title: Drug-induced panic attacks: Analysis of cases registered in the French pharmacovigilance database.
abstract: The potential role of drugs in the onset of panic attacks (PAs) is poorly understood.
  
  
  
  The objective of our study was to characterize drug-induced PAs.
  
  
  
  We performed an analysis of PAs registered in the French pharmacovigilance database between 01/01/1985 and 05/11/2014.
  
  
  
  Among the 163 recorded cases, 136 (83.4%) were directly related to drugs, mainly antidepressants (11.3%, mainly serotonin reuptake inhibitors), mefloquine (7.2%), isotretinoin (5.2%), rimonabant (3.6%) and corticosteroids (4.7%). PAs are labelled in the Summary of Product Characteristics (SmPC) for a minority (8.6%) of these drugs. In 31.4% of these cases, withdrawal of the suspected drug was performed more than a week after the onset of PAs. PAs could also be secondary to another adverse drug reaction (ADR; n = 14, 8.6%), mainly an allergy to antineoplastic or immunomodulating agents. In 13 cases (8.0%), PAs occurred during a drug-withdrawal syndrome, mainly after benzodiazepines or opioids. Most cases (73%) involved patients without any previous psychiatric disorder.
  
  
  
  This is the first pharmacoepidemiological study about iatrogenic PAs. Beside antidepressants, the most often encountered drugs are not indicated for psychiatric diseases. This study also reveals that iatrogenic PAs mostly occur in patients without any psychiatric medical history and that PAs can be triggered by another ADR. Lastly, the many cases with delayed management underline the need to raise awareness of this relatively unknown ADR among physicians, especially since PAs are generally not labelled in SmPCs of the suspected drugs.
authors.affiliation: Department of Medical and Clinical Pharmacology, Toulouse University Hospital, Faculty of Medicine, 37 allées Jules Guesde, 31000 Toulouse, France. Electronic address: delphine.abadie@aphp.fr.
authors.forename: Delphine
authors.initials: D
authors.lastname: Abadie
authors.affiliation: Department of Medical and Clinical Pharmacology, Toulouse University Hospital, Faculty of Medicine, 37 allées Jules Guesde, 31000 Toulouse, France.
authors.forename: Anaïs
authors.initials: A
authors.lastname: Essilini
authors.affiliation: Regional Pharmacovigilance Center, Hôpital Européen Georges Pompidou, 20-40 rue Leblanc, 75015 Paris, France.
authors.forename: Virginie
authors.initials: V
authors.lastname: Fulda
authors.affiliation: Regional Pharmacovigilance Center, Hospices Civils de Lyon, 162 avenue Lacassagne, 69424 Lyon, France.
authors.forename: Aurore
authors.initials: A
authors.lastname: Gouraud
authors.affiliation: Regional Pharmacovigilance Center, Hôpitaux de Nancy, 29 Avenue du Maréchal de Lattre de Tassigny, 54035 Nancy, France.
authors.forename: Mélissa
authors.initials: M
authors.lastname: Yéléhé-Okouma
authors.affiliation: Regional Pharmacovigilance Center, Department of Medical and Clinical Pharmacology, Hôpital Sainte-Marguerite AP-HM, 270 boulevard de Saint-Marguerite, 13009 Marseille, France.
authors.forename: Joëlle
authors.initials: J
authors.lastname: Micallef
authors.affiliation: Department of Medical and Clinical Pharmacology, Toulouse University Hospital, Faculty of Medicine, 37 allées Jules Guesde, 31000 Toulouse, France.
authors.forename: François
authors.initials: F
authors.lastname: Montastruc
authors.affiliation: Department of Medical and Clinical Pharmacology, Toulouse University Hospital, Faculty of Medicine, 37 allées Jules Guesde, 31000 Toulouse, France.
authors.forename: Jean Louis
authors.initials: JL
authors.lastname: Montastruc
mesh_terms: D000928:Antidepressive Agents / Q000009:adverse effects*; D014150:Antipsychotic Agents / Q000009:adverse effects*; D016208:Databases, Factual / Q000706:statistics & numerical data*; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D008297:Male; D016584:Panic Disorder / Q000139:chemically induced* / Q000175:diagnosis / Q000453:epidemiology*; D060735:Pharmacovigilance
chemical_list: D000928:Antidepressive Agents; D014150:Antipsychotic Agents
keywords: Adverse drug reaction; Panic attack; Pharmacovigilance database