were very vivid. First person I've actually seen that had it.
 
Sparda29 said:
Has anyone here seen a patient who experienced hallucinations during the course of Levaquin therapy?
Click to expand...

Levofloxacin-induced acute psychosis
Indian J Psychiatry. 2008 Jan-Mar; 50(1): 57–58.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2745871/

Abstract:
"A wide range of drugs can cause mental status changes. Fluoroquinolones are one among them and are underrecognised.The CNS side effects of levofloxacin like headache, dizziness, restlessness, tremor, insomnia, hallucinations, convulsions, anxiety and depression are well documented. We report a rare case of middle aged diabetic male admitted to hospital with multiple infections who developed acute psychosis following levofloxacin administration."

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In other news, insurance companies have been dropping coverage of J&J brand Levaquin due to tendon related issues.

Should Levaquin Carry Stronger Warnings?
http://www.lawyersandsettlements.co...antibiotics-lawsuit-side-effects-3-20298.html

(This has possibly caused the generic levofloxacin to be prescribed more frequently, raising incidence of hallucination and other side effects not caused by the brand product. This is purely speculation on my part as there are quite a few articles and blog posts online about levofloxacin induced hallucinations.)
 
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I had a demented lady get super delirious on Cipro. I don't know if she was having hallucinations, but she behaved very wildly and caused quite a stir for a few days. D/C'd it and her mental status pretty quickly returned to baseline.
 
Flouroquinalones reduce the clearance of caffeine. Maybe caffeine is the actual culprit?
 
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