Did you know that the FDA has issued a safety notification about a class of popular antibiotics called fluoroquinolones (FQs)? The announcement involves the following drugs:

  • Ciprofloxacin (Cipro)
  • Gemifloxacin (Factive)
  • Levofloxacin (Levaquin)
  • Moxifloxacin (Avelox)
  • Norfloxacin (Noroxin)
  • Ofloxacin (Floxin)

According to the FDA, over 21 million people get a prescription for one of these drugs each year. That makes this class of antibiotics among the most popular in the pharmacy. Doctors love to prescribe FQs because they are effective for a wide range of infections including bronchitis, pneumonia, sinusitis, urinary tract infections, prostatitis and skin infections.

These drugs have been around for decades. Cipro, for example, has been on the market for over 25 years. After all this time, one would think that the FDA would have a clear understanding of the benefits and risks of such drugs. In fact, you might assume that doctors would have been warned about complications of FQ drugs like Levaquin or Cipro from the very beginning. Au contraire. It comes as a great shock to patients to discover that serious fluoroquinolone warnings continue to be issued, decades after these drugs were originally approved.

The most recent FDA announcement relates to nerve damage, aka peripheral neuropathy. Here is the official safety communication issued on 8-15-2013:

“This serious nerve damage potentially caused by fluoroquinolones may occur soon after these drugs are taken and may be permanent… Peripheral neuropathy is a nerve disorder occurring in the arms or legs. Symptoms include pain, burning, tingling, numbness, weakness, or a change in sensation to light touch, pain or temperature, or the sense of body position. It can occur at any time during treatment with fluoroquinolones and can last for months to years after the drug is stopped or be permanent. Patients using fluoroquinolones who develop any symptoms of peripheral neuropathy should tell their health care professionals right away.”

In other words, patients can experience this potentially irreversible nerve damage within days of starting drugs like ciprofloxacin or levofloxacin. Even if the drugs are stopped promptly, the side effects can last.

Doctors and pharmacists may not always describe the symptoms patients need to watch out for. And people may not associate weakness, numbness or tingling with an antibiotic, since it doesn’t seem logical that a medicine designed to overcome an infection would damage nerves. Such symptoms may not seem that bad, but in some cases peripheral neuropathy can be permanently disabling.

OTHER KINDS OF NERVE DAMAGE:

We first became aware of unusual problems brought on by fluoroquinolone antibiotics in July of 1994 after receiving this question:

“I often have side effects from medicines, but have never experienced anything like Floxin. I took it for a severe sinus infection followed by pneumonia last winter. After three days of utter misery and a rash on my back, I started hallucinating. Are there other people who have had a bad reaction to this antibiotic?”

We had to do some digging, but we finally discovered that FQs can cause “hallucinations, visual disturbances confusion, dizziness and seizures.”

We talked to journalist Stephen Fried about his wife’s experience with Floxin. In the book Bitter Pills, the Frieds describe how one Floxin pill for a urinary tract infection led to debilitating neurological symptoms that lasted for years.

At the time, a lot of doctors didn’t believe such long-lasting neurological complications could happen so quickly. It has taken the FDA over 25 years to alert physicians to just such a possibility.

The same can be said about tendinitis or tendon rupture. This is another very serious adverse reaction triggered by FQ antibiotics. The first published report of an Achilles tendon problem appeared in 1983. Thereafter there were many case reports linking drugs like ciprofloxacin and levofloxacin to tendinitis and tendon rupture. These can also be disabling complications of FQ antibiotics. It took the FDA until 2008 to issue “black box” warnings about this problem, 20 years after Cipro was first introduced.

FLUOROQUINOLONE SIDE EFFECTS & COMPLICATIONS:

  • Digestive distress, nausea, diarrhea, constipation, stomach pain, heartburn, vomiting
  • Headache, dizziness
  • Agitation, anxiety, irritability, restlessness, confusion
  • Insomnia
  • Tendon problems, tendinitis, tendon rupture
  • Retinal detachment
  • Nerve damage, peripheral neuropathy, nerve tingling, numbness
  • Allergic reactions, skin rash, anaphylaxis (life-threatening reaction requiring immediate medical attention!)
  • Super-infections including C. diff diarrhea
  • Hallucinations, psychosis, seizures
  • Depression, suicidal thoughts or actions
  • Irregular heart rhythms, torsades de pointes, QT prolongation
  • Kidney or liver damage
  • Blood disorders
  • Arthritis, muscle pain, weakness

READER REACTIONS:

Here are some stories from visitors to our website. Add your own FQ experience below. If these antibiotics have worked well for you without side effects we would like to hear about that. If you have suffered, we would like to see your story as well. Please comment below.

