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Dear Epidemiologists, Consider Fluoroquinolones

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Dear Epidemiologists,

I am writing to encourage you to study the long-term and intergenerational adverse-effects of fluoroquinolone antibiotics (Cipro, Levaquin, Avelox, Floxin, and their generic counterparts). It has been noted by both patient groups and the FDA that fluoroquinolones have long-term adverse-effects, yet many patients and physicians are caught off-guard when fluoroquinolone toxicity symptoms are not transient. Fluoroquinolone toxicity symptoms are similar to those of many multi-symptom, chronic, mysterious diseases of modernity, and epidemiological studies are needed in order to determine if the similar symptoms are coincidental, or if they are indicative of a causal relationship between fluoroquinolone use and many of the diseases that fluoroquinolone toxicity resembles.

The Acknowledged Adverse Effects

The musculoskeletal adverse effects of fluoroquinolones are well-known, and fluoroquinolone antibiotics even carry a black box warning noting that they increase the risk of tendon ruptures. Studies have shown that fluoroquinolones also increase the risk of retinal detachment, and a recent (2015) article in JAMA Internal Medicine noted that the risk of aortic aneurysm and dissection is increased with fluoroquinolone use. All these adverse effects point to fluoroquinolones causing collagen synthesis disorders and/or collagen toxicity.

The 2015 BMJ Open article, “Fluoroquinolones and collagen associated severe adverse events: a longitudinal cohort study” goes over the increased risk of tendon ruptures, retinal detachment and aortic aneurysm and dissection in those given fluoroquinolones. The authors conclude that:

“Current fluoroquinolone use was associated with an increased hazard of tendon rupture (HR 3.13, 95% CI 2.98 to 3.28), and increased hazard of aortic aneurysms (HR 2.72, 95% CI 2.53 to 2.93). The relative hazard of these two collagen-associated adverse events were slightly attenuated after multivariate adjustment, but remained clinically meaningful and statistically significant (table 2). The relative hazard of retinal detachment was modest in magnitude, and only statistically significant after multivariate adjustment (table 2). The magnitude of the association of fluoroquinolones and aortic aneurysm events was stronger than the association observed with other aneurysm risk factors such as hypertension and atherosclerosis (table 3).”

“Fluoroquinolones and collagen associated severe adverse events: a longitudinal cohort study” is an excellent study, and I commend the authors for their work. However, a couple of drawbacks of it are that the authors only look at patients who are over the age of 65, and the time-period examined is only 30-days post-exposure, though many fluoroquinolone toxicity patients are under the age of 65, and many experience adverse effects months, or even years, after exposure to the fluoroquinolone.

It would be helpful for both patients and physicians if similar studies were conducted looking at the long-term health outcomes for people of various ages after exposure to fluoroquinolones.

Collagen Synthesis Problems and CNS Symptoms

The relationship between other diseases that have to do with disordered collagen synthesis and fluoroquinolone use should also be examined. For example, fluoroquinolone adverse-effects include many central nervous system symptoms, including convulsions, toxic psychosis, suicidal ideation, dizziness, confusion, tremors, hallucinations, depression, anxiety, insomnia, and many other psychiatric symptoms. It is possible that the collagen in the central nervous system is adversely affected by fluoroquinolones, and that fluoroquinolone use is associated with the rise in psychiatric illnesses in the population. It is a hypothesis that should be explored.

Fluoroquinolones and Multi-symptom, Chronic Illnesses

Many patients who have adverse reactions to fluoroquinolones suffer from multi-symptom, often chronic, illness. Fluoroquinolone toxicity has symptoms that are similar to those of autoimmune diseases (including lupus, rheumatoid arthritis and M.S.), neurodegenerative diseases (including ALS and Parkinson’s), and mysterious diseases like fibromyalgia and M.E./chronic fatigue syndrome, and the symptoms often overlap with those of chronic Lyme disease. (Some patient stories that go over the symptoms of fluoroquinolone toxicity can be found on www.fqwallofpain.com). It would be helpful if some epidemiological studies were done to see if fluoroquinolone exposure predisposes people to a diagnosis of an autoimmune, neurodegenerative or other mysterious diseases.

