Mind-Altering Side Effects: 9 Medications That Can Cause Hallucinations

Hallucinations are vivid, false sensory experiences that involve seeing, hearing, smelling, tasting, or feeling things that aren’t actually there. Many people associate hallucinations with mind-altering substances like psilocybin (an ingredient found in magic mushrooms) or mental health conditions like schizophrenia. But these are not the only triggers. Surprisingly, some common medications can also lead to hallucinations as an unintended side effect.

Medication-induced hallucinations are often unexpected, which can make them an unsettling or scary experience. But understanding which medications carry this risk can help you manage the impact of hallucinations if they occur. Below, we cover nine medications that can cause hallucinations.

1. Anticholinergic medications like scopolamine

Anticholinergic medications can cause hallucinations. This is likely because they block the effects of a chemical messenger called acetylcholine. Acetylcholine is involved in various brain functions, and blocking its effects can lead to side effects such as confusion, delirium, and hallucinations.

Examples of anticholinergic medications include:

• Oxybutynin (Ditropan XL)

• Scopolamine (Transderm Scop)

• Solifenacin (Vesicare)

• Trihexyphenidyl

Older adults are especially sensitive to anticholinergic medication side effects, including hallucinations. If you're 65 or older, experts recommend avoiding these medications. Taking more than one anticholinergic medication can increase the risk of hallucinations even more.

2. Antihistamines like diphenhydramine

Another category of medications that can affect acetylcholine and cause hallucinations is antihistamines. Not all antihistamines cause hallucinations. But it’s a good idea to know which ones can have this effect.

First-generation antihistamines have strong anticholinergic effects. They’re also able to get into the brain, where they can affect cognitive functioning, more easily than newer antihistamines. Examples of first-generation antihistamines include diphenhydramine (Benadryl), doxylamine (Unisom), and chlorpheniramine.

Taking high dosages of these antihistamines can cause hallucinations. But hallucinations can also happen at recommended dosages in older adults. For this reason, older adults should avoid these medications. Safer options include “nondrowsy” antihistamines, such as loratadine (Claritin) and fexofenadine (Allegra), which aren’t known to have these effects.

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Be sure to follow the dosage recommendations on the drug facts labels of first-generation antihistamines, which are widely available over the counter. Be cautious when taking cold and flu medications, as they may also contain these antihistamines. Taking multiple products that contain first-generation antihistamines can increase the risk of accidental overdose.

3. Dopaminergic medications like ropinirole

Dopamine is another chemical messenger that plays a role in how we perceive reality. Low dopamine is associated with health conditions like Parkinson’s disease. But too much dopamine in the brain is thought to be linked to hallucinations.

Dopaminergic medications affect the dopamine system in the brain, often by increasing dopamine activity or availability. This can be effective for managing symptoms of certain health conditions, including Parkinson’s disease. But it can also lead to hallucinations. Examples of dopaminergic medications include:

• Apomorphine (Apokyn)

• Bromocriptine (Parlodel)

• Pramipexole (Mirapex ER)

• Ropinirole

• Levodopa (found in combination medications for Parkinson's disease)

• Cabergoline

• Entacapone (Comtan)

• Stimulants, such as methylphenidate (Ritalin, Concerta) and amphetamine salt combo (Adderall)

Older age, higher dosages, and long-term use can increase the risk of hallucinations related to these medications. It’s also important to note that hallucinations are possible with certain underlying conditions, including Parkinson’s disease. So if you experience hallucinations, tell your prescriber right away. They may need to adjust your medication regimen.

4. Corticosteroids like prednisone

Corticosteroids, also known as “steroids,” act like cortisol, a hormone produced by the adrenal glands. Prednisone (Rayos) and hydrocortisone (Cortef) are two common examples.

While rare, steroid-induced psychosis is a possible side effect of steroids, especially when taken at higher dosages. This condition can cause hallucinations. While it can happen at any time, steroid-induced psychosis is most likely to occur within the first few days of starting treatment with a steroid.

Tell your prescriber if you have hallucinations after you start treatment with a steroid. They may have you stop taking it by gradually reducing your dosage over time. In severe cases, you may need treatment with an antipsychotic or other medication.

5. Benzodiazepines like lorazepam

Benzodiazepines are a class of medications that calm the nervous system. But in rare cases, they can cause paradoxical reactions. These are reactions that are the opposite of what you’d expect. So instead of feeling calm, you may feel anxious. And in some cases, hallucinations can occur. Tell your prescriber right away if you start feeling more anxious or experience hallucinations.

