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Jonathan Cluett, M.D.

FDA Warning: Some Antibiotics Cause Tendon Ruptures

By July 9, 2008

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It has long been known that some antibiotics, known as fluoroquinolones, can cause tendonitis and tendon ruptures. Fluoroquinolones include antibiotics Cipro and Levaquin. These antibiotics are favorites of many physicians because they are effective at treating different types of infections, can usually be taken orally or intravenously, and only need to be taken once or twice daily.

However, there are concerns about the side-effects of these antibiotics. One important caution is that the fluoroquinolones can cause tendonitis and tendon ruptures. Achilles tendon ruptures are at least four times more common in patients taking these antibiotics. The FDA today issued a warning to ensure doctors and patients understand this risk of tendon problems while taking these antibiotics.

Related: Achilles Tendon Ruptures | Tendonitis Treatment


FDA Requests Boxed Warnings on Fluoroquinolone Antimicrobial Drugs

July 15, 2008 at 9:54 am
(1) Carl says:

Nice read. I feel like I am seeing more and more articles about the dangers and overuse of antibiotics. What kind of kickbacks are these docs getting to prescribe this stuff!! Makes you wonder…


June 5, 2009 at 2:21 am
(2) judy says:

As my tenons now feel like they are ripping from my body and its been over a month since levaquin caused a really severe skin eruption and joint pain (thank god it wasn’t stevens-johnson syndrome as Drs feared )let me say these fluoroquinolones can be drugs from hell for a patient!

December 1, 2010 at 3:15 pm
(3) Karen says:

My 25, then 23 year old son was given Levaquin for acne on his back….500mg, 1x day, 60 days….which we now know is what the PDR recommends for someone exposed to ANTHRAX…This drug, in this dosage has crippled him…he has been in chronic pain since about day 45…..Other than filing a complaint with the Medical Board against the doctor that prescribed this insane dosage…He’s out of luck.

There is NO BLACK BOX WARNING on the medicine bottle that he was given…NO WARNING from the pharmacist.


March 19, 2011 at 11:07 pm
(4) CC says:

was taking Avelox and developed severe neuropathy and swelling in all joints. Five months later I am still having problems with my wrists and hands being swollen. This has be a hellish experience all related to taking an antibiotic for a sinus infection. I had no knowledge that there was a black box warning for this medication.

May 10, 2011 at 2:56 pm
(5) Thom says:

1 year after taking CIPRO I feel pain in right achile.
Now allways taking medication from pain.have no rescue from medics…dont know what to do.

August 13, 2011 at 9:12 am
(6) Karen S says:

Was given LEVOFLOXACIN a new generic for Levaquin. No one warned me about the side effects…Doctor or pharmacist. After 3 days both knees started hurting but I continued to take the drug because i didn’t realize it was the medication causing the problem! Finally called the doctor crying and was told it was a side effect. Ya think he could of mentioned it when I was in his office?
It’s been a month since i stopped taking it and I am still in pain. it’s been hell. I have to take pain pills to ease the pain. The crap should be taken off the market

December 17, 2011 at 7:02 pm
(7) melynn says:

I’ve been put on levaquin & cipro several times for infections to lyme tick bites & surgeries, I’m allergic to any form of penicillins & I’ve got copd,& asam.& emphysema was on several steroids form my breathing problems now even several years later now I’m having several joint & tendons causing problems & severe pain ,it now all makes sence this could be my problem. Wish would’ve known more years ago of this side affects !!!!

January 2, 2012 at 3:34 am
(8) roberta marcus says:

i have been in hell after taking levaquin for 8 days…first edema, and severe pain..now am told it is tendinitis from the antibiotic. also, had blood tests to make sure not in kidney failure…responded well to treatment for edema, but now, cannot walk without dragging a foot…extreme pain in bones and joints. i am a R.N. and didn’t realize that a antibiotic could cause the hell that i am going through. will never take another med without knowing all of the side effects etc in advance. the pharmacist said that pain usually subsides in 24 hours….it has been 3 days and pain is as bad as ever. what a wonderful way to spend the christmas holidays.! robbi

February 13, 2012 at 10:08 pm
(9) Patty says:

I was prescribed Levaquin for DivertÍculitis. It was only for 7-10 days. Both of my Achilles Tendons started hurting. Within a couple of weeks, I could hardly walk and the pain was excruciating. I was ready for a wheelchair.