Those who have experienced fluoroquinolone toxicity see the connections between fluoroquinolones and those diseases—because we went from being healthy to suddenly being sick with symptoms of multiple chronic diseases shortly after taking a fluoroquinolone—but our experiences are only anecdotal unless studies confirm our assertions. Epidemiological studies to determine whether or not there is a connection between fluoroquinolone use and autoimmune, neurodegenerative and mysterious diseases would be immensely helpful in showing whether the relationship is causal or anecdotal.

Fluoroquinolones and Diabetes, Heart-disease, and Autism

Fluoroquinolones have been shown to cause dysglycemia and use of fluoroquinolones is correlated with type-2 diabetes. Diabetes is a growing problem that is causing pain and suffering to millions of people worldwide. If even a small percentage of diabetes cases could be prevented through more prudent use of fluoroquinolones, much pain and suffering could be alleviated. Quantifying the relationship between fluoroquinolone use and diabetes via an epidemiological study would be immensely useful.

Given that fluoroquinolones have been shown to increase incidence of aortic dissection and aneurysm, it would be interesting to see if they are associated with heart-disease more generally.

It was noted in the 2013 article in Nature, “Topoisomerases facilitate transcription of long genes linked to autism” that, “chemicals or genetic mutations that impair topoisomerases, and possibly other components of the transcription elongation machinery that interface with topoisomerases, have the potential to profoundly affect expression of long ASD (autism spectrum disorder) candidate genes.” Since fluoroquinolone antibiotics are the most commonly prescribed topoisomerase interrupting drugs, it is worthwhile to look into whether or not they are related (intergenerationally, most likely) to autism.

Longer-Term Studies Are Needed

It has been known for many decades that fluoroquinolones have serious and severe adverse-effects, yet very few studies of the long-term effects of fluoroquinolones have been conducted. Fluoroquinolone affected patients have been noting that they have experienced fluoroquinolone toxicity symptoms months, or even years, after administration of the drugs has ceased, and even the FDA has noted that fluoroquinolone associated disability (FQAD) is a consequence of fluoroquinolone use. However, fluoroquinolone studies have primarily concentrated on adverse-effects that occur while the drug is being administered. Long-term, and even intergenerational, epidemiological studies will enlighten us to the true consequences of fluoroquinolones.

Many Questions to Study

How much does fluoroquinolone use increase a person’s risk of getting an autoimmune disease? How much more likely is a person to become diabetic if they use a fluoroquinolone to treat a sinus infection? How much more likely is a person to need a pain medication like Lyrica if they have been prescribed a fluoroquinolone in the past? Are thyroid diseases more common in those who have taken fluoroquinolones than in those who haven’t? Are psychiatric illnesses more common in those who have taken fluoroquinolones? Are people more likely to suffer from heart-disease if they have taken a fluoroquinolone? Are there any intergenerational effects of fluoroquinolones, and, if so, how are they manifesting?

These are all reasonable questions to ask, given the long list of adverse-effects caused by fluoroquinolone antibiotics.

Patients have been screaming about the connections between many of the diseases of modernity and the symptoms of fluoroquinolone toxicity for years, but our screams will only be heard if there are data to back them up. Studies need to be done to get necessary information, so I encourage all scientists who have the access to data and expertise needed, to study fluoroquinolones. People are being hurt by these drugs. Information, data, science and a bit of enlightenment, will help to encourage more prudent and appropriate use of fluoroquinolones, so that the pain caused by them can be minimized.

To all the scientists who have studied fluoroquinolones—your work is appreciated and I hope that it is built upon. Thank you in advance to all those who look further into fluoroquinolone adverse reactions. Your work will be greatly appreciated as well.

Regards,
Lisa Bloomquist
Patient advocate and founder of Floxiehope.com

We Need Your Help

More people than ever are reading Hormones Matter, a testament to the need for independent voices in health and medicine. We are not funded and accept limited advertising. Unlike many health sites, we don’t force you to purchase a subscription. We believe health information should be open to all. If you read Hormones Matter, like it, please help support it. Contribute now.

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This letter was published previously on Hormones Matter in December 2015.

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Fluoroquinolone Antibiotics and Thyroid Problems: Is There a Connection?

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One Fateful Day – And a Journey into the Enigmatic World of Thyroid Related Problems Begins

I remember the day of March 19, 2010 very well. That was the last day I ever went jogging. That was the last day I could have hopped on my bike and ridden 50 miles if I wanted to. That was the last day I ate my favorite breakfast of a 3-egg omelet topped with cheese and veggies, with 3 pieces of whole wheat toast slathered in butter and jam, 3 pancakes on the side, and at least a quart of milk. That was the last day I worked in my profession, brought home a paycheck, and was self sufficient financially. It was the day before I started taking Ciprofloxacin, a fluoroquinolone (FQ) antibiotic, for a simple UTI. And it was the last day I was a normal person with a normal life.

