Medicinal products can be overlooked as triggers of acute suicidality
Acute suicidality can occur, for example, in connection with psychiatric disorders; in some cases, a differential diagnosis may show a drug-related cause that should be taken into consideration. Three examples of medicinal products that are associated with acute suicidality are antiepileptics, fluoroquinolones and psychostimulants.
Incident data |
Description |
|---|---|
Case (year): 2016 Age: Adult Sex: Female Medicinal product: Lyrica® Active substance: Pregabalin Indication: Pain ADRs: Suicidal ideation Outcome: Recovered |
Treatment with 25 mg pregabalin was started in a middle-aged female patient with whole body pain in the context of post-traumatic stress disorder. Twelve hours after first administration, the patient developed suicidal ideation which disappeared within 2 days of discontinuation. The same symptom recurred following re-exposure with pregabalin 3 weeks later and again subsided within 2 days of discontinuation. |
Case (year): 2014 Age: Adult Sex: Male Medicinal product: Tavanic® Active substance: Levofloxacin Indication: Sinusitis ADRs: Suicidal ideation Outcome: Recovering |
A middle-aged male patient started antibiotic treatment with levofloxacin 500 mg daily for sinusitis. Eight days later, he developed symptoms including suicidal ideation, hallucinations and nightmares at night. The patient had no history of psychological issues. At the time of the suspected ADR, he was not taking any other medicinal products. Levofloxacin was discontinued. The outcome of the ADR at the time of the report was “recovering”. |
Case (year): 2016 Age: Child Sex: Male Medicinal product: Ritalin® Active substance: Methylphenidate hydrochloride Indication: Unknown ADRs: Suicidal ideation Outcome: Unknown |
A boy aged approximately 10 years was receiving treatment with 10-20 mg methylphenidate hydrochloride daily (precise indication, treatment duration and concomitant medication unknown). Shortly after treatment started, he developed symptoms including suicidal ideation and self-harming behaviour; the treatment was therefore discontinued. The decision was taken not to resume treatment and another medication was prescribed. The exact outcome of the reaction is not known. |
The information for healthcare professionals for the medicinal products in the three example reports all list suicidality as a potential adverse drug reaction:
In cases of new occurrence of suicidality with a temporal relationship to a medicinal product for which suicidal behaviour is described as an adverse drug reaction, this should also be considered as a differential diagnosis.
Suspected cases should be reported in order to obtain better information on this side effect, for which it can be difficult to differentiate the role of the relevant medicinal product in individual cases.
Literature:
Swiss information for healthcare professionals (www.swissmedicinfo.ch)
Statutory duty of healthcare professionals to report adverse drug reactions (ADRs)
In Switzerland, healthcare professionals who are authorised to dispense or administer medicinal products are obligated to report severe and/or previously unknown side effects. Reports to Swissmedic can be entered and sent in the Electronic Vigilance Reporting Portal “ElViS” (ElViS login).
Reporting adverse drug reactions
