Psychotoxic Effects of Ofloxacin

Zaudig, Michael; Bose, Mohua; Weber, Marc-Andre; Bremer, Dirk; Zieglgänsberger, W.

doi:10.1055/s-2007-1014570

Cited by 29 publications

(8 citation statements)

References 4 publications

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“…Ofloxacin has been reported to induce acute organic psychosis (Zaudig et al 1989). One patient developed hypomania 12 hours after initiation of therapy, with an overly cheerful mood, increased social and physical activity and restlessness.…”

Section: Organic Psychosismentioning

confidence: 99%

“…The mechanism for these adverse CNS effects may be a result of blockade of synaptic inhibition mediated by 'Y-aminobutyric acid (GABA) [Zaudig et al 1989]. The inhibition of GABA binding in isolated rat neurons has been reported to occur with ciprofloxacin, norfloxacin, enoxacin, pipemidic acid and ofloxacin (Hori et al 1985(Hori et al , 1986.…”

Section: Mechanism Of Adverse Cns Effectsmentioning

confidence: 99%

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Clinical Features and Management of Adverse Effects of Quinolone Antibacterials

Paton

Reeves

1991

Drug Safety

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The quinolone antibacterials are proving very useful in the management of infection, notably for the treatment of Gram-negative bacteria. With the increasing use of these drugs, adverse effects are being recognised more often and careful documentation is still required. In general, the quinolones are of low toxicity. Gastrointestinal adverse effects are the most common, and are usually mild; indeed, all adverse events are generally mild and resolve on withdrawal of the offending drug. Certain precautions and contraindications are apparent. Because drug-induced arthropathies occur in juvenile animals, quinolones should not be administered to pregnant or lactating women or to growing children, unless the clinical benefit outweighs the risk. Caution should also be observed in patients with previous epilepsy or severe cerebral arteriosclerosis. Neurological effects may require the use of appropriate neuro- and psychoactive drugs, as well as the withdrawal of the precipitating agent. Hypersensitivity reactions to a fluoroquinolone may require the use of antihistamines, and in some cases topical or systemic steroids, and may well preclude future use of a fluoroquinolone. Dose adjustments may be necessary in patients with reduced renal function, when the measurement of serum concentrations may be desirable. Interstitial nephritis, haematuria and acute renal failure are rare effects of quinolone therapy which will require appropriate management including withdrawal of the precipitating drug. Interactions with theophylline and warfarin are of clinical significance, and may require plasma concentration monitoring and adjustment of dosage.

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Section: Organic Psychosismentioning

confidence: 99%

Section: Mechanism Of Adverse Cns Effectsmentioning

confidence: 99%

Clinical Features and Management of Adverse Effects of Quinolone Antibacterials

Paton

Reeves

1991

Drug Safety

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“…In a recent case report of ofloxacin-induced psychosis it was described that the observed panic attacks could be successfully treated with BZD (Zaudig etal., 1989). On the other hand, in two cases of fluoroquinolone-provoked delirium (Altds et al, 1989;Zaudig et al, 1989), hallucinations and delusions could not be improved by treatment with clomethiazole, a potent CNSdepressant agent with GABA enhancing pharmacological properties, indicating a different mechanism of action of clomethiazole (Zaudig et al, 1989 Although fluoroquinolones penetrate well into the CSF (for overview see Kitzes-Cohen, 1987) with a CSF/plasma ratio for ofloxacin between 47-87% (Stubner et a!., 1986), serum levels obtained after treatment with these compounds (400 mg ofloxacin infusion: 19.4-27.7 FM, own unpublished observation) may not be sufficient to yield inhibitory CSF levels in healthy volunteers. Nevertheless it should be noted that penetration of drugs into the CSF can be increased in an abnormal state of the blood-brain barrier (Gibaldi, 1985).…”

Section: Discussionmentioning

confidence: 99%

Possible interaction of fluoroquinolones with the benzodiazepine‐GABAA‐ receptor complex.

Unseld

Ziegler

Gemeinhardt

et al. 1990

Brit J Clinical Pharma

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“…4 © MIVIV Medizin Verlag GmbH MiJnchen, Mtinchen 1995 system symptoms observed (3.3/1.3%) may be due to the inhibition of GABA binding [15]. Local injection site inflammation was observed in four patients treated with intravenous ofloxacin and erythema multiforme (one patient), pruritus (two patients) and urticaria (one patient) were reported in the ciprofloxacin group.…”

Section: /232mentioning

confidence: 98%

A randomised, multinational study with sequential therapy comparing ciprofloxacin twice daily and ofloxacin once daily

et al. 1995

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In a multinational, open, randomised, controlled clinical study, 474 hospitalised patients with moderate or severe infections were treated with sequential regimens of ofloxacin or ciprofloxacin. Ofloxacin 400 mg once daily or ciprofloxacin 200 mg twice daily were given intravenously for at least 3 days followed by oral treatment with ofloxacin 400 mg once daily or ciprofloxacin 500 mg twice daily. Overall cure rates of 86.8% (85.7%) in the ofloxacin group and 89.6 (89.5%) in the ciprofloxacin group were achieved in the intention-to-treat analysis (per protocol analysis). The overall bacteriological response rate (ofloxacin 89.5%, ciprofloxacin 89.0%) was comparable to the clinical cure rate. Both drugs were well tolerated and adverse events were rarely observed. It is concluded that ofloxacin and ciprofloxacin can be used successfully in the treatment of hospitalised patients with aerobic gram-positive and gram-negative infections. Ofloxacin has the advantage of a once-daily regimen, compared to the twice-daily regimen with ciprofloxacin.

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Psychotoxic Effects of Ofloxacin

Cited by 29 publications

References 4 publications

Clinical Features and Management of Adverse Effects of Quinolone Antibacterials

Clinical Features and Management of Adverse Effects of Quinolone Antibacterials

Possible interaction of fluoroquinolones with the benzodiazepine‐GABAA‐ receptor complex.

A randomised, multinational study with sequential therapy comparing ciprofloxacin twice daily and ofloxacin once daily

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