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 52,000 Subscribers at The People's Pharmacy

  1. Nicole D.
    Reply

    5 months ago, my life was forever changed with 3 pills of Levaquin for a sinus infection that was never cultured. I’ve even taken it before (and Cipro for that matter).

    I had constant ringing in my ears for months, tendon pains that left me crawling across the floor and up the stairs, random stabbing pains, eye pain, freezing cold when it was 75 degrees, low blood sugar, popping joints, twitching, brain fog, dizziness, fatigue and on and on.

    I was a healthy mother of 2 young kids, a runner and very active. I even told the Dr. and nurse PT that I was a runner. I was never warned about the two existing black box warnings on these drugs by the Dr, Nurse PT or Pharmacist.

    No one told me about how these side effects could cause permanent damage to tendons, nerves, mitochondria, etc. No one told me I might may never run again, may not be able to play with my kids or walk long distances like I had done in the past.

    Where was the informed consent? I’d rather have the sinus infection!

  2. Lou G
    Reply

    Anytime a doctor or nurse or medical tech, whatever mentions antibiotics. I always ask them if they have a list of my reactions. Most of the time they do, and won’t provide those.
    The opthmology OR, for whatever reason, had all but the cipro listed, so I too, am glad they asked. As you said, better to ask, than expect medical personnel know about all one’s medical history. I was in a military hospital and the checklists they use are very thorough. Every individual that had access to me asked me the same questions and initialed the forms they were using.

  3. DS
    Reply

    You are very lucky that they asked. Your experience serves as a reminder that we all need to tell medical personnel the things they may or may not ask but which they need to know. When my husband and I got food poisoning in 1976 and went to the emergency room with vomiting and diarrhea, the nurse came in to give me a shot. I was 27 years old. I asked her if it would make a difference if I were pregnant. I only suspected that I was pregnant at that point.
    She turned around and left the room and before long a doctor came in and said it made a huge difference. He gave me a different shot from the one originally planned. My perfect baby was born 8 months later. I always figured that God told me to ask the question I heard all through my twenties from doctors and nurses but which this one nurse forgot to ask.

  4. GAW
    Reply

    3 years now and still have limitations. If I exercise more than a short time, pain returns and walking is difficult….but I can walk and do most activities normally….very thankful…I have come a long way.

  5. Lou G
    Reply

    I posted my problem with Cipro here on 10/08/2013. Last Wed, 08/27, I had cataract eye surgery. While waiting for the opthamologist, the anesthesialogist and nurses were questioning me about my reactions to antibiotics, including Cipro. Apparently one of the eye drops they were considering was or had Cipro in it. When I told them it caused me tendonitis of the right elbow, several agreed they heard that it did cause it in some persons, so they didn’t use it. I hate to think what might have happened if it was put in my eye.

  6. Anonymous
    Reply

    I am 42 years old and have been taking Moxifloxacin for 6 weeks, after about 14 days I noticed my joints becoming stiff and sore and my ankles swelling I have had extreme pain in my wrists and fingers. The antibiotic has done an amazing job of clearing the infection which I had but I decided I couldn’t cope with the pain in my joints.
    I stopped the antibiotics a few days ago, Got out of bed to have horrendous pain in my hip and spent 7 hrs in the emergency room to be told that I had torn a tendon in it. Three days later my achilles tendon has given way and I am now in cast and not allowed to put weight on it. I have been put on bed rest until it settles.
    Can not use the crutches because my wrists, arms and other ankle is just too painful. It is so hard to believe that antibiotics can actually do this to me.
    I have a question to anyone who this has happen to them “how long did it take for your pain to settle?”

  7. Patty
    Reply

    I was also put on cipro for almost 14 days back in January for diverticulitis. (Also another antibiotic) and since then I have been having a winging sensation all around the gut area. It has got worse over time to the point now I feel the tingling not only in my gut but on the sides and back area. Has anyone else had these same symptoms? I haven’t had the leg pain. I do have hip pain though especially in my left hip to the point of it hurting just to reach for something. What, if anything could I take to help ease this discomfort?

