Fluoroquinolone Antibiotics Use Linked to Panic Attacks, Unravels Study
Canada: A new study by Canadian researchers suggests a possible association between fluoroquinolone antibiotics and an increased risk of panic attacks. Fluoroquinolones are widely prescribed but have previously been linked to several adverse effects, including tendinitis, tendon rupture, peripheral neuropathy, and other central nervous system complications. Because of these safety concerns, the U.S. Food and Drug Administration has repeatedly updated boxed warnings for this drug class. Although earlier case reports have described panic attacks following fluoroquinolone use, large-scale evidence examining this relationship has been limited.
To investigate the issue further, researchers led by Keeirah Hiertika Raguram from the Department of Physiology and Pharmacology at Western University in Canada conducted a systematic review along with a pharmacovigilance analysis using the U.S. Food and Drug Administration Adverse Event Reporting System (FAERS). The findings were published in the Journal of Antimicrobial Chemotherapy.
Fluoroquinolones are commonly used to treat a variety of bacterial infections. However, increasing evidence suggests that these drugs may be associated with neuropsychiatric side effects, including anxiety, depression, and other central nervous system symptoms. In recent years, isolated reports of panic attacks following fluoroquinolone exposure have raised concerns about a possible link.
For the systematic review, the researchers searched the MEDLINE and Embase databases to identify studies examining fluoroquinolone use and panic attacks. They also conducted a disproportionality analysis using FAERS data from the first quarter of 2004 to the fourth quarter of 2024. The analysis focused on commonly prescribed fluoroquinolones—ciprofloxacin, levofloxacin, and moxifloxacin—and compared them with other antibiotics such as azithromycin and trimethoprim–sulfamethoxazole.
The following were the key findings:
- The systematic review identified 12 relevant studies, including four clinical trials and eight publications describing 11 case reports.
- Across the clinical trials, the prevalence of panic attacks ranged from 0.46% to 1.76%.
- Analysis of the FAERS database identified a notable safety signal linking fluoroquinolone use with reports of panic attacks.
- Compared with azithromycin, fluoroquinolones were associated with about a sixfold higher reporting of panic attacks.
- Compared with trimethoprim–sulfamethoxazole, fluoroquinolones showed approximately a twelvefold higher reporting frequency of panic attacks.
- The findings were consistent across multiple statistical methods, including Bayesian analyses used to detect drug safety signals.
The authors noted that pharmacovigilance databases such as FAERS have several limitations. These include underreporting, incomplete patient information, and potential confounding factors such as medical history or concurrent medications. In addition, reporting frequency may increase after regulatory warnings, a phenomenon known as notoriety bias, which can influence the number of reported cases.
Overall, the findings suggest a potential pharmacovigilance signal linking fluoroquinolone use—particularly ciprofloxacin—with reports of panic attacks. However, the researchers emphasize that these results do not establish a causal relationship. They call for further pharmacoepidemiological studies to better understand the potential association and clarify the neuropsychiatric safety profile of fluoroquinolone antibiotics.
Reference: Raguram, K. H., Sidhu, M., Omrani, M. A., Baskaran, B. S., Chalabianloo, N., Chhabra, M., Sampasa-Kanyinga, H., & Muanda, F. T. (2026). Fluoroquinolones and the risk of panic attacks: A systematic review and disproportionality analysis using individual case safety reports from the FDA Adverse Event Reporting System (FAERS) database. Journal of Antimicrobial Chemotherapy, 81(4). https://doi.org/10.1093/jac/dkag083
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