Benzodiazepines are used to treat many health conditions, including anxiety, seizures, and insomnia. Examples of these medications include:

• Lorazepam (Ativan)

• Clonazepam (Klonopin)

• Alprazolam (Xanax)

• Diazepam (Valium)

Hallucinations are also a possible symptom of benzodiazepine withdrawal. This can happen if you stop taking one of these medications abruptly or lower your dosage too quickly. If you want to stop taking a benzodiazepine, your healthcare team can help you do this safely.

6. Sleep medications

Sleep medications are designed to help people fall asleep and/or stay asleep. But in rare cases, certain sleep medications have been associated with unusual side effects like hallucinations while falling asleep or waking up.

Besides benzodiazepines, nonbenzodiazepine sedative hypnotics (“z-drugs”) and orexin receptor antagonists are two types of sleep medications that have been reported to cause hallucinations. A few examples are:

• Zolpidem (Ambien)

• Zaleplon (Sonata)

• Daridorexant (Quviviq)

• Suvorexant (Belsomra)

Tell your prescriber right away if you experience hallucinations while taking one of these medications. They can help switch you to a different insomnia treatment.

7. Certain antidepressants

While rare, hallucinations have been reported with some antidepressants. This may be due to their effects on certain chemicals in the brain, such as dopamine, acetylcholine, or serotonin. Examples of these antidepressants include:

• Bupropion (Wellbutrin XL)

• Trazodone

• Tricyclic antidepressants, such as amitriptyline

• Selective serotonin reuptake inhibitors (SSRIs), such as citalopram (Celexa)

• Venlafaxine (Effexor XR)

• Monoamine oxidase inhibitors (MAOIs), such as selegiline (Zelapar, Emsam)

Keep in mind that hallucinations can also be a symptom of serotonin syndrome. Serotonin syndrome is a condition caused by high serotonin levels in the body, which can happen with some antidepressants. And SSRIs can cause low sodium levels, which can result in hallucinations in severe cases.

Most people who take antidepressants don’t experience hallucinations. But you should tell your prescriber right away if you experience them. Get immediate medical care if you have symptoms that feel severe or life-threatening.

8. Antiepileptic medications like topiramate

People living with epilepsy may experience hallucinations. And in rare cases, hallucinations have been reported with antiepileptic drugs (AEDs). Examples of these medications include:

• Topiramate (Topamax)

• Zonisamide (Zonegran)

• Vigabatrin (Sabril)

• Levetiracetam (Keppra)

One study reviewed the records of people taking AEDs and found that some experienced hallucinations. Levetiracetam was the AED most commonly taken by people experiencing these episodes.

Talk to your neurologist if you experience hallucinations. They can help you determine if they were caused by your seizures or medications.

9. Antibiotics like ciprofloxacin

Infections can cause hallucinations, especially if you have a high fever. But in rare cases, hallucinations have also been reported with certain antibiotics used to treat infections.

One study reviewed side effects reported to the FDA. The FDA hasn’t verified these reports. But in the study, several antibiotics were associated with an increased chance of psychosis, which can involve hallucinations, including:

• Clarithromycin

• Metronidazole (Flagyl)

• Cefepime (Maxipime)

• Amoxicillin (Amoxil)

• Sulfamethoxazole / trimethoprim (Bactrim)

Fluoroquinolone antibiotics, such as ciprofloxacin (Cipro) and levofloxacin, have also been linked to hallucinations. This can occur within hours to weeks of starting treatment with a fluoroquinolone.

Hallucinations usually go away when you stop taking the antibiotic. But talk to your prescriber before making any changes to your medication regiment. Otherwise, your infection may get worse or become harder to treat.

When should you contact your healthcare professional about hallucinations from medications?

Tell your healthcare professional right away if you experience hallucinations after starting a new medication or making changes to your regimen. Be sure to describe the timing, frequency, and type of hallucinations you’re experiencing. This can help your healthcare professional determine the cause, which may be a medication, health condition, or something else.

Seek immediate medical care if your hallucinations are accompanied by other symptoms, such as confusion, a rapid heartbeat, or difficulty breathing. This could indicate a more serious issue, such as a drug interaction or an underlying medical condition. And don’t stop taking your medication without talking to your prescriber. They can suggest how to safely adjust your treatment plan.

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Written by:

Kristianne Hannemann, PharmD

Kristianne Hannemann, PharmD, is a licensed pharmacist in California. She has been a retail pharmacy manager and staff pharmacist for over 7 years and has contributed drug information content to different health companies.

Reviewed by:

Christina Aungst, PharmD

Christina Aungst, PharmD, is a pharmacy editor for GoodRx. She began writing for GoodRx Health in 2019, transitioning from freelance writer to editor in 2021.

Reviewed by:

Sarah Gupta, MD

Sarah Gupta, MD, is a licensed physician with a special interest in mental health, sex and gender, eating disorders, and the human microbiome. She is currently board certified by the American Board of Psychiatry and Neurology.

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