By March 25, 2010 – six days later — I was completely bedridden with severe pain in what felt like every tendon in my body, along with peripheral and central neurological symptoms and other symptoms from the side effects of that drug. These adverse effects are collectively called “Fluoroquinolone Toxicity Syndrome” (FQT), or “floxed” for short. And although I didn’t realize it then, my physical, professional, financial, and personal life as I knew it was over. Within a few days and a few pills, I joined the ranks of the chronically disabled, those with “chronic invisible illnesses”, and “Romney’s 47%”.  It’s five long years later, and I still struggle with the aftermath of taking those few pills. I regret every single day since then that I ever even considered a fluoroquinolone antibiotic for a simple UTI.

So what does all this have to do with the thyroid gland? Well, like most victims of this toxicity, all my extensive traditional medical testing during the acute phase of the reaction, as well as for the first year and a half after, gave normal or negative results. Astoundingly enough, despite being severely disabled and feeling essentially non-functional, according to the medical profession, I was the picture of health on paper. Until I finally decided to do more than a TSH test to check my thyroid status. That’s when I discovered I had all the anti-thyroid antibodies. And that’s really when my journey into the enigmatic world of “thyroid problems” began in earnest.

Having the antibodies for both Hashimoto’s Thyroid Disease and Grave’s Thyroid Disease makes for an astounding array of symptoms. Many of them appeared to mimic or overlap my symptoms of Fluoroquinolone Toxicity. Naturally, as a result of these observations, and my experiences with these conditions, I started questioning as to how much fluoroquinolone antibiotics caused severe endocrine disruptions, in particular of the thyroid axis.

The Thyroid Fluoroquinolone Epidemic: Where Is the Research?

There is a lot of published research available showing how damaging the FQ’s are too many different body systems and cellular processes, but almost none of it includes the thyroid system or the endocrine system in general. I suspect that someday, studies will be published showing the association between fluoroquinolones and thyroid abnormalities.  Until then, it will be up to patients themselves to try and figure out if this association exists for themselves. In my case, my suspicions were further strengthened when I found that thyroid hormone medications, both T4 and T3, dramatically and profoundly affected all my floxing symptoms. Even more interesting to me, iodine alone did the same. I also found it interesting that a significant number of flox victims reported hormonal disruptions of all types post flox, such as with sex hormones, adrenal hormones, thyroid hormones, dysglycemias presumably in association with insulin hormone, and Vitamin D, which is also considered a hormone. This was also true of me after I was floxed. Eventually, I created a website* summarizing my observations, experiences, interpretations, and hypotheses on these possible correlations.

I had several intentions in creating the website, and one of them is to start the conversation about this potential link between fluoroquinolones and thyroid related problems, hopefully leading to unbiased studies and research in this area. I believe it is sorely needed. According to the U.S. Preventive Services Task Force Clinical Guidelines:

“The annual number of dispensed prescriptions of levothyroxine sodium in the United States increased by 42% over a 5-year period, from 50 million in 2006 to 71 million in 2010.  In 2013, there were more than 23 million new prescriptions and refills for a single name brand of thyroid hormone in the United States, making it the most commonly prescribed drug in the country.”  

This implies there are a lot of “thyroid problems” out there. According to several news investigations airing across the country, the FQ antibiotics are one of the top five drugs prescribed in the US each year. In our current day and age, we are bombarded by many substances which are known or suspected endocrine disrupters, including affecting the thyroid system. Could the epidemic of FQ usage be contributing to the epidemic of thyroid-related problems resulting in patients receiving thyroid medication for life?  It would not surprise me if this were the case. I hope association studies, along with causation studies, will be done someday. Until then, those of us with thyroid disorders are on our own in looking at FQ antibiotic usage history and questioning this association for ourselves.

In my case, it was pretty clear cut that the acute symptoms I experienced right after starting the antibiotic were actually caused, or at a minimum, triggered by the antibiotic. My flox symptoms were pretty classic for these reactions all around, and there is plenty of research, as well as anecdotal stories, to substantiate this. But were my symptoms also “thyroid related”?  In other words, did the antibiotic affect my thyroid system, either primarily and directly, or secondarily through a “cascade effect”, and at least some of these floxing symptoms I experienced were actually “thyrotoxic” symptoms as well?  I think the answer is yes. These are the issues that I explore in my website, and I will briefly present here.

