October 22, 2001
Epilepsy Foundation Warns that Cipro Can Cause Seizures in
- Medical advisors to the Epilepsy Foundation warned today that
fluoroquinolone antibiotics such as Cipro (ciprofloxacin), which are the
first line of defense for anthrax, can in certain circumstances induce
seizures in people with epilepsy and other individuals who might be at risk
for seizures due to family history or previous central nervous system
insults such as head trauma, stroke, tumor, or infection.
According to Gregory L. Barkley, MD, chair-elect of the Foundation's
professional advisory board, seizures may be produced by more than one
mechanism. Cipro interferes with neuronal inhibitory activity by blockade of
binding of GABA, a major inhibitory neurotransmitter, with the GABA-A
receptor. It also has been noted to potentiate the proconvulsant effects of
the methylxanthine compounds. Two common drugs in this class are caffeine
and the asthma medication theophylline.
"High levels of caffeine, as well as GABA-A receptor blockade, particularly
when combined with stress of infection and fever, can cause seizures," Dr.
Barkley said. "There is some evidence that non-steroidal pain relievers such
as aspirin can also increase the risk of seizures when taken with Cipro."
Patricia Osborne-Shafer, RN, MN, who chairs the advisory board, said the
Epilepsy Foundation advises the public not to panic and take antibiotics
such as ciprofloxacin unnecessarily. In the remote chance that a person
needs an antibiotic, physicians can consider alternatives for patients with
epilepsy. "If it is necessary to use ciprofloxacin," she adds, "patients
should be closely monitored for seizures.
"Reports that people are getting this drug from several sources without a
prescription worries me," Shafer said. "Ciprofloxacin, like all antibiotics,
should never be used without the specific recommendation of a physician.
Aside from its potential for seizures in susceptible individuals, it has
other adverse effects that people need to be aware of. And, of course,
indiscriminate use of ciprofloxacin by the public can lead to bacterial
resistance when the drug is really needed."