Patients prescribed ciprofloxacin should be informed about suicidal behavior as a rare side effect, warns the United Kingdom’s coroner.
The warning comes after Robert Stevenson, a 63 years old retired consultant cardiologist and general physician, took his own life while taking the antibiotic.
Last May, he was referred to the urology department to investigate possible prostate cancer. To relieve his symptoms of prostatitis and prepare him for an investigative biopsy, he was prescribed ciprofloxacin on May 19.
According to the Prevention of future deaths report describing his case, Stevenson had no previous history of depression or mental health problems. However, before committing suicide on May 30, he left an "uncharacteristically confused and illogical" note to his family.
Martin Fleming, coroner of West Yorkshire, says he is concerned that the potential risk of suicide as a side effect of ciprofloxacin has not been given sufficient emphasis.
"I would ask you to consider the appropriateness of reviewing the current guidelines as to the dispensation of the drug to patients by clinicians and increasing the awareness of the side effect in order to monitor and mitigate the risks," Fleming writes in the report.
The FDA's boxed warning on fluoroquinolones in 2016 suggested an increased risk of suicidal thoughts associated with the use of fluoroquinolones, a class of drugs that includes ciprofloxacin. The medications are also associated with "disabling and potentially permanent" side effects on the tendons, muscles, joints, and nerves.
A 2022 study that included over 2.7 million adults did not associate initiation of fluoroquinolones with a substantially increased risk of admission to hospital or emergency department visits for suicidality compared with other common antibiotics, azithromycin, and trimethoprim-sulfamethoxazole.
However, the researchers said they couldn’t exclude a small increase in risk or an effect on suicidal thoughts that do not lead to hospital admission or emergency department visit.
Ciprofloxacin a common antibiotic is used to treat a number of bacterial infections, such as:
- Urinary tract infections
- Chest infections (including pneumonia)
- Skin and bone infections
- Sexually transmitted infections
- Eye infections
- Ear infections
- Infections that other antibiotics have been unable to treat
Although it remains unclear whether Stevenson’s suicide was caused by ciprofloxacin, suicidal behavior should be considered a rare side effect of the drug.
- Courts and Tribunals Judiciary. Robert Stevenson: Prevention of future deaths report.
- FDA. FDA updates warnings for oral and injectable fluoroquinolone antibiotics due to disabling side effects.
- The British Medical Journal. Association between initiation of fluoroquinolones and hospital admission or emergency department visit for suicidality: population based cohort study.
- National Health Service. About ciprofloxacin.