Cipro, Levaquin and Tendon Ruptures?
Many of my patients have heard the FDA announcement about tendon ruptures, so I thought I would post an update on the story of the quinolone antibiotics.
What is the problem? Increased risk of tendon problems with fluoroquinolones has prompted the FDA to require makers of these antibiotics to include a boxed warning concerning an increased risk of tendinitis and tendon rupture.
Why the concern? A warning about the increased risk of tendinitis and tendon rupture in patients taking fluoroquinolones was previously added to the prescribing information for fluoroquinolones. However, recent evaluation of the medical literature and the post-marketing adverse event reports confirmed that serious reports of tendinitis and tendon rupture with the use of fluoroquinolones continue to be reported in similar or increased numbers.
What happens exactly? Tendinitis and tendon rupture associated with fluoroquinolone antibiotics most frequently involves the Achilles tendon.This risk of tendinitis and tendon rupture is further increased in patients older than 60 years, in kidney, heart, and lung transplant recipients, and with those using steroid therapy. Patients should be instructed to observe for signs and symptoms of tendon problems including tendon pain, swelling, and inflammation when they are prescribed fluoroquinolones.
What's a fluoroquinolone antibiotic?
1) ciprofloxacin (marketed as Cipro and generic ciprofloxacin)
2) gemifloxacin (marketed as Factive);
3) evofloxacin (marketed as Levaquin);
4) moxifloxacin (marketed as Avelox);
5) norfloxacin (marketed as Noroxin); and
6) ofloxacin (marketed as Floxin and generic ofloxacin).
Dr O.
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18
I have type II diabetes. I noticed that when I am on Cipro that my blood sugar is reduced by 15-20%. I was wondering if anyone else has seen this effect or may know what causes it.
By sookie49 November 26, 2008 3:47pm
17
Thank you for bring this up I have tendiniis in my right arm and am on
celabrex for the pain but I had no idea that taking these antibiotics might be the cause I'm going to make a doctors appiontment to find out.
Thank you
Pauline
By smileandwave November 19, 2008 11:06am
16
There are more adverse reactions than just tendon ruptures and tendinitis. Muscles can also rupture. My husband took Cipro in 1998. Around 11 months after this he had his first rupture and 2 more after that. This stopped for several years until he took Cipro for a second time in 2004 and like before, around 11 months after the rupturing began again. He had 3 more this time also. He has had 6 ruptures total that also included avulsions of his tendons and muscles involving both his legs and both arms. That's just a few of the physical reactions. He also had severe depression, suicidal thoughts and acts, anxiety and panic attacks and pychotic episodes. Those are just a few of the other adverse reactions he suffers from after taking Cipro. He was in excellent physical condition before taking Cipro. Now he's disabled. He was in his early 40's when this began. He wasn't taking steroids and had never had a transplant. During an operation to repair 1 of the ruptures, the doctor noticed lack of blood in his tissue. Before that rupture occurred there was a piece of calcified material that broke away under the skin at his elbow. Obviously calicificaion was happening before the rupture in his case. He had numerous cases of calcific tendonitis before the ruptures in his arms. I won't take any quinolones.
By ciprovictimalso October 1, 2008 4:27pm
15
I forgot to add that none of us are or ever have been on steriods.
By reddutchgirl September 5, 2008 8:02am
14
My little sister who is 28 years old just had her achilles tendon rupture from being on Levaquin for kidney stones, so it is not just the elderly that is affected. I also had serious reaction to the same antibiotic, just no tendon rupture. I wish they would pull this toxic drug off of the shelf. My husband was on Levaquin last week and he still has the chronic diarrhea. I will never allow another family member to take this awful med.
By reddutchgirl September 5, 2008 8:01am
13
I'm not sure if I'm understanding this right, but I've been taking levaquin for a week now, and going to the gym has been painful in my achilles tendon...wonder if it;s just a coincidence or from the med? Does it go away when you stop taking the med?
By kelly7463 August 31, 2008 6:03pm
12
Being a 51 year old Cf'er I have taken Cipro and Levaquin since they both came out
at least 3 rounds a year, I haven't noticed any problems, except sometimes after
my first dose of Levaquin I may feel a little sick to my stomach, But I have run into
this over the years with many of meds , it goes away after a hour or so.