  8. B
    Reply

    It’s about 9 months since I first commented. My diagnosis is “idiopathic neuropathy.” Idiopathic because, it’s hard to believe, doctors just do not seem to know that antibiotics can do such damage, and attribute it to idiopathic meaning “just don’t know the cause”.
    What does it take and how long does it take for patients to be acknowledged about their ails due to drugs? I am now being treated for neuropathy by my foot doctor, who knows more than the 2 neurologists I tried and felt the large amounts of money spent with them and getting no relief. My foot dr. has given me a Vitamin B/alpha lipoic acid/benfotiamine combo and it helps some but will it cure me of this?
    At least it’s affordable, unlike what the neurologist prescribed, a compounded lotion with costs $500. Who has the money for that? Not I. This is ironic, using affordable antibiotics to get better but ending up with something much worse that costs unaffordable money for relief and not even to cure.

  9. Cynthia
    Reply

    This is unbelievable I gave been suffering for 2 years with muscle, tendon and joint pain. Started in elbow, then shoulder, wrist and now Achilles tendon. I kept telling my Dr. I felt like I was in a shrunk body and that my muscles, tendons and my left hip. My joints really hurt as well causing me to use ice packs to ease pain.
    I came to recently find out from a friend that CIPRO had side effects that could be causing these issues over 2 years I have taken CIPRO 10 times due to an intestinal issue. I only pray this is not permanent damage. I am just shocked that the FDA would approve this.

  10. SCC
    Reply

    Do not be discouraged if joint pain is a problem which you feel is directly related to one of these floxin antibiotics. Starting in late 2008, I began visiting different doctors about terrible joint pain I’d been experiencing which was getting worse. It began as a sore right foot, then right hip, then left hip, then a knee, then a hand… I finally suffered pain in all over the place — waking hours and sleeping. Like many of you was told repeatedly that I did not have arthritis. Luckily after about 4 1/2 years the pain and terrible stiffness it vanished over a period of about a month – Alas though, about 1 1/2 years after the pain/stiffness disappeared, I began having problems w/my left arm, hand and leg. Makes lots hard to do including walking over 15′, holding things w/ arm/hand, typing…
    Hopefully that too will disappear before I die. At least it is not painful– doctors tend to blame my age (63). I planned to visit a neurologist in a week or so and in preparation for that, tried to recall when all this started (also have a vision problem). (I was very busy in years past and just hopped all would resolve w/out treatment for the most part.) I suddenly today realized it all began after the several courses of antibiotics I took over about 6 weeks in late 2007– which seemed, at the time, to be the right thing to do. My vision problem began right away– the pain/stiffness did not begin for months though. So, Googled ‘antibiotics nerve problems’ and was dumbfounded to find this and other web sites and the ‘black box’ warning info… That’s all. MY POINT HERE WAS ORIGINALLY TO SAY–TAKE HEART, THE ARTHRITIS LIKE PAIN… DID FINALLY GO AWAY. Sorry so lengthy– got carried away.

  11. Evsav
    Reply

    Regarding your leg cramps, search Mustard for Leg Cramps on this site and you will be amazed. It works for me. Mine are a side effect of statins. I take a spoonful before bedtime.

  12. AB
    Reply

    The FDA is always slow to act, if they act at all. Sadly and dangerously, clinicians are slow to believe that what patients are saying, or how they are reacting to a medication may actually be valid.
    Physicians are not scientists. Too many know very little about the science of the medications they prescribe. They actually believe the pharmaceutical reps are sharing valid information with them. They don’t understand the benefit/risk presentations reps are trained to present. Clinical trials? Journal studies? “Employ” the thought leaders in any specialty and have them involved in the promotion of your product! This is public knowledge. It’s been in the media, finally! Look it up – the info is available on line if you take the time to search.
    Finally, some clinicians are going public and sharing what they know. Unfortunately, many patients could have served as a “canary in the coal mine” had their complaints been heeded instead of ignored. Statins are another example of clinicians not paying attention to patients. It has taken years for physicians to actually realize and admit the fact that statins can have serious and ongoing side effects.
    It’s not so easy to pay attention, enter data into the computer and write a script in the fifteen minutes allocated to each patient’s visit. There are countless, caring and frustrated physicians who do realize the art of medicine has been lost and the assembly line of medicine has replaced with managed care, corporate control and loss of autonomy.
    The pharmaceutical lobby is POWERFUL!! Our legislators listen to them because they are being paid to listen. They are rewarded handsomely for listening and acting on behalf of this very powerful and dangerous lobby.
    Pharmaceutical companies know long before the public becomes aware of the dangers of certain prescription drugs or medical devices. They are willing to risk exposure as long as they’ve made their millions. Market share is what drives drug and device promotion-not safety or concern for patients.

