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Fluoroquinolone Induced Neurotoxicity: A Review

Ashwin Kamath


With increasing use of fluoroquinolones, there have been numerous reports of central nervous system adverse effects differing with individual fluoroquinolones. Structure toxicity relationship shows that the C-7 substituent on the quinolone nucleus plays an important role in the central nervous system effects of these compounds by inhibiting the interaction of gamma amino butyric acid with the receptors. Study done in healthy human volunteers has demonstrated the reversal of increased central nervous system activity induced by ofloxacin with midazolam. Risk factors for the neurotoxicity include elderly age, presence of central nervous system disorder, impaired renal function and drug-drug interactions. While the central effects are more common with ciprofloxacin and ofloxacin, these have also been reported with levofloxacin which has a better structure toxicity profile. Knowledge of these reversible and potentially avoidable adverse effects of fluoroquinolones can prevent misdiagnosis, unnecessary investigation and improper medication. A robust pharmacovigilance mechanism is essential for determining and monitoring the CNS adverse effects of existing and newer fluoroquinolones.

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