Brad, 51 w cf
By BirdDogg August 31, 2008 2:14pm
11
I have been severely ill for almost 2 weeks with acute pains which started on the backs of my calves and ankle, in turn spreading all over with severe gastric and abdominal cramping,fever, diarhhea and at one point I was passing a very dark brown urine. I just got pain killers from my dr to help get me through this suffering. I am getting very discouraged at how long I am remaining ill, I am so afraid this will be a permanent thing! I am scheduled for ct scan(s), but in the meantime would appreciate more info..dr said my muscle tissue may have been breaking down causing the brown urine....do my symptoms ring a familiar bell with you? I got this from levaquin for 6 days, but I was on cipro 1 month before for UTI..
By RubellaUmbrella August 27, 2008 12:21pm
10
Hey Taoe: The "black box" warning (literally a warning surrounded by a black box on the package insert) is something SOME physicians tell patients about but certainly most pharmacists should as well. Remember when you are picking up a new prescription a pharmacist should be counseling you about the new medication. All of your points are well taken
Dr O.
By DrOrrange August 17, 2008 2:57pm
9
and just for nothing, i thought i'd add....
there is no way in the world, that a drug should be going by TWO DIFFERENT NAMES.... this is marketing and trade mark issues, i understand that, but ONE DRUG, SHOULD HAVE ONE NAME....
ive heard about moxifloxacin being 'bad', but not specific information... had i known that moxi floxi, as its called in the hallways of the clinic i go to, if i'd known moxflox was AVELOX, i might have been able to avoid BEING SICK LIKE AN DOG IN A WAR-ZONE ALL SUMMER, (OR, PERHAPS PERMANENTLY)
YOU ALL REALISE THAT SOME OF THESE 'SIDE EFFECTS' CAN BE PERMANENT, INCLUDING THE DIARREAH?....
what is the life expectancy of someone with permanent acute diarreah..?
By Taoe August 7, 2008 12:43pm
8
what are the physicians obligations regarding verbally informing a patient of these things? is this a simple requirement to add the black box to the label, or a requirement that patients be VERBALLY INFORMED BY THE PRESCRIBING DOCTOR... and is this the same legal requirement for ALL black box labels?
By Taoe August 7, 2008 12:34pm
7
Thanks for this information, though it is disturbing because I have had lymphedema of the legs & pelvis for many years following cancer surgery & radiation, and Cipro is what I use for cellulitis.
By QueenieEJC July 19, 2008 10:30pm
6
wildthing: i would gently raise your concern over using an antibiotic in this class of drugs given that you are on steroids...so apparently at increased risk.
For those of you who took it in the past and had no problems there is no reason to think the problem (tendon rupture, tendinitis) will show up later...it usually declares itself during or shortly after the treatment with a quinolone antibiotic but this is evolving so Ill keep you posted
Dr O.
By DrOrrange July 18, 2008 3:44pm
5
i wntd to say thank you fo the information, also included in these cateragories that can cause tentenitis is cipro, i hope u will continue to help us, i have ra and i am always twisting my ankle and in severe pain, around the tendons, my akeles heels, i don,t know what doctor to see for this? i already broke my arm in half and have problems standing or walking, my wrist surgery didn,t work, my hand is still messed up and i have no feeling in my thumb, i am on medical and not to many specialist will even see me, any help u could give me would be GREATLY APPPRECIATED, SINCERELY, RHONDA LANE, P.S, I HAVE BEEN ON STEROIDS SEVERAL YEARS AND THOSE antibiotics too.
By wildthing July 18, 2008 1:33pm
4
I was put on an IV of Cipro & Flagyl last Tuesday for Diverticulitis. I started to have pounding heart, localized allergy at IV site, shortness of breath, itching on R shoulder, etc. They took me off it & I'm home now. Can I expect to have any harmful future symptoms? This is sooooo frightening, esp. w/ respect to my drug sensitivity Hx! My R shoulder is still so painful.=(
By summerwine July 18, 2008 11:50am
3
I was put on Levaquin early this year for pleurisy and bronchitis and had a severe reaction to it and it is now in my medical files as an allergy.
By reddutchgirl July 18, 2008 8:41am
2
This article really scares me because the only thing that will kill my kidney infections from stones is levaquin and if this stuff is dangerous I would like to know
By hydromama3 July 17, 2008 9:58pm
1
Interesting. I just had to stop taking cipro because it caused not only the typical upset stomach so common with antibiotics, but also because I felt like I was losing my mind. I suffered panic attacks, uncontrollable crying and terrible anxiety - all little known side effects. I saw my dr a few days later and she said she thought it was unusual, but mentioned that a male patient she'd seen earlier the same day suffered from the same side effects!!!
Another interesting fact about my case is I have fibro and suffer from bouts of tendonitis and the dr I saw had all my records on computer and never said a word!
By SeaNymph July 17, 2008 8:59pm