  13. TS
    Reply

    Reading all of these heartfelt comments and pleas for answers, I’m DISGUSTED beyond words that this antibiotic is still on the market.

  14. Kyla
    Reply

    I took norfolcine dec 18 finished my course on dec 24 and haven’t felt right since! 3 years ago I took depo provera and went in the tanning beds and had a bad reaction then lasted bout a month mostly itching, tingling and light senvity. Developed some photosenvity, but it cleared up with in 6 months ) I have saw 3 different doctors since I took this reaction and none of them can give me a answer if it’s going to be prenmeant or not and all want me to see an allergy specialist but what’s that gonna do for me ! I have been on presoadone for 7 days and just finished my medrol taper ! And alls the medrol did was take down some of the swelling in my face and itchyness ! I am terrified I’m only 27. I have bad headaches, eyes a bit funny, some itchyness, look tired all the time, really bad shakey ness, feel burnt all over a lil not as bad though but my main conceren are hands, legs and feet ! My hands have numbing tingles in them shake like a leaf @ times, have trouble moving them and pain in my fingers. I have trouble walking weak legs. But my feet conceren me the most my ankles feel swollen, can only stand for minutes @ time until I have pain, I feel like I’m walking on my toes, I have numbing tingles all over them feels like my toes are cutting of the circulation. It feel like I have never damage and arthritis in my feet and hands but worse. I really hope this wears of but I Dodnt think it will, there Hasent been any change in about 5 weeks and it’s already ruining my life !

  15. Lue
    Reply

    I was diagnosed with peripheral neuropathy approximately 15 years ago, although I was not diabetic, and am still suffering with it today, with it being last described as ‘moderately severe’, severe enough to justify being classified as ‘disabled’. A number of tests were done to try to determine the cause but all came back negative, so it was called ‘idiopathic’.
    Prior to the onset of the neuropathy, I had been given Levaquin on a number of occasions for sinusitis, bronchitis, etc., as well as Cipro. Now, my everyday routine calls for doses of Neurontin, morphine sulphate and methadone to control the pain, and have been on these drugs for many years; without them, the pain is almost unbearable. Now, as a result of having to take all the narcotics for pain, I have other side effects from them. So now I see that it all may have come from taking Levaquin or Cipro. Wonderful!!! The gift that keeps on giving.

  16. TS
    Reply

    DNB, thanks for writing back. I really can’t stress enough that comments from readers like me — we do care! — may be useful but I hope that you continue to get help from the trained medical community, be that a physician, naturopath, nutritionist, nurse practitioner. It’s good that he’s booked you with a specialist. Please ask him also if he could recommend a nutritionist who could help you. It’s good that you’re taking probiotic vitamins. I hope you will update us.
    GW and others who’ve had problems with Cipro, have your symptoms ceased yet? Please let us know.

