drug adverse effects of fluoroquinolones
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Adverse effects
- hypoglycemia* (generally within 1st 3 days)[9][25]
- hyperglycemia (generally after 3 days)[9]
- tendonitis & tendon rupture, esp Achilles tendon rupture[2][3][6]
- older age, lower BMI & glucocorticoid use increases risk[6]
- QT prolongation[4]
- retinal detachment[5]
- may occur within 5 days
- HR=4.5[5]; RR=1.5; number needed to harm - 2500[5]
- no increased risk with oral fluoroquinolones[11][19]
- acute kidney injury (absolute risk is small)[7]
- peripheral neuropathy from systemic fluoroquinolones
- permanent nerve damage may occur[8][10]
- oral fluoroquinolones are associated with a 1.5-2 fold increase in risk for polyneuropathy[12][28]
- 1 additional case per 150,000 10-day fluoroquinolone courses[28]
- oral fluoroquinolones are not associated with increased risk for serious arrhythmia, compared with penicillin[13]
- central nervous system excitatory changes
- potentially permanent side effects of the tendons, muscles, joints, nerves, & central nervous system can occur together in the same patient[16]
- 2-fold increased risk of miscarriage[18]
- risk of aortic aneurysm vs amoxicillin
- RR = 1.7, absolute risk = 0.0082%/treatment episode[24]
- no increased risk of aortic aneurysm or aortic dissection[19]
- risk for aortic aneurysm & aortic dissection (RR=2-3)[26]
- risk is marginal at best[29]
- risk of aortic aneurysm for adults > 35 years of age is 7.5 cases per 10,000 fills vs 4.6 per 10,000 fills for comparable antibiotic[30]
- fluoroquinolones may exacerbate myasthenia gravis[20]
- increased risk for pseudotumor cerebri 5-fold within 15 days of oral fluoroquinolone[21]
- increased risk of carpal tunnel syndrome (RR=1.34)[22]
- mental health issues[25]
- hypersensitivity: cross-reactivity among fluoroquinolones uncommon[31]
* may cause severe hypoglycemia when used in combination with sulfonylureas, repaglinide (Prandin) & other hypoglycemic agents
* serious side effects generally outweigh the benefits for patients with sinusitis, bronchitis, & uncomplicated urinary tract infections[15]
More general terms
References
- ↑ Prescriber's Letter 13(1): 2006 Glucose abnormalities and fluoroquinolones Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=220109&pb=PRL (subscription needed) http://www.prescribersletter.com
- ↑ 2.0 2.1 FDA MedWatch http://www.fda.gov/medwatch/safety/2008/safety08.htm#Fluoroquinolone
- ↑ 3.0 3.1 Prescriber's Letter 15(8): 2008 Fluoroquinolones and Risk of Tendinitis and Tendon Rupture Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=240802&pb=PRL (subscription needed) http://www.prescribersletter.com
- ↑ 4.0 4.1 Geriatric Review Syllabus, 7th edition Parada JT et al (eds) American Geriatrics Society, 2010
- ↑ 5.0 5.1 5.2 5.3 Etminan M e al Oral Fluoroquinolones and the Risk of Retinal Detachment JAMA. 2012;307(13):1414-1419 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/22474205 <Internet> http://jama.ama-assn.org/content/307/13/1414.short
- ↑ 6.0 6.1 6.2 Wise BL et al. Impact of age, sex, obesity, and steroid use on quinolone- associated tendon disorders. Am J Med 2012 Dec; 125:1228.e23. PMID: https://www.ncbi.nlm.nih.gov/pubmed/23026288
- ↑ 7.0 7.1 Bird ST et al. Risk of acute kidney injury associated with the use of fluoroquinolones. CMAJ 2013 Jul 9; 185:E475 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/23734036 <Internet> http://www.cmaj.ca/content/185/10/E475?ijkey=719ce2e015f88fb295f33da8cfe395060fb60430&keytype2=tf_ipsecsha
