These adverse reactions manifest as extreme anxiety, panic attacks, insomnia, brain fog (for lack of a
better term), paranoia, hallucinations, psychosis, seizures, tremors, taste perversions, abnormal dreams,
vertigo, and delirium

David A. Flockhart, professor of medicine and chief of clinical pharmacology at Indiana University School
of Medicine, says as many as a third of patients taking a fluoroquinolone will experience some sort of
psychiatric side effect, such as anxiety, personality change or confusion. "The psychiatric effects of the
fluoroquinolones are underappreciated by the medical profession as well as by the public," says
Dr. Flockhart, who has treated more than 100 patients with severe psychiatric side effects.

Severe neurological disorders are also associated with the fluoroquinolones which present as headache,
confusion, hallucination, anxiety, nervousness, and nightmares. Seizures have also been reported.
Convulsive seizures have mostly been reported in patients who are cotreated with nonsteroidal
anti-inflammatory drugs (NSAIDS) such as fenbufen. Concomitant use of NSAIDs may increase seizure
risk.

The CNS adrs are a combination of the interference with neurotransmissions, inhibiting of the clearance
of other drugs (such as caffeine), reduction of brain glucose uptake, electrolyte imbalances, neuronal
dysfunction or degeneration and inflammation, which if severe enough results in transient blood-brain
barrier breakdown.

Several reports focus on toxic psychosis following fluoroquinolone therapy, which is characterized by
disorientation, impairment of consciousness, dream-like euphoria, hallucinations and fragmented
thought processes. Similarly, there are reports on acute psychosis resembling acute schizophrenia
following fluoroquinolone therapy.  All of the fluoroquinolones are associated with this inducement of a
functional psychosis.  Patients with the latter condition differ from those with toxic psychotic in not
having altered sensorium and disorientation. Both the disorders are believed to be resolvable by
themselves in time: however there have been reports of this becoming a chronic and continuing
condition which may very well be irreversible.

A Case of Ciprofloxacin-Induced Acute Polymorphic Psychosis With a Distinct
Deficit in Executive Functions

Ciprofloxacin-Induced Manic Episode
Shree Bhalerao, P.G.D., M.D., FRCPC, Univ. of Toronto School of Medicine, Aaron Talsky, B.Sc., Keith Hansen, N.P., Edward Kingstone, M.D., Ben Schroeder, B.Sc., Zamil Karim, B.Sc., and Irene Fung, B.Sc., Toronto, ON Canada

A Case of Ciprofloxacin-Induced Acute Polymorphic Psychosis With a Distinct Deficit in Executive Functions
Oliver Grimm, M.D., Barbara Alm, M.D., and Zentralinstitut für Seelische, Gesundheit Psychiatrie, Mannheim, Germany
TO THE EDITOR: We present the case of a 45-year-old female patient who developed an acute polymorphic psychosis after treatment with the antibiotic 
          ciprofloxacin.

Exacerbation of Psychotic Symptoms Associated With Gatifloxacin 
Roy R. Reeves, D.O., Ph.D., Chief of Mental Health (11M) G.V. (Sonny) Montgomery VA Medical Center Jackson, Miss.
TO THE EDITOR: Described here are two patients who experienced exacerbation of psychotic symptoms associated with gatifloxacin treatment.


Gatifloxacin-Induced Hallucinations in a 19-Year-Old Man


Posted: 6/14/2005 8:02:30 PM  Today Eyewitness News talked to a man who says "Cipro" caused him to go crazy. Vince Mule´ says his doctors have even confirmed that it was "Cipro" that caused his irrational behavior. "

10.    Grimm O, Alm B, Fur Seelische Z.
A case of ciprofloxacin-induced acute polymorphic psychosis with a distinct deficit in executive functions.
Psychosomatics. 2007 May-Jun;48(3):269. No abstract available.
PMID: 17478598 [PubMed - indexed for MEDLINE]