All prescription medications come with a risk-reward ratio providing potential benefits at the risk of potential adverse effects.  Classified by duration and onset, adverse effects may be transient and self-limiting, disappearing shortly after discontinuation, or in other cases may be persistent, continuing after medication usage cessation.  Sometimes adverse effects are delayed.  Persistent or delayed adverse effects are associated with a number of medications including anthracyclines, 5α-reductase inhibitors, vitamin A derivatives, and fluoroquinolones.


Some side effects reported with fluoroquinolones include: Gastrointestinal disturbances, central nervous system reactions, phototoxicity [1], rashes, cardiovascular effects, joint pain, tendon pain [2], muscle pain [3], and peripheral neuropathy [4].  Central nervous systems reactions can include headache, dizziness, agitation, sleep disorders, psychoses, and in rare cases, convulsions [5].  While most of these symptoms occur during medication usage, tendon symptoms, in particular, are reported to occur as late as 3 months [6] to 6 months [7] after discontinuation.  Lengthy symptom durations have also been reported, with tendon symptoms featuring extended recovery [8] [9], and neuropathy symptoms persisting for more than one year after discontinuation [4] [10], and muscle abnormalities detectable by 31(P) magnetic resonance spectroscopy 6 months after discontinuation [11]. 


The goal of our research is to improve the understanding of symptoms that occur with fluoroquinolones and their effects on those who experience them.



References

  1. [1] Ball P, Tillotson G.  Tolerability of fluoroquinolone antibiotics. Past, present and future.  Drug Saf. 1995 Dec;13(6):343-58.

  2. [2] Stahlmann R, Lode H.  Safety Overview: Toxicity, Adverse Effects, and Drug Interactions.  In: VT Andriole, ed.  The Quinolones, 3rd ed.  San Diego, Academic Press, (2000):397-453.

  3. [3] Eisele S, Garbe E, Zeitz M, Schneider T, Somasundaram R.  Ciprofloxacin-related acute severe myalgia necessitating emergency care treatment: a case report and review of the literature.  Int J Clin Pharmacol Ther. 2009 Mar;47(3):165-8.

  4. [4] Hedenmalm K, Spigset O.  Peripheral sensory disturbances related to treatment with fluoroquinolones.  J Antimicrob Chemother. 1996 Apr;37(4):831-7.

  5. [5] De Sarro A, De Sarro G.  Adverse reactions to fluoroquinolones. an overview on mechanistic aspects.  Curr Med Chem. 2001 Mar;8(4):371-84.

  6. [6] Ribard P, Audisio F, Kahn MF, De Bandt M, Jorgensen C, Hayem G, Meyer O, Palazzo E.  Seven Achilles tendinitis including 3 complicated by rupture during fluoroquinolone therapy.  J Rheumatol. 1992 Sep;19(9):1479-81.

  7. [7] Casparian JM, Luchi M, Moffat RE, Hinthorn D.  Quinolones and tendon ruptures.  South Med J. 2000 May;93(5):488-91.

  8. [8] Greene BL.  Physical therapist management of fluoroquinolone-induced Achilles tendinopathy.  Phys Ther. 2002 Dec;82(12):1224-31.

  9. [9] Haddow LJ, Chandra Sekhar M, Hajela V, Gopal Rao G.  Spontaneous Achilles tendon rupture in patients treated with levofloxacin.  J Antimicrob Chemother. 2003 Mar;51(3):747-8.

  10. [10] Cohen JS.  Peripheral neuropathy associated with fluoroquinolones.  Ann Pharmacother. 2001 Dec;35(12):1540-7.

  11. [11] Guis S, Bendahan D, Kozak-Ribbens G, Mattei JP, Le Fur Y, Confort-Gouny S, Figarella-Branger D, Jouglard J, Cozzone PJ.  Investigation of fluoroquinolone-induced myalgia using (31)P magnetic resonance spectroscopy and in vitro contracture tests.  Arthritis Rheum. 2002 Mar;46(3):774-8.









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