Psychiatry Res

Common medications show unexpected link to Alice in Wonderland syndrome

January 15, 2026

A pharmacovigilance study using VigiBase® data identified 87 reports of drug-associated Alice in Wonderland Syndrome (AIWS) through December 2024, including pediatric (29.9%) and adult (51.7%) cases; most were serious, but nearly 80% recovered. Montelukast showed the strongest signal in both adults and children, followed by methylphenidate in pediatric cases. Adults also showed signals for sertraline, topiramate, and aripiprazole. Sensitivity analyses confirmed consistency after excluding COVID-19 cases. While causality cannot be established, findings highlight age-dependent drug profiles and reinforce prior case reports.

Clinical takeaway: Consider AIWS when patients—especially children or teens—on montelukast or methylphenidate report visual or perceptual distortions; symptoms are typically reversible but warrant clinical awareness.

Source:

Merino DA, et al. (2025, December 21). Psychiatry Res. Alice in wonderland syndrome: Down the rabbit hole of VigiBase®. https://pubmed.ncbi.nlm.nih.gov/41448101/