There are no official guidelines to assist in answering this question. I will search for relevant research papers instead.
From the FDA Drug Label
- 6 Central Nervous System Effects Convulsions, toxic psychoses, increased intracranial pressure (including pseudotumor cerebri) have been reported in patients receiving fluoroquinolones, including levofloxacin Fluoroquinolones may also cause central nervous system stimulation which may lead to tremors, restlessness, anxiety, lightheadedness, confusion, hallucinations, paranoia, depression, nightmares, insomnia, and, rarely, suicidal thoughts or acts.
The relationship between Levofloxacin and psychiatry is that it may cause central nervous system effects, including:
- Anxiety
- Depression
- Hallucinations
- Paranoia
- Suicidal thoughts or acts
- Toxic psychoses Levofloxacin should be used with caution in patients with a known or suspected central nervous system (CNS) disorder that may predispose them to seizures or lower the seizure threshold 1.
From the Research
Relationship Between Levofloxacin and Psychiatry
The relationship between levofloxacin and psychiatry is complex, with several studies indicating that levofloxacin can cause psychiatric adverse effects, including delirium, psychosis, anxiety, and insomnia 2, 3, 4, 5, 6.
Psychiatric Adverse Effects
- Delirium: Levofloxacin has been reported to cause delirium with psychotic features in rare cases, which can be reversible upon withdrawal of the medication 2, 5.
- Psychosis: There have been cases of levofloxacin-induced psychosis, including in patients without underlying psychological history 3, 4.
- Anxiety and insomnia: Levofloxacin can also cause acute anxiety and insomnia, which can resolve upon discontinuation of the medication 6.
Risk Factors
- Renal insufficiency: Patients with renal insufficiency may be at higher risk of developing neurotoxicity, including psychiatric adverse effects 2.
- Underlying CNS disease: Patients with underlying central nervous system (CNS) disease may be more susceptible to levofloxacin-induced psychiatric adverse effects 2, 5.
- Increased CNS penetration of drug: The risk of psychiatric adverse effects may be higher in patients with increased CNS penetration of levofloxacin 2.
Clinical Relevance
- Quinolone-induced psychosis is a clinically relevant issue due to the high prescription of these antibiotics and the severity of this clinical syndrome 4.
- Physicians should be aware of the potential for levofloxacin to cause psychiatric adverse effects, particularly in patients with underlying CNS disease or renal insufficiency 2, 5.