levaquin tendons

Why Athletes Should Never Take Fluoroquinolone Antibiotics

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fluoroquinolone antibiotics and athletes

I could tell you that if a drug has a black-box warning stating that it can cause tendon ruptures, you shouldn’t take it if you are an athlete—after all, tendons are necessary for movement. Or, I could tell you about how the black-box warnings on fluoroquinolone antibiotics (Cipro, Levaquin, Avelox, Floxin, and their generic equivalents) are completely and utterly inadequate because fluoroquinolones not only lead to achilles tendon ruptures in those over 60, they lead to “a wide spectrum of musculoskeletal complications that involve not only tendon but also cartilage, bone, and muscle” in people of all ages.

I could describe the mechanisms through which fluoroquinolone antibiotics age cells and make people feel as if they are geriatric when they are young or middle-aged. No one wants to age prematurely, but athletes in particular want to keep their bodies youthful and strong.

I could tell you about the debilitating, chronic pain that people going through fluoroquinolone toxicity experience, or I could tell you about the autonomic nervous system dysfunction. Or, I could tell you about how fluoroquinolones downgrade GABA neurotransmitters and can lead to chronic insomnia and anxiety. All people, athletes included, want to avoid debilitating pain, autonomic nervous system dysfunction (and all of its manifestations), insomnia, and anxiety.

But technical information about the dangers of fluoroquinolone antibiotics isn’t near as convincing as true stories about the pain that fluoroquinolones have caused. Data in a study isn’t relatable, and neither are descriptions of mechanisms of action. However, people can relate to examples and case-studies, and I hope that athletes reading this will realize that fluoroquinolone antibiotics can hurt and disable all people, including athletes. Unless there is no alternative and one must take a fluoroquinolone to save his or her life, these drugs are too dangerous for athletes to use.

Jeremy’s Story

In a comment on a Consumer Reports article, “Fluoroquinolones Are Too Risky for Common Infections,” Jeremy stated:

“I took one dose of Levaquin 2.5 years ago and it ruined my life. I was/am an athlete and was administered it for a sinus issue. I was on crutches for 8 months and I am still in pain 24/7 with peripheral neuropathy. I can’t sleep and there is no respite from the pain. Please don’t take these drugs unless it’s a last resort… life and death. It’s not worth the pain and suffering, I didn’t know if I was going to make it for a long long time and may never recover or be able to kite surf, ski, back country, hike, backpack or even go up stairs easily again, ever!”

Athletic pursuits were a huge part of Jeremy’s life before he took Levaquin. Now he is in constant pain and fears that he will never again be able to do the sports and activities that he loves.

Chris Danelly’s Story

chris-fqwall

The picture of Chris Dannelly above speaks volumes. Chris was at the prime of his life and the peak of his fitness when he took levofloxacin. Tragically, after just two pills of levofloxacin, Chris suffered a toxic reaction (rhabdomyolysis) that took his life. He was not only an athlete, he was a loving husband and a father to two young children.

In this video Chris’s widow Kathy speaks out about Chris’s tragic death:

JMR’s Story

JMR was a 50 year old active and athletic woman before she took Ciprofloxacin. In the article, “Fluoroquinolone Antibiotics and Thyroid Problems: Is there a Connection?” she states:

“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.”

Additionally, in “Adverse Drug Reactions (ADRs): We’re ALL at Risk” JMR describes the severity of her adverse reaction to ciprofloxacin:

“I’m lying in my bed, with my arms and legs straight out. I figured out pretty fast that any stress whatsoever on the tendons, makes things worse for days, weeks even. “Stress” includes not only trying to walk or use my arms or legs for any reason at all, but also simply bending my arms, or my knees, or my fingers, in one position for too long. What’s “too long”? Maybe 3-5 minutes or so. I can’t use crutches or a wheelchair, because both of those involve use of my arms and shoulders and hands, which are also out of commission. I can’t type or use the computer, because every tendon in my fingers, hands, wrists, and arms are affected and severely painful. I can’t hold up a book to read, because the weight of the book is too much and I can’t bend my arms, without increasing the tendon pain. The weight of the sheets on my toes causes severe pain in the tendons there. There must be tendons around the eye muscles too, because it hurts simply to move my eyes. So I lay there in my bed, with my arms and legs flat out, with my head still and my eyes closed, waiting. Waiting for what, I’m not sure. It’s hard to believe that I went jogging and bike riding and swimming only a few days ago. I’m also in shock. How in the world could a simple antibiotic that I took for a simple UTI do this to me?”

More information about the effects of ciprofloxacin on JMR’s life can be found on www.fluoroquinolonethyroid.com.