Tendon Pain and Ruptures: A Link between FQ Antibiotics and Endocrine Disorders?

One of the most well known adverse effects of FQ antibiotics are tendon problems. Most flox victims will experience some level of tendon pain at some point in time during their flox reaction. Regardless of what other symptoms occur with FQT, the severe tendon pain that can occur, sometimes with resultant ruptures, is distinctive, idiosyncratic, and unique to FQ antibiotic use alone. It is a hallmark of FQT. So much so, that an FDA  “Black Box Warning” about it exists for all fluoroquinolone antibiotics.

It turns out there just aren’t a whole lot of things in life, either natural or synthetic, that can cause sudden spontaneous tendon ruptures or severe tendon pain and tendinopathies –but all of the endocrine disorders can. This includes: hyperadrenocorticism (cortisol), diabetes (insulin), parathyroid disorders (calcium/PTH/Vitamin D), hyper and hypothyroidism (tyrosine/iodine/thyroid hormone), hyper/hypo sex hormones (estrogens/testosterone), and probably other steroid and sex hormones and their metabolites as well (see references). A specific genetic metabolism disorder of tyrosine, which is a major component of thyroid hormones, can also cause spontaneous tendon rupture later in life as a first manifestation of this disorder. Many rheumatic diseases also often have an associated, if not underlying, endocrine component (especially thyroid related).  Additionally, conditions that at first glance appear to be unrelated, such as chronic renal failure, often have a high association with endocrinopathies, in particular, parathyroid hormone abnormalities. The parathyroid glands are intimately associated with the thyroid gland via proximity alone; if thyroid gland architecture is destroyed, presumably these glands could be affected too.

I took a fluoroquinolone antibiotic and developed severe, systemic tendon pain, Type 2 Diabetes, and two Autoimmune Thyroid Disorders. A legitimate question could be:  Are fluoroquinolone antibiotics severe endocrine disrupters, which, among other symptoms, can result in tendon pain, tendinopathies, and tendon rupture?

I then found that the thyroid hormone medications T4 and T3, as well as iodine alone, profoundly affected my tendon pain and other symptoms, capable of making these symptoms dramatically better — or much worse. This, too, seemed to support the argument that the fluoroquinolones had somehow damaged my thyroid system, as supplying exogenous hormone in the form of medication now could make such dramatic differences in my symptoms.

One of my hypotheses is that people with healthy and normally functioning thyroid glands or other endocrine systems can probably withstand these dramatic changes in the hormonal axes that may be occurring while on the FQ  – at least, up to a point. For people who don’t react at all to these drugs, they probably never even feel the fluctuations, as their hormonal axes can automatically adjust rapidly. But I would suspect that anyone with any underlying genetic predisposition, or possibly harboring a subclinical, latent, or silent endocrinopathy might be “pushed over the edge” into full blown clinical pathology.  This is actually what I think may have happened with me, even though I had no overt indications of any kind of thyroid or endocrine disorder prior to taking the Cipro.

Additional Links To Consider Relating Fluoroquinolones to Thyroid System Damage

I don’t profess to even begin to know the millions of ways fluoroquinolones could possibly exert their damaging effects on the thyroid or endocrine system in general. However, that didn’t stop me from thinking about this problem. As I said, I hope research studies will be initiated in this area sooner than later. In the meantime, I came up with several mechanisms of FQ-Induced Thyroid Pathology to consider as possibilities, to narrow down the search. Additional unintentional targets of fluoroquinolones that I considered could have thyroid-related repercussions included targets such as mitochondria, acetylcholine, steroid receptors and hormone response elements and their common pathways, selenium dependent enzymes and proteins, halogenated peroxidase enzymes, iodine receptors located on most or all cells as well as on the thyroid gland, and more. I think one of the more interesting observations is the fact that new fluoroquinolone derivatives are now being considered for use as “tyrosine kinase inhibitors” (TKI’s).  TKI’s are relatively recent chemotherapy drugs developed to fight cancer – and one of their adverse effects appears to affect the thyroid system with some rather alarmingly high statistics. From my perspective, there appeared to be striking similarities between thyroid abnormalities occurring with TKI’s and the thyroid abnormalities I suspect may occur with the FQ’s.

