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| The Fluoroquinolone
Toxicity Research Foundation
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Tendon Damage Research | See downloads for: Adobe Files |
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TENDINITIS AND TENDON RUPTURE WITH FLUOROQUINOLONES ADRAC first reported tendinitis in association with the fluoroquinolone antibiotics in 1997. 1 The Committee has continued to monitor this adverse reaction, and has now received 60 reports of tendinitis, tenosynovitis and/or tendon rupture in association with these drugs. Most involved ciprofloxacin (55), but there were also reports with norfloxacin (4) and enoxacin (1). Forty five reports described tendinitis alone, one report described tenosynovitis, and 14 reports documented tendon tear or rupture. Fifty five of the 60 reports specified the Achilles tendon, including 20 which described bilateral Achilles tendon damage. All 14 reports of tendon rupture involved the Achilles tendon. The 58 patients ranged in age from 38 to 91 (median 69) years, with no significant difference between those with tendinitis and those with tendon rupture. The daily doses of ciprofloxacin ranged from 500 mg to 2250 mg, with 46% of patients taking 1500 mg and 46% of patients taking 1000 mg daily. For those who developed tendon rupture, 57% were taking 1500 mg daily. Time to onset varied from within 24 hours after the drug was commenced to 3 months after starting but the majority of cases of tendinitis occurred within the first week. Time to rupture was longer with a median time of 2-3 weeks. Known risk factors for these reactions include old age, renal dysfunction and concomitant corticosteroid therapy.2 In the ADRAC cases, 29 reports documented concomitant corticosteroid use, and in 21 of the other 31 reports, the patients were aged 69 years or older. In the reports of tendon rupture, 12 of the 14 described either concomitant steroid use (9 cases) or old age (9 cases). Prescribers are reminded that tendinitis and tendon rupture can be adverse reactions from the fluoroquinolones, particularly ciprofloxacin. The fluoroquinolone should be withdrawn immediately when symptoms of tendinitis appear, in order to attempt to reduce the risk of tendon rupture. References: |
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