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Levaquin and Other Risky Antibiotics

Levaquin, which was a best selling antibiotic in 2010, it and similar antibiotics can have dangerous side effects, especially for older patients.

Fluoroquinolones or quinolones are a class of powerful and popular antibiotics that includes:

  • Avelox (moxifloxacin)
  • Cipro, generic ciprofloxacin, Cipro XR and Proquin XR (ciprofloxacin)
  • Factive (gemifloxacin)
  • Floxin (ofloxacin)
  • Levaquin (levofloxacin)
  • Noroxin (norfloxacin)

In general, fluoroquinolones should only be used for lymphedema related cellulitis after other antibiotic options have been exhausted. See Cellulitis is Treated with Antibiotics.

The FDA requires a black box warning on fluoroquinolones to highlight the risks of side effects including:

  • Tendon rupture (see Risks of Tendon Rupture below) or tendinitis.
  • Neuromuscular blocking that may exacerbate muscle weakness in myasthenia gravis.
  • Brain swelling from abnormal levels of water and salt (hyponatraemia) may cause confusion, decreased consciousness, coma, convulsions, fatigue, headache, irritability, appetite loss, muscle spasms or cramps, muscle weakness, nausea, restlessness, or vomiting.
  • Central nervous system problems including cognitive issues in the elderly, seizures, hallucinations, and depression.
  • Heart rhythm changes (QTc prolongation and torsade de points).
  • Intestine infection with diarrhea (Clostridium difficile).
  • Rarely, damage to the liver, kidneys or bone marrow, and changes to blood sugar may occur.

Risks of side effects are increased for older patients.

Tell Your Doctor

Before your health care provider decides which antibiotic to prescribe, be sure they know:

  • If you are allergic to any medications, including penicillin.
  • Antibiotics that have been effective for you in the past.
  • Any antibiotics that caused side effects, and the severity of these side effects.
  • What other medicines you take. Some medicines may interact with a fluoroquinolone and cause serious side effects.
  • Other medical conditions that you have. Some conditions may make you more likely to have a serious side effect when you take a fluoroquinolone.
  • Any risk factors for tendon rupture:
  • Over 60 years of age
  • Taking steroids (corticosteroids)
  • Rheumatoid arthritis or a history of tendon problems
  • Kidney, heart, or lung transplant recipient
  • Physical activities or exercise habits
  • Kidney failure or kidney disease
  • Other risk factors: Myasthenia gravis

Risks of Tendon Rupture

Pain, swelling, inflammation, and tears of tendons including the Achilles, shoulder, hand, or other tendons can happen in patients taking fluoroquinolone antibiotics. Tendons are the areas that connect your muscles to your joints. The Achilles tendon is at the back of the ankle.

The chance of having tendon problems is higher if you are:

  • Over 60 years of age
  • Taking steroids (corticosteroids)
  • A kidney, heart, or lung transplant recipient

Other reasons for tendon ruptures include:

  • Tendon problems in the past, such as with rheumatoid arthritis
  • Physical activity or exercise
  • Kidney failure

Precautions While Taking Fluoroquinolones

Ask your healthcare provider for written instructions on how and when to take your medications. Follow these instructions carefully.

Call your healthcare provider right away at the first signs or symptoms of pain, swelling or inflammation in a tendon area. These could be symptoms of tendinitis or tendon rupture. Stop taking your fluoroquinolone until a healthcare provider has determined that you do not have tendinitis or a tendon rupture.

Signs or symptoms of tendon rupture include:

  • Snap or pop in a tendon area
  • Bruising right after an injury in a tendon area
  • Inability to move the affected area or bear weight

At the first sign of pain, swelling, or inflammation in a tendon area, avoid exercise and use of the affected area.

Protect your skin from exposure to the sun or other sources of ultraviolet light. Fluoroquinolones and other antibiotics may make your skin very sensitive to light (phototoxicity).

If you are diabetic, monitor your blood glucose levels and seek treatment if you are not able to keep them in the normal range.


Food and Drug Administration. Information for Healthcare Professionals: Fluoroquinolone Antimicrobial Drugs [ciprofloxacin (marketed as Cipro and generic ciprofloxacin), ciprofloxacin extended-release (marketed as Cipro XR and Proquin XR), gemifloxacin (marketed as Factive), levofloxacin (marketed as Levaquin), moxifloxacin (marketed as Avelox), norfloxacin (marketed as Noroxin), and ofloxacin (marketed as Floxin)]. Updated: 05/29/2010. www.fda.gov/drugs/drugsafety/postmarketdrugsafetyinformationforpatientsandproviders/ucm126085.htm

Brody, Jane. “Popular Antibiotics May Carry Serious Side Effects” New York Times, September 10, 2012. http://well.blogs.nytimes.com/2012/09/10/popular-antibiotics-may-carry-serious-side-effects/

Got a question or comment? Post in the 'How Lymphedema is Treated' forum.
Category: How Lymphedema is Treated Updated: 2014-10-08


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