“I have taken Cipro a number of times over the years and wondered why my tendons, especially the Achilles tendon, were so inflamed. Finally read the side effects and saw it can be a serious side effect to the point of bursting the Achilles tendon. I carry a note with my insurance card in my wallet warning not to give me any of this family of antibiotics.” C.G.


“It’s been eight months and I’ve been to two specialists trying to determine if I have arthritis. They say I do not. I took Cipro and Levaquin within a one month period and it has been eight months since then, and I have pain and stiffness EVERY DAY. What started out as plantar fasciitis and wrist tendinitis then moved into my hips and elbows and is now in my upper back and shoulders.

“I ran a low grade fever for 6 months after taking these drugs. The symptoms started within two days of taking the last dose of Levaquin. I have not even addressed the fatigue, irritability and mood changes I experienced during the first three months after taking the drug. I was healthy, active and exercised regularly. Now I don’t know what to do–stretching generally aggravates my pain. How can the FDA allow this drug to be prescribed?” Augsdi


“In 2000 I had an adverse reaction to Cipro: inflammation of most of my connective tissue to the point of needing help to get up out of bed or get dressed. I was unable to lift much and could not sit for more than 15 minutes due to the pain. My doctors could not believe it was the Cipro. It was 5 years before I was able to hike and ride my bike again.” Jo


“The quinolone drugs, Cipro, Levaquin, Avelox, etc. are extremely strong and dangerous. When they go awry the adverse effects are serious, long term and often permanent.

“The awareness in the medical community of these dangers is extremely poor and often the concerns of patients suffering from adverse effects of these drugs are dismissed as ‘not possible,’ despite studies and literature citing these very effects i.e. neuropathy, tendon ruptures, neuromuscular damage, cartilage damage and others.

“I struggle to heal from 5 days of Cipro given a year ago and have met hundreds of people now who are going through similar struggles due to quinolone antibiotics. These drugs, though tolerated by many, should only be dispensed when there is no safer alternative due to the severity and permanence of adverse effects.” Tao

 

Join Over 68,000 Subscribers at The People's Pharmacy

Each week we send two free email newsletters with breaking health news, prescription drug information, home remedies and a preview of our award-winning radio show. Join our mailing list and get the information you need to make confident choices about your health.

  1. gary
    georgia
    Reply

    I took this antibiotic and after SIX doses stopped as it made me ill. Two months later my arm began aching and the pain would move from sholder to fingers then some locations would go numb. The pain is now top scale and none of the otc medicines even temper this pain… I was prescribed Dilaudid and even that is not effective. Seeing a specialist soon (thanks to Obamacare)

  2. Kathryn
    Oregon
    Reply

    Over the past 2 years, I have been prescribed Cipro for UTIs on several occasions. Last year, the UTIs became a problem when immediately after the 10 day dose, the UTI would return. A refill of Cipro was then ordered and another 10 days, almost back to back, with the first 10, was taken. That was the middle of summer, 2014. At the end of August, I left for a 2 week vacation to see grandbabies in Minnesota.

    5400 miles later, I was a wreck, and my vacation consisted primarily of pulling off the highway so I could walk around my vehicle a few times, trying to make the sharp pins and needles go away. In my head, if you sit too long and your foot falls asleep, you massage it, stand up on it, and when ready, you walk it off. Not so on this trip. It just wouldn’t let up. Within 2 months after vacation, the flare ups were increasing, and the pain was getting worse on a daily basis. By Christmas, I could barely walk. The bottoms of my feet are unrecognizable to me now. They don’t feel what they should. It’s like my feet never actually touch the floor. I feel like there’s a can of soup under my left foot and a sharp, grated bike pedal under my right foot.

    The magnitude of the pain has increased to a level I can barely stand at times. I live 5 minutes from one of the most beautiful beaches on the west coast. Every day I would walk that beach, breathing in the freshness, releasing tension, and counting my blessings. Now, I just want to gently pull on a loose fitting, soft cotton sock, without sobbing from the pain. Cipro was never intended for use on trivial matters such as a UTI. It was meant for possibly life threatening infections. But because it works and works quickly, it’s prescribed over and over again. My life has come to a screeching halt this month when my safety became a huge issue. I am too unstable to get around my little apartment, let alone, make it to the beach or to the post office or the grocery store. Instead, I sit, and I cry, and I think about suicide. Living with this for another 20 years, or whatever, will drive me insane. I need relief. And I need it soon. Sooner.

