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Violent behaviour towards others: sometimes caused by medication

Certain drugs expose patients to violent behaviour, sometimes with tragic consequences.

Aggressive and violent behaviour can have various causes: neuropsychiatric disorders such as dementia, intellectual disability, etc.; or the toxic effects of cocaine, alcohol, cannabis withdrawal, etc.

But some violent behaviour, including in children, can be caused by medication, in particular smoking cessation and neuropsychotropic drugs: selective serotonin reuptake inhibitor antidepressants (fluoxetin, etc.), anti-anxiety drugs,  amphetamines, antiepileptics, etc.

Other non-psychotropic drugs are also implicated: antiviral corticosteroids (such as efavirenz, atazanavir and ribavirin), antimalarials (such as mefloquine), interferon alpha, testosterone, an antiasthmatic drug (montelukast), and insulin when it causes severe hypoglycaemia.

The combination of a drug exposing a patient to violent behaviour with a substance also having this effect – especially alcohol and some illicit substances – increases this risk.

Aggressive behaviour sometimes exposes patients and those around them to severe consequences. Cases of homicide and/or suicide have been attributed to medication.

When a patient is treated with a drug known to carry a risk of violent behaviour, it is wise to warn the patient and also any carers or family members to be on the lookout for behavioural changes, especially for signs of aggressiveness, irritability and agitation. And patients should be reminded that alcohol increases these risks.

©Prescrire 1 June 2014

"Medication-induced violence towards others" Prescrire Int 2014; 23 (150): 153-155. (Pdf, subscribers only).
Download the full review.
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See also:

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(June 2008)
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