- ↑ 8.0 8.1 FDA MedWatch. August 15, 2013 Fluoroquinolone Antibacterial Drugs: Drug Safety Communication- Risk for possibly permanent nerve damage. http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm365302.htm
- ↑ 9.0 9.1 9.2 Chou HW et al Risk of Severe Dysglycemia Among Diabetic Patients Receiving Levofloxacin, Ciprofloxacin, or Moxifloxacin in Taiwan. Clin Infect Dis. August 14, 2013 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/23948133 <Internet> http://cid.oxfordjournals.org/content/early/2013/07/23/cid.cit439.abstract
- ↑ 10.0 10.1 Prescriber's Letter 20(10): 2013 Adverse Reactions with Systemic Quinolones Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=291004&pb=PRL (subscription needed) http://www.prescribersletter.com
- ↑ 11.0 11.1 Pasternak B et al Association Between Oral Fluoroquinolone Use and Retinal Detachment. JAMA. 2013;310(20):2184-2190. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/24281462 <Internet> http://jama.jamanetwork.com/article.aspx?articleid=1785461
Brett AS Oral Fluoroquinolone Use and Retinal Detachment Reconciling Conflicting Findings in Observational Research. JAMA. 2013;310(20):2151-2153 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/24281459 <Internet> http://jama.jamanetwork.com/article.aspx?articleid=1785435 - ↑ 12.0 12.1 Etminan M et al. Oral fluoroquinolone use and risk of peripheral neuropathy: A pharmacoepidemiologic study. Neurology 2014 Aug 22 PMID: https://www.ncbi.nlm.nih.gov/pubmed/25150290
- ↑ 13.0 13.1 Inghammar M et al Oral fluoroquinolone use and serious arrhythmia: bi-national cohort study. BMJ 2016;352:i843 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/26920666 <Internet> http://www.bmj.com/content/352/bmj.i843
- ↑ Raguideau F et al. Association between oral fluoroquinolone use and retinal detachment. JAMA Ophthalmol 2016 Apr; 134:415 PMID: https://www.ncbi.nlm.nih.gov/pubmed/26967005
- ↑ 15.0 15.1 FDA Safety Watch. May 12, 2016 Fluoroquinolone Antibacterial Drugs: Drug Safety Communication
FDA Advises Restricting Use for Certain Uncomplicated Infections. http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm500665.htm - ↑ 16.0 16.1 16.2 FDA Safety Communication. July 26, 2016 Fluoroquinolone Antibacterial Drugs for Systemic Use: Drug Safety Communication - Warnings Updated Due to Disabling Side Effects. http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm513065.htm
- ↑ 17.0 17.1 Medications Can Cause Seizures Prescriber's Letter 10(3):16 2003 Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=190320&pb=PRL (subscription needed) http://www.prescribersletter.com
- ↑ 18.0 18.1 Muanda FT, Sheehy O, Berard A Use of antibiotics during pregnancy and risk of spontaneous abortion. CMAJ 2017 May 1;189:E625-33 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/28461374 <Internet> http://www.cmaj.ca/content/189/17/E625.full.pdf+html
- ↑ 19.0 19.1 19.2 Brooks M FDA: Fluoroquinolones Not Linked to Retinal Detachment Medscape - May 11, 2017 http://www.medscape.com/viewarticle/879889
FDA Drug Safety Communication. May 12, 2017 FDA updates warnings for oral and injectable fluoroquinolone antibiotics due to disabling side effects. https://www.fda.gov/Drugs/DrugSafety/ucm511530.htm - ↑ 20.0 20.1 Lowes R FDA Approves Delafloxacin (Baxdela) for Skin Infections Medscape - Jun 19, 2017. http://www.medscape.com/viewarticle/881827
- ↑ 21.0 21.1 Sodhi M, Sheldon CA, Carleton B, Etminan M. Oral fluoroquinolones and risk of secondary pseudotumor cerebri syndrome: Nested case-control study. Neurology 2017 Jul 28 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/28754842 <Internet> http://www.neurology.org/content/89/8/792