  3. John
    Wappingers Falls, NY
    Reply

    I have a 20 year history of prostate problems and have been prescribed Cipro more times than I can recall. Coincidentally, I have had what feels much like stepping barefoot on a bare electric wire – a stabbing, stinging electric shock-like feeling between the 3rd and 4th metatarsal head left foot with a simultaneous stinging shock in the upper upper thigh – totally over-riding uncontrollable pain. No, Not Mortons neuroma – MRI negative for that. Random, intermittent – Never know when it will hit – sleeping, middle of nite, sitting / relaxing, anytime – almost wrecked the car one time. I believe Cipro is the cause. Never had this before taking it. that this drug causes problems is Not New info…why is it still being prescribed? I just had a doc give me a script for More of it This week! I prefer the infection to the treatment

  4. Katherine
    Oklahoma
    Reply

    In January (2015) i ended up in the ER with an extremely bad kidney infection, sepsis and just to make it more fun, diabetic ketoasidosis. They put me on IV Levaquin. I began complaining about my lips being dry and chapped. They felt like they were growing. the next thing I started complaining about was the water tasting bad. Food too, but I was in the hospital. I was complaining about how cold my fingers were, touching my face, they felt like ice. But when others felt them they didn’t think they were cold at all. I went to wash my hands for the first time and the cold water felt like fire! Thats when I began to realize that the cold fingers i was complaining about was actually my face reacting to touch. My lips were numb, but also I had the feeling of cool, like taking a breath after using mouthwash or a strong breath freshener. My face had that same feeling too. It was very strange and hard to describe.

    At first it was weird, but it continu ed to get worse. It seemed to have started in my mouth and spread down my body. I suspected it was a reaction to the antibiotic. The nurses didn’t think so. My hands, my arms, my chest all progressed to the same numb feeling with the cool sensation, but it had progressed , getting worse. It was getting more uncomfortable. I would complain to anyone who would listen. And I kept saying I felt it was the antibiotic.

    After a few days my husband stopped my nurse and made her listen. She looked up to see what the side effects were. What I was describing wasn’t a side effect. My husband thought neuropathy could be what it was. However , most people feel numb, burning stinging, not the cool sensation I was describing. My husband asked if I felt better about it. I said NO! She said I could refuse it but they culture the bacteria I had and chose the best antibiotic for it. I said ok, I just wanted to get out of there so I shut up.

    I was still worried but they should know better than me. Right? The next day I felt it down my torso and my legs. My legs were already weak and painful. Interestingly, a few years ago something attacked my nerves too. I had pain and numbness both legs and my ride side. I’m beginning to wonder if I took the same class of antibiotics and it caused the problem. I tore a muscle tendon connection, while sleeping something else I need to look into. Anyway, after 4 days I told them I was done I told the dr about my symptoms, she had a neurologist see me, to rule out a stroke. Stupid. She also changed my antibiotic, to CIPRO.! My treating dr came in, and my husband asked him about the antibiotic , told him about the issues I was having.

    Apparently he had no idea. He says u should have told someone, we can prescribe something else. We told him we have been telling them. They were telling me it was the best one for me. So he says he’s gonna have an infectious disease dr look into it. At the time I didn’t know she gave me the same class as the Levaquin.

    I went home the next day after putting in a pic line for 3 more weeks of IV antibiotics. By the time it was over, I have neuropathy from head to toe. It wasn’t the hospital food that tasted bad, it’s most food. Most sweet things are bitter. Chocolate is horrible. Water is horrible. I use a little orange juice in it to make it tolerable. i have to be careful with hot water, foods and anything else hot because I don’t feel it right away. I can only use water that is lukewarm to bath or wash my hands or anything. If something is too rough on my skin I get extremely cold. That happened to me in the hospital. I was so cold I thoughti was gonna freeze. The nurse taking care of me was not very understanding. Kept telling me there was no reason for me to be cold. I hope this gets better. I’m so angry about the hospital staff not listening to me. Maybe it wouldn’t have become so bad!

  5. jay
    LA
    Reply

    In the beginning of april 2014, I thought I had a tract infection and went to see a doctor. He said he didn’t think it was anything and to wait. I got impatient and saw another doctor. I knew so little about antibiotics cause I had taken them a few times before without effects. I was given an 11 day course of levofloxacin or levoquin. I can’t remember now (maybe because of it.lol)
    I immediately had a bad reaction.

    It was like a vice was placed around my head and neck. My neck got very tight and I went to the ER 2 times because I thought I was going to die. They said I had GERD. I’ve have several tests and all came back normal. I’ve taken GERD meds for months with no improvement. I truly believe I do not have gerd/ silent reflux but I’m pushing for a ph test.
    Today, my throat is still very tight and there is something very wrong with it. it still feels inflamed.

