Warning: Cipro and Cousins’ Side Effects

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IF YOUR doctor prescribes Cipro or another drug in the class of fluoroquinolones, you should ask why that drug – whether your bacterial infection is especially hard to treat or because allergies prevent you from taking other choices like penicillin.  Otherwise, according to the FDA, the benefit of taking these drugs may not worth the risk of “disabling and potentially permanent side effects.”

While such side effects are deemed “rare,” three people in my immediate family (not blood relations of each other) who took these drugs suffered a ruptured Achilles tendon.

Since taking Levaquin, also in this class, a previously healthy North Carolina woman has suffered 25 tendon ruptures requiring surgery, as well as ongoing memory problems, seizures and sudden drops in blood pressure.

After reviewing more than 1,200 cases of disabling side effects, the FDA found 16% of patients had at least two different conditions, dubbed FQAD for fluoroquinolone-associated disability.  Also, by clearing good, healthy bacteria along with the bad, these drugs have paved the way for potentially life-threatening and difficult- to-eradicate Clostridium difficile (C.diff) infections.

Last year, the FDA revised its strongest “black box” warning for fluoroquinolones to include mental health issues like depression and anxiety, as well as trouble paying attention, disorientation and memory loss. FDA warnings also address patient reports of ruptures or tears in the aorta, which can be fatal; dramatic drops in blood sugar levels; and neuropathy or nerve damage —all of which lasted longer than a year and could be permanent.

Fluoroquinolones—the third most commonly used antibiotics for adults—are “over-prescribed because they are so potent and easy to use,” Orlando Health infectious disease specialist Antonio Crespo told Web MD.   For drugs in this class, a once-a-day pill can be as effective as intravenous treatment and can allow some patients to avoid hospitalization.

But about 5% of fluoroquinolone prescriptions are “completely unnecessary.” About 20% are wrongly employed—not adhering to black-box warnings —as the first round of treatment, according to CDC medical officer Sarah Kabbani.

One target of misuse is prevention of traveler’s diarrhea, for which Cipro has been a staple of vacationers’ medical kits for years.  And in 2016, the FDA warned specifically against prescribing fluoroquinolones for sinus infections, bronchitis or uncomplicated urinary tract infections for which only about half of patients currently receive the recommended first-line antibiotic therapy.

Contrary to warnings issued by both the FDA and its European equivalent, the Infectious Diseases Society of America continues to suggest these drugs for treating community-acquired pneumonia—in “patients who frequently are elderly and have hypertension or vascular disease…precisely those for whom fluroquinolones are counter-indicated,” writes San Diego infectious disease specialist George Sakoulas.

Because fluoroquinolones interfere with production of the kind of collagen present in both the Achilles tendon and the aorta, collagen is one focus of likely mechanisms for adverse effects.  Another is damage to the mitochondria that create energy needed for cellular function.

Patients at particular risk for FQAD include those with high blood pressure, peripheral artery disease and genetic conditions that affect collagen structure, such as Ehlers-Danlos and Marfan syndromes.  Also at risk are patients on immune-suppressing glucocorticoid therapy to treat autoimmune diseases like these and to treat inflammation associated with allergies.

If your doctor prescribes a fluoroquinolone, first ask why that drug.  Then, advises American Pharmacists Association consultant and infectious disease specialist Heather Free, make sure they know your health history and all the medications you are taking.

—Mary Carpenter

Every Tuesday, well-being editor Mary Carpenter reports on health news you can use.