Montelukast, Fluoroquinolone, Psychotropic Withdrawal & Toxicity

( – Last week’s post on Montelukast Withdrawal Syndrome has attracted comments at a higher rate than any prior post in 7 years of RxISK posts.

It followed a post on Asthma causing Suicide and Homicide two weeks previously, which had links to the QuarterWatch 2015 report of adverse events in children finding montelukast and suicidality as the second most common pediatric adverse event received by FDA.

It also in my case followed an intriguing consult some years ago from a young man who had been arrested and was likely to be charged in a case that would have ruined his life, which put me onto the QuarterWatch material and the growing online concerns about montelukast especially given to children.

This individual was hoping a drug he was on might explain what had happened – it didn’t.  But the montelukast he was also on, but hadn’t fingered as a possible cause – who would think an asthma drug could cause behavioural changes, did explain what happened.

The extraordinary rate of and quality of the comments on last week’s post is worth noting.  It would be great to be able to say “celebrate” as with the post about the European Medicines’ Agency and Post SSRI Sexual Dysfunction the previous week, but in the light of the lessons that seem to fall out of this scenario, celebration is not the right word.

The lessons are common to the problems that happen on fluoroquinolones (See Here), mefloquine, isotretinoin, finasteride, pretty well all antipsychotics, all serotonin reuptake inhibitors, dopamine agonists, as well as montelukast and related drugs.


  1. Montelukast (last week) and PSSD (the week before) make it clear that withdrawal syndromes can last for months, years and maybe even longer.
  2. Based on opioids and alcohol lasting 2-3 weeks, industry have sold doctors a story that withdrawal lasts 2-3 weeks – is transient.  And of course all of these drugs are mild in comparison to opioids.  This is completely and utterly wrong. Getting off SSRIs or montelukast can be a lot more difficult that getting off opioids.
  3. In some cases the enduring aftereffects from these drugs may stem from irreparable damage as when fluoroquinolones rupture a tendon.  In others the effects like PSSD or tardive dyskinesia may be better termed legacy effects rather than withdrawal but whatever they are called it is clear that effects can endure indefinitely.
  4. There is no doctor anywhere who has any training in how to handle the toxicities from montelukast, fluoroquinolones, mefloquine or most psychotropics.
  5. There is no evidence base for managing the toxicities both on and withdrawing from these drugs.
  6. Psychiatrists will gladly pump you or your child full of antidepressants, sedatives or antipsychotics – as several of the comments on last week’s post make clear – but there is no evidence that any of these drugs will help the anxiety or suicidality or behavioural changes that stem from montelukast or fluoroquinolones.
  7. The psychiatrists will simply not see the prior montelukast, fluoroquinolone, mefloquine, isotretinoin or finasteride event.
  8. There is no evidence base even for managing the toxicities linked to SSRIs or stemming from withdrawal from then.  If some part of your physiology becomes unstable on these drugs it will often be impossible to put it right.
  9. In some cases pharmaceutical companies know what to do but can’t be seen to tell doctors – as when they quietly told doctors in the early 1990s to co-prescribe benzodiazepines with SSRIs while at the same time they were funding campaigns to paint the benzodiazepines as more dangerous than opioids.
  10. As a result people are being killed by doctors, mostly psychiatrists, putting them on drugs they typically use for patients who are anxious, suicidal or emotionally labile but which will only make many of these problems worse.
  11. If you’ve been damaged by Montelukast, or a fluoroquinolone or mefloquine, or even an SSRI, you want to get the doctor to produce the evidence that what s/he is proposing to do is going to help – its not enough for him to say this is what we give to people who are labile or suicidal, s/he needs to show you the evidence that whatever s/he is proposing has been shown to work when the damage has been caused by montelukast etc.
  12. In the case of children none of these drugs work even when the anxiety or suicidality is not caused by a prior drug.
  13. If any doctor ever does show you evidence that SSRIs or whatever work to put the problems caused by montelukast or fluoroquinolones or mefloquine right – either the toxicity on treatment or stemming from withdrawal, please post it here.  There are thousands of people who would love to see it.
  14. You can show this post to any doctor you are attending and invite them to make direct contact with RxISK.
  15. Prescribing seems to damage brains.  Laura Marotta’s post and the many penetrating comments that came after it show doctors unable to see what is in front of their eyes or hear what people tell them.
  16. PSSD sufferers have had exactly the same experience as these days pretty well everyone does who has a significant adverse effect on drugs – we will have a post on this soon.  The act of prescribing it seems damages the brains of the doctors who write the scripts.  Prescribing causes an agnosia, a typical feature of brain damage – in this case a venomagnosia – see Come back when you Have a Medical Degree.


I get more and more requests for consults on withdrawal every week. I am afraid I leave many unanswered or answer some tersely.

There is a reason for this.  Its stressful knowing that there is no answer for the problems many of these correspondents have.  This is not a message anyone wants to hear.  Better for them to think Healy is a creep who doesn’t answer emails than to think there is no answer, and better than taking money off people when if people haven’t found their own way off a drug there is little I or anyone else can do – other than tell them that, which is not something they are inclined to believe.

No-one easily accepts the fact that so many million people can be screwed over like this – of course there must be an answer out there.

This is a pressing issue.  As several posts here recently on assisted dying have pointed out, the situation is getting worse – not better.

Even though there are millions of people in all developed countries in compromised states because of treatments they for most part should never have been given, nobody it seems wants to tackle the issues – neither mainstream nor academic media.  One of the biggest culprits in all this is the BMJ, who are managing things rather like the way the catholic church have been managing child abuse issues.

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