    I have been thinking and researching this for ages now and have a few theories… something in my throat became inflamed after the antibiotics, perhaps some tendons were disrupted.
    GERD is a possibility but I dont believe that’s it.

  6. hassan
    tprehran / iran
    Reply

    cipro was prescribed for two weeks after my simple prostatectomy surgery four month ago. The side effects on me is severe pain , burning and rupture on bottom of feet . Still the symptoms not go away. I am 68 years old.

  7. Melissa
    Denver
    Reply

    Two months before the black box warning was placed on Levoquin and its generic, my mom was prescribed it for a stubborn sinus infection. After a few days a red rash appeared. She stopped the medicine, but the rash continued to spread. She spent 11 days in the hospital while medical personnel paid attention to everything but the rash. Upon return she worsened. A dermo assured me they sent a biopsy for examination, though we discovered she lied to me about that. Unfortunately this was the same doctor who assured us it was merely a rash. Eight days after her discharge we took her ourselves to our region’s burn hospital where they met us at the door, rushed her into E.R. and diagnosed Stevens-Johnson Syndrome (actually TENS because the rash covered more than 70% of her body). Basically her skin was detached from her skeleton. She died after six days in an induced-coma.

    Until then I never realized why warnings cautioned against a rash. I didn’t know a rash could be fatal. Such a benign word for something that carries such horrifying possibilities.

    Two years later despite notifying my docs and pharmacies that I was allergic to fluoroquinolones, my doc gave me a prescription, the pharmacy filled it and then handed it over to me without even sharing that I just picked up a med with a black box warning. When I got the med and realized it was a fluoroquinolone (I’m still trying to commit the names to memory), I inquired. She wasn’t aware of the stated allergy. I asked if it had a black box warning and the pharmacist said she didn’t know and had to check. I was stunned nobody thought to include me in the decision to ingest such a potentially dangerous class of drugs. It was casually prescribed and dispensed. While I recognize my individual responsibility in investigating and asking questions, I strongly believe professionals also have responsibility to educate and inform their patients, and include them in the process of diagnosis and treatment.

  8. LJ
    Reply

    I am sitting here crying, knowing full well what all of you have been through and hoping you will all be luckier than I have been. As I said before, I have been going through the same hell since 1990, 25 YEARS now. All these years, I thought it was damage to my tendons until 2 days ago, when I finally got an actual diagnosis of advanced peripheral autonomic neuropathy from a wonderful doctor and her great PA who both believed me and did the appropriate tests to confirm.

    I had been incorrectly diagnosed with lupus about 1991, and one doctor actually said to me, “you need to be committed to a mental hospital, lady, cause you’re crazy”. I would scream in pain and agony even if a hair brushed my skin anywhere. I truly have PTSD any time I hear stories like yours and that Cipro is the miracle antibiotic. I even did an interview many years ago with a local TV anchor about his report that Cipro symptoms disappeared after stopping it. I tell anyone and everyone who will listen not to take it or any of the quinolones. I insist that any medicines prescribed to me be only those medicines that were made over 25 years ago, and that I receive pediatric doses as well. God Bless all of you. God oh God, touch each of us who have been affected by this terrible antibiotic and heal us all. Amen lj

  9. LJ
    San Antonio, Texas
    Reply

    I was given Cipro during hospital treatment prior to a hysterectomy in 1990 for 5 days, then sent home with Rx for more Cipro. The same evening of release, family had to take me to emergency room, and I was readmitted, this time for hallucinations, extremely high fever and excruciating pain in both arms and hands, and both feet.

    I subsequently had the hysterectomy and still prescribed Cipro. I was to be on medical leave for 6 weeks for the surgery, but could not return for 3 months due to the unbearable pain and limited use of both hands which made my job as a computer clerk almost impossible. During the 3 months after the first episode from the Cipro, I was so humiliated because I could not even do my own toileting/cleaning, brush my teeth or even feed myself. It took me almost a year before I could use both hands without severe pain.