One night after taking my grandkids to the movies, walking up/down the stairs, I typed in ‘sore ankles; hard to walk’ on the internet and the first hit was ‘Levaquin’, which was the antibiotics I had been prescribed.

When I discussed with my physician, he seemed skeptical. I asked if it could be the medicine and he admitted it was possible. It was never mentioned prior to taking the meds by him or the pharmacy.

I thought it was going to be permanent as it was 6 months before the pain subsided.

It really makes me read about all possible side effects, prior to taking any antibiotics.

April 3, 2012 at 9:54 pm
(10) Ms Kitty says:

Still have leg tendon pain a year later. Was given Cipro to prevent infection after minor surgery. No infection but doctor gave me this antibiotic anyway. I fear my life will never be the same as it was. Previously an active person, exercising 3-4x per week. Now I live in horrible pain each day. Doctor, pharmacy, FDA, drug manufactures have no solution or treatment plan for me or any other victim of adverse side effects from these class of drugs. Oh well, they made their money. Why should they care about patients.

April 20, 2012 at 4:29 am
(11) Ronnie Plant says:

Have just come out of hospital with a badly damaged heel but worse still I have an enormous and terribly sore blister (40mm x 40mm) on my heel. Four doctors have told me that these problems are as a result of the use of antibiotics. The cure is worse than the disease.

April 27, 2012 at 2:18 pm
(12) marilyn says:

I was on cipro for 7 days due to a UTI infection. About 5 days into the antibiotic, I began experiencing pain in my Achilles Tendon on my right foot and pain in my left foot. Swelling and feverishness began soon and I had to limp on my right foot to get around. I continued taking the course of antibiotics and now have tendonitis in both feet….with the right one being more serious.
I went for xrays on my leg, thinking I might have a blood clot, but, the test was negative. My primary nurse practioner (not the doctor who I had seen immediately after the swelling began) diagnosed me with tendonitis. My primary dr. said he thought I might have a broken capillary causing the swelling and pain.
Thank God for my nurse practioner. She knew immediately. I told her I had read the warning on the prescription information flyer and wondered if that was it.
I know one thing, it sure does hurt. Now to start the healing process. Thank you for the posted information. It really helps.

April 27, 2012 at 3:11 pm
(13) Teresa says:

all of this happened to me can anyone tell me what they are doing to heal themselves. The doctor that precribed the med has been no help his nurse basicly told me that it was all in my head

May 5, 2012 at 3:56 pm
(14) Margaret says:

I was on a Cipro IV drip for minor surgery, sent home with a prescription. That night I had horrendous pain in my knee, which shot up my leg. Same thing next day … went and saw an Orthopedic doctor, asked me about meds … well need I say more? Cipro in the garbage. Three days later am better, but still cannot lay down comfortably before the pain returns.

June 2, 2012 at 4:33 pm
(15) Vivian says:

Thank God I am a doctor because when I experienced the excruciating pain I somehow remembered it could be a side effect of the antibiotic! Just as someone else here stated, my internist did not know what it was when I called him and shrugged me off. I reminded him that in about nine years of being his patient I had NEVER called after-hours! I’m only a psychiatrist but fortunately I had this vague memory and googled the side effects. The nurse practioner the next day knew what it was. But like everyone else leaving comments here, I have had pain since then. The worst pain, in the tendon inserting into my right knee, is over, but my right wrist and left ankle both have swollen crunchy tendons that do not seem to be getting better (I didn’t really notice those at first when my leg could not support my weight). Celebrex helps a little but I don’t like to take it too often because it upsets my stomach and it could theoretically give me a heart attack. I had to sit out the family kite-surfing vacation and at this point I am just praying that I will be able to ski next winter. I went for a walk today and it was painful. I only had a stupid sinus infection – I get one or two every year – next time I am sticking to bactrim.