Fluoroquinolone Antibiotics: Consider the Risks

Thyroid disorders, especially autoimmune based ones, are no joke. Autoimmune Thyroid Disorders are not simply disorders of the thyroid gland; in my opinion, they are systemic disorders, affecting many or all of the cells and tissues in the body, which is why there can be such widespread and potentially devastating symptoms. There are numerous environmental stressors that contribute to thyroid disease and endocrine disease, and the fluoroquinolone antibiotics may be one of them. Fluoroquinolones exert many damaging effects, and if they are damaging the thyroid axis directly or indirectly via a cascade effect, actually causing anti-thyroid antibody production, or even if they are triggering or unmasking a subclinical or silent condition in susceptible patients to an active pathological condition, this is of serious concern – or it should be. A “silent” condition means just that –  you don’t know you have that predisposition. I can say from my own experience that taking a fluoroquinolone antibiotic is a hell of a way to find out. It is Pharma’s responsibility to provide adequate warnings and risks of this possibility, and the medical profession’s responsibility to make sure adequate testing rules out these antibodies along with other potential risk factors, before prescribing a fluoroquinolone antibiotic. Sadly, neither of these things is happening right now. Until it does, I think anyone considering taking a fluoroquinolone antibiotic for a simple infection, such as uncomplicated UTI or sinusitis, should be aware of the risk factors and possible alternatives.

Based on what I’ve learned in the past several years, I believe anyone with pre-existing endocrinopathies of any type (whether they’re known or not), to be at increased risk for these adverse reactions. I also believe that anyone who has experienced any kind of flox reaction has now gotten a warning sign, and is at increased risk of developing an overt or clinical endocrinopathy as a result of being floxed at any time after. One of the few supportive pieces of evidence for this hypothesis is buried in Table 3, Page 136 of a Mayo clinic paper here. Note the at risk population includes people with autoimmune or endocrine disorders (diabetes, thyroid, parathyroid) and steroid usage (ie, Prednisone, inhalers, anabolic steroids, etc.).

The best approach, of course, is to stay away from these drugs altogether if at all possible.  In my opinion based on my own experience, developing a lifelong severe thyroid disorder – or any other disorder — to solve a short term problem such as an uncomplicated infection with a fluoroquinolone antibiotic, isn’t worth the risk.

References and Resources

  1. Musculoskeletal Complications of Fluoroquinolones: Guidelines and Precautions for Usage in the Athletic Population 
  2. The Risk of Fluoroquinolone-Induced Tendinopathy and Tendon Rupture:  What Does The Clinician Need to Know?
  3. Spontaneous rupture of Achilles tendon: missed presentation of Cushing’s syndrome.
  4. Spontaneous rupture of Achilles tendon and Cushing’s disease. Case report.
  5. Incidence and predictors of hospitalization for tendon rupture in type 2 diabetes: the Fremantle diabetes study.
  6. Musculoskeletal Complications of Diabetes
  7. Biomechanical Properties of Achilles Tendon in Diabetic vs. Non-diabetic Patients.
  8. Spontaneous and serial rupture of both Achilles tendons associated with secondary hyperparathyroidism in a patient receiving long-term hemodialysis.
  9. Simultaneous chronic rupture of quadriceps tendon and contra-lateral patellar tendon in a patient affected by tertiary hyperparatiroidism.
  10. The level of vitamin D in the serum correlates with fatty degeneration of the muscles of the rotator cuff.
  11. Parathyroid disease.  
  12. Primary hyperparathyroidism due to atypical parathyroid adenoma presenting with peroneus brevis tendon rupture.
  13. Thyroid hormones and tendon: current views and future perspectives. Concise review.
  14. Thyroid hormones increase collagen I and cartilage oligomeric matrix protein (COMP) expression in vitro human tenocytes.
  15. Suspected role of ofloxacin in a case of arthalgia, myalgia, and multiple tendinopathy. (Inhaled steroids and moderate hypothyroidism precipitating factors).
  16. Could Low Total and Free Testosterone Levels be risk factor for Achilles Tendon Ruptures in Males.
  17. Pathological rupture of the distal biceps tendon after long-term androgen substitution.
  18. Effect of estrogen on tendon collagen synthesis, tendon structural characteristics, and biomechanical properties in postmenopausal women.
  19. Female Athletes with Higher Estrogen Levels May Have Higher Injury Risk.
  20. Effect of administration of oral contraceptives in vivo on collagen synthesis in tendon and muscle connective tissue in young women.
  21. Successive ruptures of patellar and Achilles tendons. Anabolic steroids in competitive sports.
  22. Spontaneous rupture of the anterior cruciate ligament after anabolic steroids.
  23. Spontaneous rupture of the extensor pollicis longus tendon after anabolic steroids.
  24. Spontaneous tendon ruptures in alkaptonuria. 
  25. Rheumatic manifestations of endocrine disease.
  26. The endocrine system and connective tissue disorders.
  27. Same Disease, Different Symptoms: It’s all in the Mitochondria.
  28. Your Mighty Mitochondria.
  29. Department of Health and Human Services Public Health Service Food and Drug Administration Center for Drug Evaluation and Research Office of Surveillance and Epidemiology Pharmacovigilance Review. (References provided for mitochondrial toxicity within the document).

