Family

Examples

Reactions

Notes

Amphetamine-Like Drugs
Herbal dietary supplements containing ephedra should also be considered as  amphetamine-like drugs.

This family includes the diet drugs such as sibutramine (MERIDIA) and phentermine (IONAMIN)

bizarre behavior, hallucinations, paranoia, agitation, anxiety, mania, nightmares

Usually with overdose or abuse; can occur with asthma inhaler abuse; depression on withdrawal

Anabolic steroids
(body-building steroids)

oxymetholone (ANADROL); oxandrin (OXANDRIN); stanozolol (WINSTROL). There are many illegal sources of anabolic steroids.  Anabolic steroids may also be contained in dietary or herbal supplements.

psychosis, mania, depression, anxiety, aggressiveness, paranoia

most reports are with abuse

Angiotensin-Converting Enzyme (ACE) Inhibitors

captopril (CAPOTEN); enalapril (VASOTEC); lisinopril (PRINIVIL, ZESTRIL)

mania, anxiety, hallucinations, depression, psychosis

many reports

Anticholinergics and Atropine

many drugs have anticholinergic properties including some antidepressants, antihistamines, antipsychotics, drugs for intestinal problems, and antiparkinsonian drugs

confusion, memory loss, disorientation, depersonalization, delirium, auditory and visual hallucinations, fear, paranoia, agitation, bizarre behavior

more frequent in the elderly and children with high doses; can occur with transdermal scopolamine (TRANSDERM SCOP); atropine eye drops, particularly when mistaken for nose drops can cause sudden incoherent speech, delirium with high fever, flushed dry skin, hallucinations, or amnesia

Antidepressants, Tricyclic

amitriptyline (ELAVIL); doxepin (SINEQUAN); imipramine (TOFRANIL)

mania or hypomania, delirium, hallucinations, paranoia, irritability, dysphoria

patients with bipolar disorder are at highest risk for mania; anticholinergic effects may cause delirium in elderly

Antiepileptics (drugs for seizure disorders)

phenytoin (DILANTIN)

agitation, confusion, delirium, depression, psychosis, aggression, mania, toxic encephalopathy (disease of the brain), nightmares

usually with high doses or high blood concentrations

Barbiturates

phenobarbital (SOLFOTON); aprobarbital (ALURATE); butabarbital (BUTISOL)

excitement, hyperactivity, visual hallucinations, depression, delirium-tremens - like syndrome (seen in alcohol withdrawal)

especially in children and the elderly, or on withdrawal

Benzodiazepines

diazepam (VALIUM); flurazepam (DALMANE); alprazolam (XANAX)

rage, hostility, paranoia, hallucinations, delirium, depression, nightmares, anterograde amnesia, mania, disinhibition

during treatment or on withdrawal; may be more common in the elderly

Beta - Blockers

atenolol (TENORMIN); metoprolol (LOPRESSOR, TOPROL); propranolol (INDERAL); levobunolol (BETAGAN); betaxolol (BETOPTIC); timolol (TIMOPTIC)

depression, psychosis, delirium, anxiety, nightmares, hallucinations

with oral or eye drop preparations, incidence of depression may be overestimated

Calcium Channel Blockers

amlodipine (NORVASC); diltiazem (CARDIZEM, DILACOR, TIAZAC); verapamil (CALAN, ISOPTIN, VERELAN)

depression, delirium, confusion, psychosis, mania

several reports

Cephalosporin Antibiotics

cefaclor (CECLOR); cefuroxime (CEFTIN); cephalexin (KEFLEX)

euphoria, delusions, depersonalization, illusions

kidney disease is a risk factor

Dopamine Agonists for Parkinson's Disease

bromocriptine (PARLODEL); pergolide (PERMAX); pramipexole (MIRAPEX)

hallucinations, paranoia, delusions, confusion, mania, hypersexuality, anxiety, depression, nightmares

during treatment or on withdrawal

Estrogens

conjugated estrongens (PREMARIN); estradiol (CLIMARA, ESTRACE)

panic attacks, depression

several reports

Fluoroquinolone Antibiotics

ciprofloxacin (CIPRO); levofloxacin (LEVAQUIN); sparfloxacin (ZAGAM)

psychosis, confusion, agitation, depression, hallucinations, paranoia, Tourette-like syndrome (a form of tic), mania

many reports

Histamine H-1 Blockers

chlorpheniramine (CHLOR-TRIMETON); diphenhydramine (BENADRYL); loratadine (CLARITIN); fexofenadine (ALLEGRA)

hallucinations

especially with over dosage of the older antihistamine drugs such as diphenhydramine

Histamine H-2 Blockers

cimetidine (TAGAMET); famotidine (PEPCID); nizatidine (AXID); ranitidine (ZANTAC)

delirium, confusion, psychosis, mania, aggression, depression, nightmares

especially in the elderly and seriously ill

Monoamine Oxidase (MAO) Inhibitor Antidepressants

isocarboxazid (MARPLAN); phenelzine (NARDIL); tranylcypromine (PARNATE)

mania or hypomania

Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)

ibuprofen (MOTRIN); naproxen (NAPROSYN); meloxicam (MOBIC); rofecoxib (VIOXX)

depression, paranoia, psychosis, confusion, anxiety

probably more common with indomethacin (INDOCIN); one case of auditory hallucinations with celecoxib (CELEBREX)

Opioids

narcotic pain relievers such as morphine, codeine, and oxycodone (OXYCONTIN)

nightmares, anxiety, agitation, euphoria, dysphoria, depression, paranoia, psychosis, hallucinations, dementia

usually with high doses; also occurs with intrathecal (administration into the spine) morphine; especially in the elderly

Procaine Derivatives (procainamide, procaine penicillin G)

procainamide (PROCANBID); procaine penicillin G is an injectable form of penicillin given by a doctor

fear of imminent death, hallucinations, illusions, delusions, agitation, mania, depersonalization, psychosis

probably due to procaine

Salicylates

aspirin

agitation, confusion, hallucinations, paranoia,

with chronic intoxication

Selective Serotonin Reuptake Inhibitors (SSRIs)

escitalopram (LEXAPRO); citalopram (CELEXA); fluoxetine (PROZAC); paroxetine (PAXIL); sertraline (ZOLOFT)

mania, hypomania, hallucinations

anxiety, irritability, aggression or impulsivity on withdrawal

Statins

atorvastatin (LOPID); fluvastatin (LESCOL); pravastatin (PRAVACHOL); simvastatin (ZOCOR)

anxiety, depression, obsessions, delusions

several reports

Steroids, Inhaled

triamcinolone (AZMACORT); beclomethasone (VANCERIL)

hyperactivity, aggression, disinhibition

several reports

Steroids, Oral

prednisone (DELTASONE, METICORTEN); prednisolone (METRETON)

psychosis, delirium, mania, depression

1% to 3% incidence, may be dose-related; can occur on withdrawal

Sulfonamides

sulfamethoxazole and trimethoprim (BACTRIM, SEPTRA, COTRIM)

confusion, disorientation, depression, euphoria, hallucinations

several reports

Thiazide Diuretics

hydrochlorothiazide (HYDRODIURIL); chlorthalidone (HYGROTON)

depression, suicidal ideation

after weeks to months of use