June 30, 2012 at 10:22 pm
(16) Barbara says:

I first took Cipro in Feb. 2011 after TKR. …began having Achilles tendon problems. Therapy helped. My problem is reoccuring! Therapy (@$40 a session), cleared it up. Six weeks later I have it again but THIS time I’ve developed a Sciatic nerve problem b/c of the tendon problem. I started using a cane..tripped with it ….fell, hurt my cheekbone and am now sporting a HUGE hematoma on my face. I’m SOOO aggravated.,despondent, and disgusted. Ending on a ☺ note……I’m 74 and have enjoyed good health most of my life.

June 30, 2012 at 10:22 pm
(17) Barbara says:

I first took Cipro in Feb. 2011 after TKR. …began having Achilles tendon problems. Therapy helped. My problem is reoccuring! Therapy (@$40 a session), cleared it up. Six weeks later I have it again but THIS time I’ve developed a Sciatic nerve problem b/c of the tendon problem. I started using a cane..tripped with it ….fell, hurt my cheekbone and am now sporting a HUGE hematoma on my face. I’m SOOO aggravated.,despondent, and disgusted. Ending on a ☺ note……I’m 74 and have enjoyed good health most of my life.

July 9, 2012 at 1:48 pm
(18) Anonymous says:

I have had tendon issues after taking Cipro and am really annoyed that because I’m in my 40′s my ortho feels that my new injury, is not related to the Cipro.

As an ex-pharma sales rep, I know that side effects of a drug can occur after the prescription has been completed. If patients do not ask that doctors report their side effects, then it is not linked to the drug.

I have called my primary care doctor and have asked that chart be noted with allergic reactions to flouroquinolones.

July 14, 2012 at 12:32 pm
(19) meg says:

I’ve had severe pain in my left anterior-crushial (sp?) tendon for the past 6 months. Only when reviewing w/ my internist, did she mention that the Levaquin I took in January for bronchitis may be the culprit. My podiatrist said I should “stay off my feet,” wear a boot to immobilize it, and take lots of NSAIDs until it heals, which should take about 6 months! With two young children, and a job as a nurse (on my feet), and running a household, staying off my feet is not an option. Now I’m told the tendon is inflamed to the point of rupture. Someone suggested I see a naprapath, who specializes in manipulation of soft tissues (muscles, tendons), and I really hope this will help. Wearing the boot has made my other foot start to hurt, too, from compensating. I can hardly walk 1/2 a block anymore. I’ve gained weight, since I can’t even walk on a treadmill. I feel about 20 years older than I am, and I’m afraid of becoming totally debilitated.

July 26, 2012 at 10:52 am
(20) Joe says:

Hey Everyone,
I took Levaquin for 2 weeks. The day I stopped I decided to get working out again,and lifting light weights caused severe pain in both arms. So much so that I could not lift a lightweight aluminum ladder.

After thinking it would get better, and waiting almost 6 months, I decided to seek help by physical therapy.

After a few months treatment with ultrasound, massage, ice treatments, and general therapy, my situaiton improved and I am back to normal…

Not sure this will help everyone, but it’s worth mentioning

September 16, 2012 at 9:45 pm
(21) debra says:

I took cipro for a urinary tract infection, in july 2011, and more than 15 months later my tendons are STILL painful, swollen and inflamed. I am at my wits’ end.
It came on about 2 weeks after i stoppped taking the drug, got very bad very quickly, to the point that i could barely walk. Then it seemed to start getting better, which gave me false hope, because it got to a certain point and then stopped improving. Now I cannot walk any kind of distance and my tendons and into the feet hurt a lot. I am worried that the constant inflammation is going to result in a rupture and that I am premanently crippled.
My question is: has anyone discovered any kind of treatment or healing for this? since obviously the drug company, bayer, has no incentive to actually research the terrible side effects of the drug they make.
I don’t know what to do.

October 14, 2012 at 6:56 pm
(22) Kate says:

I, too, took Avelox and have had severe pain in my feet and legs. At present, i am laid up with a type 3 sprain in my left foot. I have been using a boot walker and i have an appointment with my orthopedic doctor this coming week. I injured myself two weeks ago merely stepping off a step. My foot did not support me and crumpled, giving me pain that felt like i was being electrocuted up the side of my leg.
I know it was the avelox…i had pain during treatment but did not know of the side effects. I finally googled avelox and got the low down on this drug. I am going to look for a class action suit against the maker of this drug. My ability to exercise and even walk has been very affected.
Now i am unable to put weight on my left foot and my right foot is quite sore from the stress of the left foot injury. Don’t take Avelox!!!

