FDA puts black-box warning on antibiotics: tendon damage

by James Hubbard, M.D., M.P.H.Achilles tendon

I quit playing competitive basketball in my late 30s because I had seen several weekend warriors near my age who had torn their Achilles. It would just happen out of the blue. To me, it did not seem to be worth the risk. Tendon tears are very painful and sometimes require surgery, and you might have to wear a splint or cast for six weeks to three months.

The FDA has issued a strong warning about an increased risk of tendinitis (inflammation) or tendon rupture (tear) with flouroquinolone antibiotics (such as Avalox, Cipro, Factive, Floxin, Levaquin, Noroxin and Proquin XR).

The warning will be in a “black box” in the package insert. Doctors widely prescribe flouroquinolones for wound, ear, urinary tract, prostate and other infections. They’re usually well tolerated.

So, what is a person to do?

First, you should know that they’ve been aware of this increased risk for many years. A 2002 study of 46,776 fluoroquinolone users found 704 had Achilles tendonitis and 38 developed a tear. I think you’ll agree the risk is low. Still, the incidence was double those who were not taking the drug.

The FDA has been receiving more and more reports of incidences lately. Most are Achilles-related, but some involve other parts of the body. The risk is higher in people over 60 and those also taking steroids or who have had organ transplants.

My advice is talk over the pros and cons with your health-care provider. Remember that all antibiotics have potential side effects. If you do take it, lay off of vigorous exercise until even a few days after completing the course (and please continue the course if you start it). Stop it immediately and contact your health-care provider if you have pain, redness, swelling or bruising around a tendon area.

Does anyone have any experience with the antibiotic, side effects or tendon problems?

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2 Responses to “FDA puts black-box warning on antibiotics: tendon damage”

  1. Mark Salinas Says:

    I occasionally try to squeeze in some basketball but rarely. I have seen many people come down with a torn tendon. All have said the pain is excruciating…..my worst basketball injury has been shin splints. Very good article.

    Mark Salinass last blog post..Resistance Bands

  2. jhubbard Says:

    Yes, very painful indeed.

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