Moxifloxacin-Induced Visual Hallucinations, Alterations in Mood and Behavior, and Hyperglycemia

Abstract

Visual hallucinations are sensory perceptions that occur without external stimuli. Moxifloxacin-induced visual hallucinations are very rarely reported (<0.1%). We describe a 66-year-old woman, without any known neuropsychiatric disorder or illicit drug abuse, who experienced complex visual hallucinations, mood, and behavioral alterations secondary to peroral 1 dose of moxifloxacin treatment that persisted for approximately 36 hours. In addition, a sudden increase in her blood glucose level was noted which also improved a few days after discontinuation of moxifloxacin treatment. Although very rare, it should be kept in mind that moxifloxacin may coincidentally induce neuropsychiatric adverse effects and hyperglycemia. Clinicians should be alert to recognize such uncommon offending adverse drug reactions.

Effect of ciprofloxacin vs levofloxacin on QTc‐interval and dysglycemia in diabetic and non‐diabetic patients

“…In addition, the results of the present study revealed that 34% and 44% of non‐diabetic patients had hyperglycemia events, 72 hours after the first dose in ciprofloxacin and levofloxacin, respectively. This is in accordance with another study reporting that the highest hyperglycemia event was found with levofloxacin (70%), followed by ciprofloxacin and moxifloxacin (39% and 33.3% respectively) 54 . The results of the current study were identical to the results of the Kabbara and Ramadan study, which reported that ciprofloxacin was safer than levofloxacin regarding their risk of hyperglycemia 6 .…”

“…This is in accordance with another study reporting that the highest hyperglycemia event was found with levofloxacin (70%), followed by ciprofloxacin and moxifloxacin (39% and 33.3% respectively). 54 The results of the current study were identical to the results of the Kabbara and Ramadan study, which reported that ciprofloxacin was safer than levofloxacin regarding their risk of hyperglycemia. 6 The mechanism of fluoroquinolones induced hyperglycemia may be associated with an elevated level of epinephrine.…”

Depressive and Other Adverse CNS Effects of Fluoroquinolones

“…Metronidazole (12/30) and vancomycin (7/30) were the most frequent concomitant antibiotics used. Other medications simultaneously administered were paracetamol (6/71) [ 17 , 19 , 27 , 29 , 73 , 75 ] and non-steroidal anti-inflammatory drugs (NSAIDs) (4/71) [ 14 , 40 , 62 , 73 ]. In 11 cases, patients were treated with psychoactive drugs, including opioids [ 20 , 25 , 27 , 51 , 64 , 81 ], antipsychotics [ 31 , 81 ], benzodiazepines [ 25 , 27 , 64 ], 5-hydroxytryptamine antagonists [ 25 , 68 , 69 ], antiepileptic drugs [ 31 , 69 ], dopamine agonists [ 66 ], and antidepressants [ 31 , 72 ].…”