Terry’s Story

I don’t have a direct quote from Terry to illustrate her situation, so I’ll just do my best to summarize it. Terry loves tennis and plays it often. She’s not a professional tennis player by any means, but it is one of her favorite activities.

Terry took ciprofloxacin to treat a urinary tract infection. Three weeks later she returned to playing tennis and noticed that her ankles hurt after playing an easy game. She played tennis again a few days later and noticed that her ankles hurt worse than before, and that her wrists were starting to hurt. After a few months she went to her doctor and her doctor told her that she had multiple tears in her ankle tendons. Her knees became tender shortly thereafter. Now, with her ankles, wrists and knees in pain, the joy of playing tennis has been taken away from her. She is hopeful that her tendons will heal and that she will be able to play tennis like she did before she took ciprofloxacin, but she is scared that her tendons may continue to tear and rupture. Only time will tell.

Other Case Studies

The article, “Fluoroquinolone-induced serious, persistent, multisymptom adverse effects” published in the British Journal of Medicine, goes over four cases of people who were healthy, active and athletic prior to taking fluoroquinolone antibiotics who are now disabled because of their reactions. I recommend that everyone read through it prior to taking a fluoroquinolone antibiotic.

Mayo Clinic Physician Recommendations

In the article “Musculoskeletal Complications of Fluoroquinolones: Guidelines and Precautions for Usage in the Athletic Population” published by the American Academy of Physical Medicine and Rehabilitation, and written by three physicians with ties to the Mayo Clinic College of Medicine in Rochester, Minnesota, proposes the following guidelines for fluoroquinolone use in athletes:

  1. Athletes should avoid all use of fluoroquinolone antibiotics unless no alternative is available.
  2. Should a fluoroquinolone antibiotic be prescribed, the athlete, and ideally the coaching and athletic training staff, should be made aware of the increased risk for the development of musculoskeletal complications. Health Insurance Portability and Accountability Act guidelines should always be followed when discussing the athlete’s health with coaching and athletic training staff.
  3. Oral or injectable corticosteroids should not be administered concomitantly with fluoroquinolones.
  4. Consideration should be given to supplementation with magnesium and/or antioxidants during the fluoroquinolone treatment course if no contraindications are present.
  5. Training alterations should begin at the time of the first dose, including a reduction in high-intensity and ballistic activities and total training volume. The reductions should remain throughout the duration of the antibiotic course. If the athlete has no symptoms after completing the full course of the antibiotic, then a graduated return to full activity under direct medical supervision should be initiated, with close monitoring for the development of musculoskeletal symptoms.
  6. All athletic activity should cease at the onset of symptoms, with graduated return to activities when the person is asymptomatic. The fluoroquinolone should be discontinued if possible, and alternative antibiotic treatment should be prescribed if clinically indicated.
  7. Close monitoring should continue for [at least] one month from completion of the antibiotic course. The athlete should understand that symptoms have been reported as late as 6 months after fluoroquinolone exposure, and prompt medical evaluation should be sought if symptoms develop. During this period, special consideration should be given to adequate recovery between bouts of high-intensity activity or competitions.

Avoid Fluoroquinolones

Athletes, and everyone who values their tendons, muscles, cartilage, autonomic nervous system, central nervous system, and peripheral nerves, should avoid fluoroquinolone antibiotics whenever possible. Fluoroquinolones are powerful drugs with life-altering consequences. Adverse-reactions to fluoroquinolones are often severe. The people mentioned above certainly didn’t think that they could experience a life-altering adverse-reaction to an antibiotic, but it happened to them. Please heed their warnings and don’t let it happen to you.

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.

This article was first published on Hormone Matter in March 2016.

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Don’t Take Cipro, Levaquin or Avelox If….

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Lisa Bloomquist flouroquinolone antibiotics

There is a huge range in how people react to fluoroquinolone antibiotics (Cipro/Ciprofloxacin, Levaquin/Levofloxacin, Avelox/Moxifloxacin and Floxin/Ofloxacin). Some people take fluoroquinolones repeatedly and never experience an adverse reaction. Some people are left bed-bound after one pill, or one prescription. Some people take a full fluoroquinolone prescription without incident at one time in their life, then, when they take a second (or third, or fourth) prescription, their body goes hay-wire. Some people have a sudden and severe adverse reaction, where they are unable to move or think after previously being fine, and other people have a gradual onset of symptoms where they damage tendons or develop neuropathy slowly, over time.