November 3, 2012 at 12:04 am
(23) Judy johnson says:

Husband was given levofloxacin for upper resp. Problems. Developed severe pain in Achilles’ tendons and back of legs. Treated with prednisone…did not help. Now using DMSO cream/prescription.
No warning was given about the levofloxacin.
Bad reaction to this drug.

February 26, 2013 at 11:52 pm
(24) Shawn says:

I fail to see the point the first commenter is making by the website he discreetly links with a Comma.

“Therefore the net loss to a hospital doing this number of cemented femoral components is somewhere between $325,000 and $700,000 if antibiotic cement composite is used routinely.”

I fail to see what the hospitals have to gain using the article he quoted. Net loss = Not beneficial…

April 24, 2013 at 1:57 am
(25) bobbie antoine says:

I started hurting from right hip down right leg alter taking 3 ciprofloxacin. I was also on Flagil and thought the flagil was the problem, so I took the 20 day’s of cipro. Into 3rd day as I walked still in pain I heard a loud noise as if someone had fired a gun next to my head, I do not mean a pop like you hear from a knee crack as the Dr.s want to believe. I must have screamed for 20 minutes the pain was so sevier. I had grabbed my leg from just at the hip on the right side and inside the leg with my left screaming and rubbing. Telling me it came from my body. Swelling was instant from hip to toes. My leg was nearly twice the size it should be. Dr says Sprained knee, OH my he will not listen he sees the swelling I say, in most evident pain what about the rest of my leg? That was 1-16-13 I sit here after 3 more Dr.s still telling me meds don’t do this it’s a sprained knee.

May 2, 2013 at 1:44 pm
(26) Sharon says:

Another antibiotic that can cause tendon injury is Rifampin. My doctor and I knew about the dangers of Cipro and Levaquin for tendons, but we did not realize that Rifampin could have the same effects. I was on it IV for several months, with more and more severe tendon problems, but unaware that the drug was causing them (because I have multiple illnesses and am on multiple treatments). Now I’ve been off it a couple of months and I am trying to heal from tendonitis in my wrists and hands. Only the hand specialist I saw knew about Rifampin causing tendon damage — none of the other doctors, nor the OT I saw about my wrist problems — was aware of this issue. Please spread the word.

May 13, 2013 at 4:29 pm
(27) Kathy McSparran says:

My best friend was given Levaquin for an ear infection she got while scuba diving. She ended up in the hospital with a horrible skin rash all over her body that itched and burned terribly. It was indeed Hellish for her, and far, far worse than the stupid ear infection had ever been. Then my father was given Cipro during a surgery, and seven days later developed crippling achilles tendon problems. He finally recovered from them, but had to have the same operation again months later, and guess what? They gave him Cipro again and exactly seven days later the achilles tendon problem returned, worse than ever. He was bedridden and in horrible pain. His neighbor is a pharmacist and it was he who figured out that the Cipro he was given during surgery was the cause of the horrible achilles tendon problems. My 72 year old Dad had to tell the surgeon what had caused the tendon problems, and insist that they use a different antibiotic next time he has to have this surgery again. What the &^$^%$? Why do they keep prescribing this stuff?

My philosophy is to take as good care of myself as I possibly can so I can avoid all these health-industry-induced calamities!

January 11, 2014 at 7:11 pm
(28) Nancy says:

I have take cipro and leavaquin, and did not have any side effects, although the side effects were given to me by my pharmacist, when I picked up my script.

January 14, 2014 at 8:08 am
(29) Lisa says:

I was prescribed Cipro for 7 days a year ago for a UTI. I am a runner and when my Achille’s started hurting 5 months ago, i thought my running may have contributed (which it may have) but couldn’t figure out why. I got another UTI recently and was put on Cipro again, took it for 2 days and then read the papers that came w/ and got off it right away. I’ve tried PT, icing, antiinflamms and am no longer running. I believe Cipro caused the inflammation in my right Achilles. The warning says issues can occur months after being on the drug. A drug that breaks down tendons…

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