Share Your Story

If you have been injured by a fluoroquinolone antibiotic, please share your story. Send us a note here, for more information.

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More people than ever are reading Hormones Matter, a testament to the need for independent voices in health and medicine. We are not funded and accept limited advertising. Unlike many health sites, we don’t force you to purchase a subscription. We believe health information should be open to all. If you read Hormones Matter, like it, please help support it. Contribute now.

Yes, I would like to support Hormones Matter. 

Laboratoires Servier, CC BY-SA 3.0, via Wikimedia Commons

*The website is no longer available. 

This post was published originally on Hormones Matter on May 7, 2015; links have been updated where appropriate. 

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Can Fluoroquinolone Antibiotics Cause Dental Problems?

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Cipro Tooth Damage

Amid the long and growing list of side effects associated with the fluoroquinolone antibiotics (Cipro/ciprofloxacin, Levaquin/levofloxacin, Avelox/moxifloxacin, Floxin/ofloxacin and a few others), dental problems seem increasingly prevalent but least understood. On the patient boards, dedicated to understanding the adverse reactions of these antibiotics, patients routinely report serious dental problems after taking fluoroquinolone antibiotics.

Susan, pictured above, age 50, reported the following:

“My top teeth started rapidly decaying after the Cipro, the bottom ones are going too, but at a slower pace. Over the summer, I had all my top teeth pulled, they were just snapping off, one by one. This is what they looked like just before having them removed.”

Christopher, also age 50, reported:

“Finally my teeth started to deteriorate and calcify as well. This happened very suddenly. My teeth then began cracking and breaking off at the gum line. Eventually I lost all of my teeth. It was the scariest thing I have ever experienced in my life.”

One woman wrote the following about her mother, age 72:

“My mom has had several rounds of Levaquin over the years and it destroyed her gut. Along with other chronically prescribed medications, by the time we reached her last prescription of Levaquin, she was very ill and severely depleted in several key nutrients. Through much pain and suffering, we removed all unnecessary medications, which turned out to be all of them. It took 6-8 months to titrate some of the medications down gradually before complete cessation. During that time, we cleaned up her diet (mostly organic, no gluten, no sugar, no processed food) and added nutrient supplements (B vitamins, vitamin D, magnesium, coQ10, fish oil, and others). She swims regularly. As a result, I think she has mostly avoided the side effects of these drugs. Recently, however, her teeth began falling out – just falling out. She had really good teeth before this, no problems whatsoever. Each time a tooth came out, there was a period of what I think was nerve pain, but the dentist couldn’t find anything. Then, a couple days later the tooth would fall out. Three teeth have fallen out so far. We don’t know what to do.”

Becky, age 41, noted that,

“I have lost 3 teeth after being floxed! and they didn’t rot they were fine from the outside…They abscessed at the roots! I take good care of my teeth but now that I have put 2 and 2 together, I def believe it was from being floxed!!!”

None of the patients who experienced tooth loss had a history of methamphetamine use or any other known factor that would cause such extensive dental problems.

Possible Mechanisms for Fluoroquinolone Tooth Loss

Very little research has been done on the long-term effects of fluoroquinolones on dental health. There are several possible mechanisms for fluoroquinolone induced tooth loss, but none have been proven – or even examined as far as I can tell.  Here is what I was able to dig up.