  17. DNB
    Reply

    TS
    Thank you so much for commenting. Its nice to know that someone out there cares. I asked my doctor about Cipro possibly causing nerve pain but he didn’t think it would and he said it would be best to ask an infection specialist dr. So he booked me in to see that dr. And I am taking probiotic vitamins. Is there any other vitamins I should be taking? From all of the research that I have been doing its sounding like this is MS.:( I have two little kids and I am so scared that I have this disease:( Anyways I really appreciate the response. If there is anyone out there going through the same thing as me or even similar please let me know if you have any answers or know what I could do!! Thanks DNB

  18. TS
    Reply

    Jana, I also stopped taking Cipro with five days left on my treatment course….with full awareness that doctors strongly urge continuing the treatment. It may have been stupid of me, but I had to trust the strong warnings my body was sending me…the Cipro was making me feel so terrible and causing so much pain I absolutely could not stand it. Thankfully, the infection has gone away. I hope your son’s nose bleeds have stopped.
    Trish

  19. TS
    Reply

    Dear DNB,
    I’m sorry I don’t have a definitive answer. You certainly have my sympathy. I think you need to see a specialist. I’m struck by the fact that it’s YOU doing all of the research. That’s fine, but you need answers from the medical community. Please go back to your GP and tell him/her that you’re not satisfied and need to know what is causing your symptoms. Urge them to keep looking.
    I took CIPRO for about two weeks for a kidney infection and had a hell of a time, the pills seemed to make the pain worse, and I had to take Vicodin. It did cure the infection and I’ve been symptom-free for about a month.
    But back to you: all of the reading I’ve done points to some possibility of short term, temporary nerve damage in a proportion of patients using Cipro. You were on this antibiotic for a long time and it may take time for the symptoms to abate. Why don’t you consult a nutritionist and/or naturopathic doctor as well, to see if you need a radical diet realignment?
    Is your doctor prescribing probiotics or any other nutritive treatment to counteract the long effects of Cipro? If not, he or she should also be addressing that area. Good luck! Please come back with an update.
    Trish

  20. DNB
    Reply

    I was on Cipro for 3 months due to a infection I had in my stomach. I was also on Flagyl oral and Ampacillin through a pic line. During that time I started noticing pain in my joints and weakness in my hands and legs. I finished my medications in march and was fine. In July I started getting sick again.
    I had a weird pain in my throat and then it went to my head. It felt like knife stabbing pain in my head. Then it turned in to burning pain in my head, ear and throat and left breast. Numbness and tingling in head, face, lips, tongue, right side of back. Weakness in left arm. Pain in joints and twitching in body.
    I saw my GP and had a bunch of test done, MRI on head and spine, CT scans on head, spinal tap, blood work, test for lyme disease, x-rays, and I have been to many specialist. Everything came back normal. so the doctors are puzzled about what is wrong with me. All my symptoms are sounding like MS but nothing is showing up.
    I am getting worse so I am researching myself to figure out what is wrong with me. It’s so scary not knowing. So my question is, is it possible that all the antibiotics that I was on could of caused some kind of damage? Please if there is anyone out there that is going through the same thing or knows anything about this please respond!!!!

  21. EZ
    Reply

    I was given Levaquin a few weeks ago for a roaring bout of bronchitis. In addition, my physician gave me prednisone… as the bronchitis aggravated my asthma. By day 10, I had horrible cramping in my right calf. I used some Aleve, and daily epsom salts baths, and some massage.
    I had been warned by the pharmacist about the tendon rupture possibility, so stretched my calves VERY carefully. Even so, have been hobbling around the hospital and home with difficulty. If I sit for any amount of time, like driving the 90 minutes to the airport to pick up family, I can barely get out of the car.
    I saw the NP at the office today for this problem, and she suggested tonic water to alleviate the cramping. I had a couple of glasses prior to work, and felt a bit of relief… will see how it goes.
    Have had to suspend any exercise (was doing Kosama, a pretty high intensity program), but did pull my rebounder out and have been gingerly bouncing on it, hoping to get the benefit of rebounder and stretch together. Massage helped quite a bit, if only for a short time.
    I won’t be taking Levaquin, or the Cipro the hospital usually prophylaxes us with when we are exposed to meningitis or whooping cough. Hopefully this cramping will calm down, but what I am reading here doesn’t give much hope! Anyone find a cure yet?

What Do You Think?

Share your thoughts with others, but be mindful of protecting your own and others' privacy. Not all comments will be posted. Advice from web visitors is not a substitute for medical attention. Do not stop any medicine without checking with the prescriber. In posting a comment, you agree to our commenting policy and website terms and conditions.