Britons taking commonly prescribed antibiotics should be reminded of the risk of suicidal thoughts, health chiefs have said.
The move comes after the death of a recently retired doctor, who committed suicide just a week after starting to take ciprofloxacin.
Respected cardiologist Robert Stevenson, 63, had no history of depression or mental health problems.
Ciprofloxacin is one of the five Antibiotic officials have raised the alarm, sparked by the coroner’s report into Mr Stevenson’s death.
They all belong to the fluoroquinolone family.
Five types of fluoroquinolone antibiotics could increase the risk of patients experiencing thoughts of self-harm and suicide after taking the drug, the UK’s medicines watchdog has said. She is concerned that doctors do not tell patients about the side effect when prescribing it, even though the warning is listed in patient information leaflets.
Warnings about possible “psychiatric reactions” are already on leaflets inside medication boxes.
The Medicines and Healthcare products Regulatory Agency (MHRA) said healthcare professionals “are reminded to advise patients to be alert to these risks”.
Patients should also be advised to read patient information leaflets and asked to seek medical advice if they experience similar symptoms, according to the agency.
Use should be discontinued at the “first signs” of a serious adverse reaction.
The MHRA said: “When prescribing a fluoroquinolone, advise patients to be alert to any mood changes, distressing thoughts or feelings of suicide or self-harm at any time during treatment.”
In advice given by the watchdog to doctors, it also said they should inform Britons who handed out the drugs to alert their loved ones about their prescription.
Does the antibiotic ciprofloxacin cause depression?
Ciprofloxacin is a powerful antibiotic designed to fight serious infections.
They belong to a class of medications called fluoroquinolone antibiotics, other examples being levofloxacin, moxifloxacin, and ofloxacin.
Like any medication, it can cause side effects that vary in severity and frequency.
One of the most serious is an alteration in mood and mental state that can include severe fatigue, depression, anxiety or memory problems.
The information provided about ciprofloxacin warns of this “very rare” risk and that it can even lead to suicidal thoughts.
The NHS estimates that these side effects occur in less than one in 100 people who take them.
Patients experiencing such side effects are urged to contact their doctor or call 111 immediately so that their doctor can prescribe an alternative antibiotic.
Patients themselves “may not notice” changes in mood and behavior “so it is very important that you inform your friends and family that you are taking these medications.”
“Others can notice changes and help you quickly identify any symptoms you need to talk to your doctor about,” the MHRA said.
Patients with depression and psychosis may see their symptoms worsen with treatment, the agency added.
In addition to ciprofloxacin, the other antibiotics mentioned are delafloxacin, levofloxacin, moxifloxacin and ofloxacin. They are designed to combat serious bacterial infections.
GPs and other professionals dispensed almost 500,000 fluoroquinolone prescriptions in England alone in 2022, according to the latest NHS data.
Mr Stevenson had not been told about a “potentially rare link” with suicidal behavior in patients taking the drug as this was not in line with medical guidance, a hearing heard earlier this year. .
The Preventing Future Deaths Report, which was published in June and sent to the MHRA, said the consultant cardiologist and general practitioner at Huddersfield Royal Infirmary, West Yorks, had retired in May 2022.
At that time he had been referred to a urology service for investigation of possible prostate cancer, with a private consultant urologist.
To help with the inflammation of his prostate and prepare him for a research biopsy, he was prescribed ciprofloxacin.
But just over a week later, Dr. Stevenson left his house for his “usual walk.” According to the report, “she had previously given no indication to his family to worry about him.”
That afternoon, however, his wife received a message from him on Facebook saying that he had left a note under his bed pillow.
Dr. Stevenson was later found dead in nearby woods.
In the report, coroner Martin Fleming said that while it was not clear whether he suffered from this side effect, it was still possible.
“I have heard evidence to suggest that the prescribing doctor did not make reference to this side effect at the time of issuing the prescription to Mr Stevenson as he did not agree with current advice,” Mr Fleming wrote.
“I have also heard evidence suggesting that prescribing doctors may not be fully aware of this rare side effect, and that patients suffering from depression may be more vulnerable to it.”
All Britons are urged to report any medication side effects they notice to the MHRA Yellow Card Scheme.
The watchdog stated that it was not possible, from the available data, to indicate the risk period or the frequency with which these possible adverse reactions occur.
It is believed that because fluoroquinolones act on the mitochondria (power centers in cells responsible for releasing energy), the effects can be felt throughout the body.
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