On the web site Cipro is Poison, it is noted that “Cipro can calcify all of the nerves in your teeth as well as permanently dry out your mouth, promoting extensive tooth decay and/or tooth loss. There are people in their thirties who now wear dentures as a direct result of Cipro destroying all of their teeth from the inside out. Others have had teeth literally break off at the gum line after becoming floxed.”  The administrator of the Cipro is Poison site was 30 years old when he was “floxed” by Cipro, and reported experiencing “horrific neuropathic pain inside all of my teeth lasting for a good three or four years–it felt like the nerves inside my teeth had electric current running through them at all times.  All of my teeth also became extremely brittle.”

Peripheral and autonomic nervous system dysfunction have been reported from those suffering from fluoroquinolone toxicity. Often, the autonomic nervous system dysfunction fluoroquinolone toxicity symptoms display in ways that are similar to the symptoms of Sjogren ’s syndrome; such as dry mouth, dry eyes, skin rashes, joint pain, fatigue, etc.  As is noted on Cipro is Poison, perpetual dry mouth can lead to tooth decay and tooth loss. According to the Sjogren’s Syndrome Foundation, “Most Sjögren’s patients no longer produce sufficient quantities of protective saliva. Not only can that make our mouths feel dry, but also our teeth can be damaged. Most people don’t realize the protective value of saliva. They think it’s just moisturizing their mouth, when in reality it’s helping to recoat their teeth with important minerals that will slow down cavities and infection. Without saliva, you have a higher chance of infections and quick moving cavities.”

Fluoroquinolone toxicity and Sjogren’s syndrome are not one in the same (though there is more overlap than is generally recognized), but the common symptom of dry mouth may be the mechanism for tooth loss associated with both fluoroquinolone toxicity and Sjogren’s syndrome.

The fluoroquinolones might lead to dental problems through the destruction of the microbiome, the so-called good bacteria necessary for health and wellness. Fluoroquinolones are powerful, broad-spectrum antibiotics that cause a massive amount of oxidative stress in the microbiome. The health of the microbiome of the entire digestive tract, including the microbiome of the mouth, plays a significant role in the health of teeth. Should the bacterial balance of the mouth be altered, like that of the gut, it is conceivable that tooth damage would arise (source).

Additionally, fluoroquinolones cause mitochondrial dysfunction  which leads to oxidative stress and cellular dysfunction on many levels. One of the downstream effects of cellular dysfunction may be the cause of dental problems among patients dealing with fluoroquinolone toxicity. Although, there is little research regarding its impact on teeth.

The chelation of magnesium from cells by fluoroquinolones may also have something to do with the loss of teeth experienced by victims of fluoroquinolone toxicity, but again, there is no research on the topic.

Dental Problems are Delayed Fluoroquinolone Toxicity Reactions

Most of the patients who reported tooth loss experienced dental problems months or years after administration of the fluoroquinolone had ceased. Susan, quoted and pictured above, noted that her teeth were fine 6-months after her experience with fluoroquinolone toxicity began. Becky noted that she lost a tooth per year after going through fluoroquinolone toxicity. Chris didn’t lose his teeth until the end of his 8-month course of Cipro. It should be noted also, that most patients suffer from a constellation of post fluoroquinolone symptoms, in addition to the dental problems.

Though studies documenting tooth loss were difficult to come by, the patient reports of dental problems after fluoroquinolone exposure are common and concerning. Losing teeth should not be a side-effect of antibiotics taken to treat urinary tract or sinus infections. If you or someone you know suffered from post fluoroquinolone dental problems, please leave a comment below and take few minutes to complete the fluoroquinolone side-effects study described below.

Information about Fluoroquinolone Toxicity

Information about the author, and adverse reactions to fluoroquinolone antibiotics (Cipro/ciprofloxacin, Levaquin/levofloxacin, Avelox/moxifloxacin and Floxin/ofloxacin) can be found on Lisa Bloomquist’s site, www.floxiehope.com.

Participate in Research

Hormones MatterTM is conducting research on the side effects and adverse events associated with the fluoroquinolone antibiotics, Cipro, Levaquin, Avelox and others: The Fluoroquinolone Antibiotics Side Effects Study. The study is anonymous, takes 20-30 minutes to complete and is open to anyone who has used a fluoroquinolone antibiotic. Please complete the study and help us understand the scope of fluoroquinolone reactions.

Hormones MatterTM conducts other crowdsourced surveys on medication reactions. To take one of our other surveys, click here.

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This article was published previously on Hormones Matter in December 2014.

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