Insomnia levofloxacin

Fluoroquinolones are extremely well tolerated. The most common effects are nausea, vomiting, and diarrhea. Occasionally, headache, dizziness, insomnia, skin rash, or abnormal liver function tests develop. Photosensitivity has been reported with lomefloxacin and pefloxacin. QTC prolongation may occur with gatifloxacin, levofloxacin, gemifloxacin, and moxifloxacin, which should be avoided or used with caution in patients with known QTC interval prolongation or uncorrected... 

Many other commonly used antibiotics can cause psychiatric symptoms, for example, clarithromycin (trade name, Biaxin)—which is frequently used to treat respiratory illness, ear infections, and skin infections—has been reported to cause mania in some patients. Metronidazole (trade name Flagyl), which is used to treat many types of infections—from parasites to vaginal infections and abscesses—has been reported to cause depression, agitation, confusion, hallucinations, and mania. Trimethoprim-sulfamethoxazole (trade names Bactrim and Septra)—which is used, for example, for bladder infections and sinus and ear infections—has been reported to cause delirium, psychosis, depression, and hallucinations in rare cases. The fluoroquinolone antibiotics—such as ciprofloxacin (trade name Cipro), levofloxacin (trade name Levaquin), ofloxacin (trade name Floxin), trovafloxacin (trade name Trovan), and others of this class—can cause psychiatric symptoms fairly often, including confusion, agitation, depression, insomnia, mania, paranoia, and psychosis. 

The adverse effects rates of levofloxacin are 1.3% for nausea, 0.1% for anxiety, 0.3% for insomnia, and 0.1% for headache. No levofloxacin-related adverse events were reported at a rate higher than 1.3%, and most were less common. High-dose levofloxacin (750 mg) was also well tolerated. Surveillance data reported low adverse event rates nausea 0.8%, rash 0.5%, abdominal pain 0.4%, and diarrhea, dizziness, and vomiting 0.3%. The adverse drug reactions rate for levofloxacin is stiU one of the lowest of any fluoroquinolone, at 2% compared with 2-10% for other fluoroquinolones (6-9). 

Theophylline clearance was reduced by levofloxacin plus clarithromycin in a 59-year-old Japanese man, who had stimulation, insomnia, and tachycardia due to theophyl-hne toxicity (39). 

A 59-year-old Japanese man taking theophylline for emphysema had stimulation, insomnia, and tachycardia owing to theophylline toxicity after he also took levofloxacin and clarithromycin (76). His theophylline clearance returned to normal and his symptoms resolved after withdrawal of levofloxacin, while clarithromycin was continued. 

Three cases of insomnia and anxiety were reported in young adults (age 30-32) in direct association with levofloxacin use (500-750 mg orally (PO) daily) [38 ] Disturbingly, levofloxacin was implicated in an episode of acute psychosis in a 38-year-old man with known schizoaffective disorder [39 ]. 

Kandasamy A, Srinath D. Levofloxacin-induced acute anxiety and insomnia. J Neurosd Rural Pract 2012 3(2) 212-4. 

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