Dozens of drugs may cause violent behavior–but one drug stands out

It’s rough out there

It’s hard to imagine someone going on a violent rampage after taking a fish oil supplement for a few days.

Same for someone looking for a sedative effect with melatonin or chasing the blues with St. John’s wort. I don’t think you’ll find any cases where nonviolent people used those supplements and then assaulted someone.

But prescription drugs? Better put your protective headgear on, because with certain types of drugs the side effects can get pretty rough. Especially for innocent bystanders.

Anger mismanagement

Last summer, a team led by the Institute for Safe Medication Practices took a close look at adverse event reports for Chantix, the popular smoking cessation drug.

A quick glance at the Chantix website, and you’ll see what they were looking for. The list of side effects reads like a Stephen King plot outline: hallucinations, suicidal thoughts, panic attacks, depression, and paranoia.

With a dramatic list like that, these other side effects don’t really pop out quite as vividly: anger, and aggressive or violent behavior.

When the ISMP team did some digging, they came up with dozens of wild adverse event reports that involved acts or thoughts of aggression or violence.

For instance…

• A young woman using Chantix attempted suicide after she began beating her boyfriend because she said he looked “peaceful.”
• Another young woman had nightmares and attacked her fiancé with a knife.
• A middle-aged man punched a stranger in a bowling alley.
• A woman became enraged while driving and struck her daughter in the mouth.
• In three cases, subjects committed suicide. Two others attempted suicide.

What’s most disturbing is that almost none of these people had ever displayed extreme moods or behaviors like this before.

One subject, who had nightmares, anger, depression, and homicidal thoughts, reported: “It wasn’t me at all during the time I was taking the drug.”

If you’re like me, you might wonder if irritability from nicotine withdrawal could spill over into very aggressive behavior. But nearly all the adverse events took place soon after medication started–BEFORE most of the subjects had actually stopped smoking.

A history of violence

More recently, the same ISMP team expanded on their earlier research by combing through the FDA Adverse Event Reporting System. They examined five years of reports that included thoughts or acts of violence toward others.

More than 1,500 reports were spread out among 31 drugs. These reports included homicides, physical assaults, physical abuse, homicidal ideation, and other acts of violence. About 80 percent of the reports were linked to antidepressants, sedatives, hypnotics, and ADHD drugs.

And can you guess which drug topped the list? Of course! Old, reliable Chantix racked up the lion’s share among those 1,500+ reports.

The ISMP team admits that an adverse event report doesn’t necessarily mean the drug caused the event. But they also note that many cases probably go unreported because patients usually don’t make the connection between their drug use and violent actions.

A spokesperson for Pfizer (the maker of Chantix), told Pharmalot, “There is no reliable scientific evidence that Chantix causes violent thoughts or actions.”

That statement could cause violent thoughts or actions! Wouldn’t it be great if people beating people up or killing themselves was enough for Pfizer to do something–even without scientific evidence?

Sources:
“Thoughts and Acts of Aggression/Violence Toward Others Reported in Association with Varenicline” Annals of Pharmacotherapy, Published online ahead of print 7/20/10, theannals.com
“Prescription Drugs Associated with Reports of Violence Towards Others” PLoS ONE, Vol. 5, No. 2, 12/15/10, plosone.org
“Chantix, Prescription Drugs and Violent Acts” Ed Silverman, Pharmalot, 12/16/10, pharmalot.com