What determines how a person reacts to fluoroquinolones? The black box warning label on fluoroquinolones states that, “risk (of tendinitis) is further increased in older patients usually over 60 years of age, in patients taking corticosteroid drugs, and in patients with kidney, heart or lung transplants.” But people who fit into those categories aren’t the only people who are hurt by fluoroquinolones. I didn’t fit into any of those categories. I was 32, athletic, strong, not on any medications, etc. when I was sickened by Cipro. I was healthy. But fourteen 500 milligram pills of Cipro (half taken in 2009 without incident and half taken in 2011 with a sudden severe adverse reaction) were enough to cause my body and mind significant harm.

I must have had risk factors that made me susceptible to fluoroquinolone toxicity though, because Cipro made me quite sick. I’m honestly not sure what those factors are (no one knows – or at least they aren’t publishing papers about it if they do). Perhaps those who are hurt by fluoroquinolones have depleted liver enzymes and therefore they aren’t able to metabolize drugs like people who have more robust supplies of drug metabolizing enzymes. Perhaps people who suffer from fluoroquinolone toxicity are depleted of cellular magnesium, as magnesium has been shown to have protective effects on cells that are exposed to fluoroquinolones. Perhaps the microbiome of those who are hurt by fluoroquinolones is depleted of good bacteria and an overwhelming number of bad bacteria in the gut leads to many of the symptoms of fluoroquinolone toxicity. Perhaps there are some people who are genetically predisposed toward having an adverse reaction to fluoroquinolones. As with everything, there is a mix of genetics and environment that goes into how the body reacts when faced with a chemical onslaught. Human bodies are unbelievably complex and multifaceted; once individual differences are considered, the complexity becomes mind-boggling.

Customizing medicine is difficult. The entire human genome, though sequenced, has not yet been mapped out. We are not at a point yet where we can easily and inexpensively test genes and interpret the results of genomic tests.

Genes aren’t the only things that determine how a person reacts to a drug. The microbiome also plays an important role in determining drug metabolism. Per an article entitled, Role of Intestinal Microflora in Xenobiotic-induced Toxicity, “individual differences in the intestinal microflora may result in individualized xenobiotic (a chemical or substance that is foreign to an organism or biological system) toxicities.” The differences in the bacteria in our gut make a difference in how drugs are metabolized. As the microbiome is changed, through drugs – especially antibiotics, the reaction of the individual patient to formerly well tolerated drugs, can change.

Until customizing medicine to the individual becomes feasible, what are doctors supposed to do to prevent their patients from having a dangerous adverse reaction to a drug? Drugs with potentially devastating adverse effects could be avoided entirely unless they are necessary to save a life. This is the policy that I would like to see applied to fluoroquinolones. (The cellular damage that fluoroquinolones inflict make their use inappropriate for infections that are not life-threatening.) Unfortunately, prudence in regards to prescribing fluoroquinolones is not the current trend. In 2011, 23.1 million prescriptions for fluoroquinolones were written in the U.S., and despite the 43 page warning label that comes with Cipro/Ciprofloxacin, fluoroquinolone toxicity is denied by many physicians. As much as I would like to cut the number of fluoroquinolone prescriptions by 90%, the entire medical establishment is not yet listening to me and others who are screaming about the pain and suffering caused by fluoroquinolones. To reduce the number of people hurt, either a study or news story must induce a paradigm shift enabling all doctors to see that fluoroquinolones are vastly more dangerous than penicillin, or patients (especially those in the risk categories listed below) must ask their doctors to not prescribe them.

Though the true risk factors for fluoroquinolone toxicity (genetic, enzyme and microbiome markers) are not yet established, there are some groups of people who are at higher risk of an adverse reaction than others. They should never be given fluoroquinolones. Those groups are:

  1. People who have had an adverse reaction to a fluoroquinolone in the past. Despite the fact that all of the warning labels for fluoroquinolones state that they should not be given to people with a history of hypersensitivity to fluoroquinolones, the recommendation that they be avoided is often ignored. This is the case because people often don’t realize that they are having a mild adverse reaction to a fluoroquinolone. Who would think that muscle twitches, insomnia, urgency when urinating or loss of endurance would be related to the administration of an antibiotic? The connection is so bizarre that it is often not recognized. A list of warning signs that your body has reached its threshold for fluoroquinolones can be found here: Warning Signs of Fluoroquinolone Toxicity.
  2. Athletes. It is well documented and known that fluoroquinolones degrade the structure of tendons. They “exert a toxic effect not only on tendons but also on cartilage, bone, and muscle,” per a Mayo Clinic affiliated article entitled Musculoskeletal Complications of Fluoroquinolones: Guidelines and Precautions for Usage in the Athletic Population. Further information about why the Mayo Clinic researchers note that, “Athletes should avoid all use of fluoroquinolone antibiotics unless no alternative is available” can be found here: Deciphering the Pathogenesis of Tendonopathies: A Three Stage Process.
  3. People on steroids. Steroids are contraindicated with fluoroquinolones. As is noted in the Cipro/Ciprofloxacin warning label, people who are on corticosteroids are at an increased risk of tendonitis when administered fluoroquinolones. In addition to the increased risk of tendon damage, the combination of steroids and fluoroquinolones can increase the risk of development of a deadly glabrata fungal infection.
  4. People who need to take NSAIDs regularly. NSAIDs, and other drugs that contain a carboxylic acid molecule, are contraindicated with fluoroquinolone toxicity. Patients suffering from fluoroquinolone toxicity have reported adverse reactions to NSAIDs even weeks or months after they have stopped taking fluoroquinolones. The adverse interaction between fluoroquinolones / fluoroquinolone toxicity and NSAIDs is likely because of the formation of poisonous acyl glucuronides. Articles describing this process can be found on Fluoroquinolone Links and Resources.
  5. Immunocompromised individuals. Fluoroquinolones, and other broad spectrum antibiotics, kill good bacteria along with harmful bacteria. When the good bacteria in the gut are wiped out, they can no longer keep the bad bacteria, or fungal infections, in check. Fungal infections can take over a person’s body and they can be deadly. This can happen with people who have healthy immune systems. For people with already compromised immune systems, vulnerability to fungal infections may be increased. Per an article in Life Extension Magazine, “Anyone can acquire a fungal infection, but the elderly, critically ill, and individuals with weakened immunity, due to diseases such as HIV/AIDS or use of immunosuppressive medications (such as corticosteroids), have a higher risk.”
  6. People with mitochondrial dysfunction. Per an article entitled Mitochondrial Reactive Oxygen Species Control T Cell Activation by Regulating IL-2 and IL-4 Expression: Mechanism of Ciprofloxacin-Mediated Immunosuppression, “ciprofloxacin was also shown to deplete the mitochondrial DNA (mtDNA) content, thus leading to mitochondrial dysfunction and retarded cellular growth.” Ciprofloxacin and other fluoroquinolones damage mitochondria. Those with preexisting mitochondrial dysfunction will suffer more as their mitochondria are further damaged.
  7. Children. Fluoroquinolones have been shown to degrade cartilage in juvenile animals and, for this reason, are generally considered to be contraindicated in the juvenile population. Unfortunately, children are still prescribed fluoroquinolones by pediatricians who are unaware of the severity of adverse reactions to fluoroquinolones.

Until medicine is more individualized and every factor that makes a person more or less susceptible to experiencing an adverse reaction to a drug can be tested before that drug is administered, everyone who takes a fluoroquinolone is at risk of experiencing an adverse reaction. The best way to protect oneself from fluoroquinolone toxicity is to not take a fluoroquinolone. Though there are some risk factors that make some groups of people more susceptible to experiencing a severe adverse reaction to fluoroquinolones than others, there is no guarantee that not fitting into one of those groups will ensure your safety. With that noted, the people who fit into any of the seven categories listed above should avoid fluoroquinolones whenever possible.

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.

To sign up for our newsletter and receive weekly updates on the latest research news, click here.

What Else Can I Do To Help?

Hormones MatterTM is completely unfunded at this juncture and we rely entirely on crowdsourcing and volunteers to conduct the research and produce quality health education materials for the public. If you’d like help us improve healthcare with better data, get involved. Become an advocate, spread the word about our site, our research and our mission. Suggest a study. Share a study. Join our team. Write for us. Partner with us. Help us grow. For more information contact us at: info@hormonesmatter.com.

To support Hormones Matter and our research projects – Crowdfund Us.

This post was published previously on Hormones Matter in January 2014.

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The Doctor Said Not to Worry About Levaquin Warnings

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Patty Ireland

I was floxed on October 8 of 2012. I was given Levaquin while on high dose of prednisone as a prophylactic measure during an asthma flare. I had been on a 10 day course of 60mg/day prednisone, was off a week, and then had to go back on for an asthma flare. The asthma doctor gave me Levaquin as a “prophylactic measure” because she was afraid I would pick up some kind of infection at work. I had no infection at the time.

When I filled the prescription, the pharmacist warned me about the tendon issues with Levaquin, especially since I was over 60, and on prednisone. He said I should drink plenty of water and I should be fine. The scrip came with a 7-page patient medication guide. On the first page was “What is the most important thing I need to know about Levaquin?”  It included the warning about tendon issues.

