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Researchers believe there may be a potential link between fluoroquinolone antibiotics and increased risk of panic attacks, according to a systematic review and meta-analysis published in the Journal of Antimicrobial Chemotherapy. Using the Food and Drug Administration’s Adverse Event Reporting System database, researchers examined 4 clinical trials and found panic attack prevalence was low (0.5%–1.8%) but was reported with wide confidence intervals. Case reports generally suggested a probable causal link, according to the authors. Further analyses demonstrated 6- to 12-fold higher reporting of panic attacks for fluoroquinolones compared to non-fluoroquinolone antibiotics (azithromycin and trimethoprim/sulfamethoxazole). The authors say fluoroquinolones—particularly ciprofloxacin—may be associated with panic attacks, although controlled studies are needed to confirm the risk.
Authors found total panic attacks reported for each drug:
- All fluoroquinolones—1.2% (1,022/82,632)
- Ciprofloxacin—1.8% (609/33,661)
- Levofloxacin—0.9% (305/32,873)
- Moxifloxacin—0.7% (108/16,098)
- Azithromycin—0.2% (40/21,431)
- Trimethoprim/sulfamethoxazole—0.1% (10/10,067)
Post-marketing surveillance: Fluoroquinolones have been on the market since the 1980s, and as of 2019, there were about 21 million outpatient prescriptions written annually in the United States. FDA added black box warnings over the years, which include tendinitis and tendon rupture, peripheral neuropathy and neuropsychiatric adverse events, and exacerbation of myasthenia gravis. Aortic aneurysm and aortic dissection have also been associated with the use of fluoroquinolones.