Psychotic symptoms induced by clarithromycin and chlorpheniramine.

Psychotic-like experiences and psychotic symptoms that are characteristic of psychotic disorders also emerge as a consequence of drug and substance misuse or medical illness (Binbay et al. 2012). Reporting psychotic symptoms due to drug and substance misuse is particularly important, as their mechanism of action may contribute to our understanding of the etiopathology of psychosis. Macrolide antibiotics are commonly prescribed in Turkey, ranking third among all antibiotic prescriptions (Tuna 2004). Clarithromycin—a macrolide antibiotic—is commonly used for upper and lower respiratory tract infections, as well as for helicobacter pylori eradication (Peter and Clissold 1992). Although the primary adverse effects of clarithromycin are related to the gastrointestinal system, several serious mental health outcomes, including mania, delirium, and psychosis, have been reported (Bandettini di Poggio et al. 2011; Abouesh et al. 2002; Sturgill and Rapp 1992). In addition, common cold medications containing chlorpheniramine that are used widely as over-the-counter preparations may have side effects, including psychotic symptoms (Hellbom 2006). This letter presents a patient that experienced psychotic symptoms after oral intake of clarithromycin and chlorpheniramine, and a discussion of the possible underlying molecular mechanisms of psychotic symptoms.