    After diligent research, found out Cipro was probable cause. Confirmation when given again for UTI and exact same symptoms occurred. TWENTY-FIVE YEARS LATER, I still suffer from the same symptoms. JUST 2 DAYS AGO, I FINALLY GOT AN ACTUAL DIAGNOSIS OF ADVANCED PERIPHERAL AUTONOMIC NEUROPATHY!!! After reading some the comments on this website, I find yet another tragic case. My Mom died in 2003 from c-diff after taking Levaquin. After all these years it appears too late to even file a lawsuit for me or my Mom. I hope everyone reading this will think many times before taking any of these antibiotics. LJ

  10. Rocky B.
    LA
    Reply

    I started having numbness. & tingling in my upper thighs, the after a couple days or so I started having severe pain in my Elbow which was diagnosed as Tendinitous (tennis elbow) … Then after a couple days or so I started have severe pain in my Shoulder and this went on for better than a week when it kept getting worse so I went to my Dr and he gave me a shot in my shoulder, (which I have to say was painful but after a couple days it seemed to help with the shoulder pain.. It’s only been a couple days since that shoulder shot!! I have also been having numbness and tingling in the back side of my left arm with numbness in my left arm and my little finger along with the finger next to it . It does come and go with my arm but I have to say it comes more now and continues for several days in my left arm..

    I will have to say I was prescribe both Levetin & Cipro but it never once crossed my mind that all these effects could be caused by the Antibiotics ! Now I don’t know what to do about it cause it’s been several months since I was prescribed the Antibiotics.
    Like who do I turn to, or in general what should I do about this !!
    Rocky B.

  11. Pat
    United States
    Reply

    I took Macrobid for a Urinary Trac Infection for 7 days. After completion I had severe numbness & tingling, pain and burning in my feet and hands. I have been diagnosed with severe toxic peripheral neuropathy. I am on a heavy doseage of medication to control the pain. This will be a lifetime condition now for me.

  12. Dennis
    Texas
    Reply

    I’ve been fatigued, having constant headaches; to the point of an ER visit… having nerve issues and joint pain ever since taking Cipro, levaquin and steroidal pac… also an ER visit with anaphylactic reaction to Avolox. Within this time I broke out all over like a teenager. I’m 50 and haven’t had acne for years.
    After the ER visit for the excruciating headache, I started looking into these drugs and reactions. I was amazed to find out how many problems there are and the extent.
    My primary doctor refrains from associating any of the issues with these drugs and tells me they’re all individual issues. (He prescribed them)

    I’m now seeing a neurologist that is giving me Botox treatments for nerve pain and some of the muscle spasm issues, a pain management specialist that has performed a rhizotomy to alleviate the pains that go through my neck, shoulder, elbow and arm, a spinal specialist that can’t find any reason for the nerves to be acting this way and causing so much pain, and also, going to physical therapy to try and get normal range of motion. I in pain EVERY DAY. My family suffers right along with me.
    I get very little relief from any of the procedures.
    All I can do is hope the rest of the procedures do some good and I get some of my life back.

  13. rad
    australia
    Reply

    I read that eating food containing MSG ( monosodium glutamate ) can promote abnormal nerve growth and as a result, cause nerve pain. Also that MSG is hidden in many types of foods and sometimes not declared in the packaging. Might need to check it out.

  14. Emily
    USA
    Reply

    I had a UTI and was prescribed Cipro, two pills a day for five days. The nurse practitioner who prescribed it said it might interfere with my prescription for my hypothyroidism, but it shouldn’t really do anything when only taking it for a week. She also advised taking Ibuprofen for UTI pain. After the second day, I had throbbing headaches, intense pressure in my head and neck, dizziness, trouble focusing my eyes, and I was completely exhausted. Because none of these problems would be cause by a simple UTI, I searched online for the effects of Cipro. I was shocked and angry to learn that Cipro can attach to DNA, cause chemotherapeutic effects, and that NSAIDs (Ibuprofen) only intensifies the effects! I stopped taking it a week ago and I’m still getting throbbing headaches, dizziness, trouble focusing my eyes, and my neck is so stiff it hurts to look side to side. I’m furious that I was given such a drug for such a simple infection that any number of antibiotic without half of the risks as Cipro would have taken care of.

  15. sharon r.
    yorkshire
    Reply

    I was given Norfloxacin for urine infection, my doctor told me it could cause problems but I will give it to you anyway his exact words. I took a weeks worth, I had no problems feet felt hot though but did not think anything at this time, then as soon as I stopped taking them I went into the shower that morning looked down at my feet I just screamed they were both black as coal.

    I was sent to hospital and was told i had nerve damage in both feet from my ankles down, now I am in pain all the time plus my feet keep turning black and my ankles keep getting infected.

What Do You Think?

We invite you to share your thoughts with others, but remember that our comment section is a public forum. Please do not use your full first and last name if you want to keep details of your medical history anonymous. A first name and last initial or a pseudonym is acceptable. Advice from other commenters on this website is not a substitute for medical attention. Do not stop any medicine without checking with the prescriber. Stopping medication suddenly could result in serious harm. We expect comments to be civil in tone and language. By commenting, you agree to abide by our commenting policy and website terms & conditions. Comments that do not follow these policies will not be posted.