I called the doctor back and said I didn’t think I should take the drug.

She said they use it this way all the time and no one ever really has a problem. So I took the first pill and went to bed.

My Levaquin Reaction

I woke up 4 hours after taking the first pill, with tremors, ringing in my ears that sounded like I was in a tent full of cicadas, and audial hallucinations that sounded like the soundtrack to Rosemary/s Baby (the evil Roman chanting). I was also seeing things out of the corner of my eyes. I called the doctor the next day to report the symptoms.

She said, “Oh it can’t be the Levaquin, it must be the prednisone. It can make you jumpy.”

I replied that I have been taking prednisone all my life, and never had anything like this. I took the second pill that night, anyway.

The side effects got worse and I finally read all 7 pages of the patient guide. I realized that I was suffering the CNS and peripheral neuropathy issues, and decided I would quit the Levaquin. I called the doctor the next morning and she wanted to give me another antibiotic.

I said “but I don’t actually have an infection, right?”

She said, “yes.”

I said no more antibiotics.

The Next Few Weeks Post Levaquin Toxicity

The audial and visual hallucinations went away after two days, but the tinnitus and the tremors remain to this day.

Eight days later I left for a long-planned trip to Florida for wildlife photography. I woke up in the middle of the night in a hotel room 1100 miles from home with my whole body on fire, pain in my neck, shoulders, elbows, wrists, hips, knees and ankles feeling like they had hot pokers sticking through. I had burning electrical sensations in my hands and feet, a ring of electricity running around the top of my head. I could barely walk. My thighs felt like I had tried to run a marathon with no warm up and that they were going to collapse under me at any moment. Prior to this, I was used to hiking all day carrying 25 lbs of photo equipment through forests, swamps, etc.

Post Levaquin Insomnia and Sleepwalking

I won’t even try to describe the next 10 days in Florida before I could get home, but needless to say I did not do a lot of wildlife photography that trip. I also developed insomnia. I could not sleep more than 1-2 hours at a time, and I would have very vivid dreams. I found myself sleepwalking, and having nightmares, which continued when I returned home. I would find myself in the kitchen making coffee at 1:30 AM because the dream that the alarm had gone off was so vivid. One night, I woke up on my deck in my underwear and barefoot at 2 AM in below zero weather (with snow on the deck) smoking a cigarette, because I was dreaming I was back in Florida at the non-smoking condo. The side effects of fluoroquinolone antibiotics are worse than the symptoms of the illnesses for which they are prescribed. This is not appropriate.

In the year since my reaction, I have been through neurologists, rheumatologists, physical therapy, and psych/neuro testing for the loss of memory and brain function. I have been diagnosed with essential tremor and fibromyalgia and osteoarthritis, with brain fog, reduced cognitive functioning, insomnia, high blood pressure, to name a few. I also have ongoing stomach issues. Here too, the medications that have been prescribed for the adverse effects of Levaquin – the antidepressants, anti-seizure medications, benzodiazepines and pain killers – have side effects far worse than what I experienced post Levaquin reaction and do nothing to heal my body. They only mask my symptoms and don’t even mask them that well.

Going Forward Post Levaquin Toxicity

I use turmeric extract 3 times a day for pain management. The pain never goes away totally, but the turmeric keeps it down to a dull roar. The hot poker sensation that I once felt, is now less frequent. I always have pain though. The sensation of imminent collapse in my thighs never goes away, even though I am  back to  walking 3 miles a day. The tremors have actually progressed. The tremors and the brain fog (memory loss, loss of words, losing track of what I am doing, loss of ability to multi-task ) have kept me unable to work since May of 2013.  And, I still can’t sleep more than 2 hours at a time or with sleep aids 3-4 hours. Here, in December of 2013, I am still disabled. My GP is also certified in Functional Medicine, and we are working with a course of supplementation based on blood tests for oxidative stress and dietary changes. We are following Dr. David Perlmutter’s Grain Brain Diet to improve neurological issues. We are both researching all of the possibilities we can, and hoping each day for some kind of breakthrough for this incredible illness.

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.

To sign up for our newsletter and receive weekly updates on the latest research news, click here.

What Else Can I Do To Help?

Hormones MatterTM is completely unfunded at this juncture and we rely entirely on crowdsourcing and volunteers to conduct the research and produce quality health education materials for the public. If you’d like help us improve healthcare with better data, get involved. Become an advocate, spread the word about our site, our research and our mission. Suggest a study. Share a study. Join our team. Write for us. Partner with us. Help us grow. For more information contact us at: info@hormonesmatter.com.

To support Hormones Matter and our research projects – Crowdfund Us.

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