Brits taking commonly-prescribed antibiotics should be reminded about the risk of getting suicidal thoughts, health chiefs have said.
The move follows the death of a newly-retired doctor, who killed himself just a week after starting on ciprofloxacin.
Respected cardiologist Robert Stevenson, 63, had no history of either depression or mental health problems beforehand.
Ciprofloxacin is one of five antibiotics officials have raised the alarm over, sparked by a coroner’s report into Mr Stevenson’s death.
All fall within the fluoroquinolone family.
Five types of fluoroquinolone antibiotics could raise the risk of patients experiencing thoughts about self-harm and suicide after taking the drug, the UK’s medicines watchdog said. It is worried medics are failing to inform patients of the side effect when they prescribe it, despite the warning being listed in patient information leaflets
Warnings of potential ‘psychiatric reactions’ are found in leaflets inside drug boxes already.
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 the patient information leaflets and asked to seek medical advice if they suffer similar symptoms, according to the body.
Usage should be stopped 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 about suicide or harming themselves at any point during treatment.’
In advice given by the watchdog to medics, it also said they should tell Brits handed the drugs to alert their loved ones about their prescription.
Does the antibiotic ciprofloxacin cause depression?
Ciprofloxacin is a powerful antibiotic designed to fight off serious infections.
They belong to class of drugs called fluoroquinolone antibiotics, with other examples being levofloxacin, moxifloxacin and ofloxacin.
Like any medication it can cause side effects which vary in severity and frequency.
One of the most serious is an alteration of mood and mental state which can include severe tiredness, depression, anxiety, or memory problems.
Information provided with ciprofloxacin warns of this ‘very rare’ risk and that it can even lead to thoughts of suicide.
The NHS estimates these side effects occur in less than one in 100 people who take them.
Patients who experience such side effects are urged to contact their doctor or call 111 immediately so their doctor can potentially prescribe an alternative antibiotic.
Patients themselves ‘may not notice’ changes in mood and behaviour ‘so it is very important to tell your friends and family you are taking these medicines’.
‘Others may notice changes and help you quickly identify any symptoms that you need to talk to your doctor about,’ the MHRA said.
Depression and psychosis patients may see their symptoms become worse under treatment, the agency added.
As well as ciprofloxacin, the other antibiotics named are delafloxacin, levofloxacin, moxifloxacin, ofloxacin. They are designed to fight off serious bacterial infections.
Almost 500,000 fluoroquinolone prescriptions were dispensed by GPs and other practitioners in England alone in 2022, according to latest NHS data.
Mr Stevenson hadn’t been told about a ‘potential rare link’ to suicidal behaviour in patients who took the drug as this wasn’t in line with medical guidance, a hearing heard earlier this year.
The Prevention of Future Deaths Report, which was published in June and sent to the MHRA, said the consultant cardiologist and general physician at Huddersfield Royal Infirmary, West Yorks, had retired in May 2022.
At that time, he had been referred to a urology department for the investigation of possible prostate cancer, with a private consultant urologist.
To help with the inflammation of his prostate gland and to get him ready for an investigative biopsy, he was prescribed ciprofloxacin.
But just over a week later, Dr Stevenson left his home for his ‘usual walk’. According to the report, ‘he had not previously given any indications to his family for them to be concerned for him’.
That afternoon, however, his wife received a Facebook message from him saying he had left a note under the pillow of his bed.
Dr Stevenson was later found dead in a nearby wood.
In the report, coroner Martin Fleming said while it was unclear if he was suffering from this side effect, it remained possible.
‘I heard evidence to suggest that the prescribing doctor did not reference this side effect at the time of issuing the prescription to Mr Stevenson, since it was not in accord with current advice,’ Mr Fleming wrote.
‘I also heard evidence to suggest that prescribing doctors may not be fully aware of this rare side effect, and that patient’s suffering from depression may be more vulnerable to it.’
All Brits are urged to report any medicines side effects they notice to the MHRA’s Yellow Card Scheme.
The watchdog claimed it was not possible, from the available data, to indicate the period of risk or how frequently these potential adverse reactions occur.
It’s thought that because fluoroquinolones act on the mitochondria – powerhouses in cells responsible for releasing energy – effects can be felt all over the body.
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