From the Research
Vancomycin can rarely cause psychosis as a side effect, and healthcare providers should be aware of this potential adverse effect, particularly in patients with renal impairment or those receiving high doses. While not among its common adverse reactions, there have been documented cases of neuropsychiatric effects including confusion, hallucinations, and psychotic symptoms associated with vancomycin therapy 1. These neurological effects may be related to vancomycin's ability to cross the blood-brain barrier in certain circumstances, especially when kidney function is compromised, leading to higher serum concentrations. Patients with pre-existing neurological conditions, the elderly, or those with multiple medical comorbidities may be at higher risk.
Some key points to consider:
- The prevalence of psychosis as an adverse effect of antibiotics, including vancomycin, has been investigated in several studies, with varying results 1, 2.
- A systematic review of cases of antibiotic-associated acute psychosis during treatment of urinary tract infections found that a majority of reported cases were "highly suggestive" of a potential causal relationship between antibiotic treatment and psychosis 2.
- The use of vancomycin has been associated with several adverse effects, including nephrotoxicity, ototoxicity, and hypersensitivity reactions, but psychosis is not a commonly reported side effect 3.
- However, a study published in 2020 found that 15 antibiotics, including vancomycin, were associated with a significantly increased odds of psychosis, with a range of 0.3 to 3.8% 1.
If a patient develops new-onset confusion, hallucinations, or other psychiatric symptoms while on vancomycin, healthcare providers should consider the medication as a potential cause, monitor vancomycin levels, assess renal function, and potentially adjust the dose or switch to an alternative antibiotic if appropriate 1. Symptoms typically resolve after discontinuation of the medication or dose adjustment.