- ↑ 22.0 22.1 Cheng JZ, Sodhi M, Etminan M, Carleton BC. Fluoroquinolone Use and Risk of Carpal Tunnel Syndrome: A Pharmacoepidemiologic Study. Clin Infect Dis. 2017 Apr 24. PMID: https://www.ncbi.nlm.nih.gov/pubmed/28444196
- ↑ 23.0 23.1 Farid S, Mahmood M, Abu Saleh OM et al. Clinical manifestations and outcomes of fluoroquinolone- related acute interstitial nephritis. Mayo Clin Proc. 2018 Jan;93(1):25-31 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/29157532 <Internet> http://www.mayoclinicproceedings.org/article/S0025-6196(17)30695-X/fulltext
- ↑ 24.0 24.1 Pasternak B, Inghammar M, Svanstrom H. Fluoroquinolone use and risk of aortic aneurysm and dissection: nationwide cohort study BMJ 2018;360:k678 http://www.bmj.com/content/360/bmj.k678
- ↑ 25.0 25.1 25.2 FDA Safety Alert. July 10, 2018 Fluoroquinolone Antibiotics: FDA Requires Labeling Changes Due to Low Blood Sugar Levels and Mental Health Side Effects. https://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm612979.htm
FDA News Release, July 10, 2018 FDA updates warnings for fluoroquinolone antibiotics on risks of mental health and low blood sugar adverse reactions. https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm612995.htm - ↑ 26.0 26.1 Walker M FDA Warns on Aortic Aneurysms With Fluoroquinolones. Adds to already long list of issues with popular antibiotic class. MedPage Today. Dec 20, 2018 https://www.medpagetoday.com/publichealthpolicy/fdageneral/77060
FDA Safety Alert. Dec 20, 2018 Fluoroquinolone Antibiotics: Safety Communication - Increased Risk of Ruptures or Tears in the Aorta Blood Vessel in Certain Patients. https://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm628960.htm - ↑ Lewis T, Cook J. Fluoroquinolones and tendinopathy: a guide for athletes and sports clinicians and a systematic review of the literature. J Athl Train. 2014 May-Jun;49(3):422-7. Review. PMID: https://www.ncbi.nlm.nih.gov/pubmed/24762232 Free PMC Article
- ↑ 28.0 28.1 28.2 Morales D, Pacurariu A, Slattery J et al. Association between peripheral neuropathy and exposure to oral fluoroquinolone or amoxicillin-clavulanate therapy. JAMA Neurol 2019 Jul; 76:827 PMID: https://www.ncbi.nlm.nih.gov/pubmed/31034074 https://jamanetwork.com/journals/jamaneurology/fullarticle/2731583
- ↑ 29.0 29.1 Gopalakrishnan C et al. Association of fluoroquinolones with the risk of aortic aneurysm or aortic dissection. JAMA Intern Med 2020 Sep 8; [e-pub] PMID: https://www.ncbi.nlm.nih.gov/pubmed/32897307 https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2770379
Dong Y-H et al. Association of infections and use of fluoroquinolones with the risk of aortic aneurysm or aortic dissection. JAMA Intern Med 2020 Sep 8; [e-pub]. PMID: https://www.ncbi.nlm.nih.gov/pubmed/32897358 https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2770378 - ↑ 30.0 30.1 Newton ER, Akerman AW, Strassle PD et al Association of Fluoroquinolone Use With Short-term Risk of Development of Aortic Aneurysm. JAMA Surg. Published online January 6, 2021 PMID: https://www.ncbi.nlm.nih.gov/pubmed/33404647 https://jamanetwork.com/journals/jamasurgery/fullarticle/2774747
- ↑ 31.0 31.1 Shah S et al. In-class cross-reactivity among hospitalized patients with hypersensitivity reactions to fluoroquinolones. Antimicrob Agents Chemother 2023 May 8; [e-pub]. PMID: https://www.ncbi.nlm.nih.gov/pubmed/37154772 https://journals.asm.org/doi/10.1128/aac.00374-23
Adams KK, Shah S. Health system evaluation of fluoroquinolone hypersensitivity: An assessment of cross-reactivity. J Antimicrob Chemother 2023 May 10; [e-pub] PMID: https://www.ncbi.nlm.nih.gov/pubmed/37161664 https://academic.oup.com/jac/advance-article-abstract/doi/10.1093/jac/dkad136/7158810