Are Antibiotics Levaquin and Cipro Dangerous?

two prescription bottles with pills next to them
Dr. Sharon Orrange
Dr. Orrange is an Associate Professor of Clinical Medicine in the Division of Geriatric, Hospitalist and General Internal Medicine at the Keck School of Medicine of USC.
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Cipro (ciprofloxacin) and Levaquin (levofloxacin) are commonly prescribed fluoroquinolone antibiotics that have been making news recently. (Moxifloxacin and ofloxacin are some other examples).

Why have they been in the news? Restrictions have recently been placed on their use. While they are effective for the treatment of pneumonia, urinary tract infections, sinusitis and bronchitis among other things, there are some major downsides. Downsides significant enough to lead us to other options first.

Here are ten things to know about why the FDA placed restrictions on their use in 2016:

  1. Second line. For use in acute sinusitis, bronchitis and uncomplicated (no fever, nausea, vomiting) urinary tract infections, the serious adverse effects of these antibiotics may outweigh the benefits. Using another antibiotic first is recommended. This should be emphasized again as well—most cases of bronchitis are viral and do not require an antibiotic at all.
  2. Serious side effects. While side effects of ciprofloxacin and levofloxacin are uncommon, they can be disabling and potentially permanent.
  3. How they can harm. Side effects involving everything from the tendons, muscles and joints to the nerves and central nervous system have been described.
  4. Achilles heel. Achilles tendonitis and rupture, and less commonly, rotator cuff tendonitis, have been well documented with the use of levofloxacin and ciprofloxacin. This led to a 2008 black box warning on fluoroquinolone antibiotics.
  5. Blood sugar. In both diabetics and non-diabetics, the use of these antibiotics may cause both low sugars (hypoglycemia) and high sugars (hyperglycemia) more commonly than other antibiotics.
  6. Heart electrical issues. Fluoroquinolones can lead to arrhythmias. This is especially important if using levofloxacin or ciprofloxacin with amiodarone, a medication used to treat heart rhythm problems.
  7. Nerve pain. While rare, in some studies on Cipro and Levaquin, less than 1% of folks reported tingling, weakness and neuropathic (nerve) pain. These symptoms usually stopped after discontinued the medication.
  8. Interactions. Levofloxacin and ciprofloxacin also interact with other medications and supplements.
  9. Iron and Zinc. Taking fluoroquinolones with certain supplements reduces absorption so they aren’t as effective. This includes iron sulfate or a multivitamin containing zinc.
  10. Nonsteroidal anti-inflammatory drugs (NSAIDs). Taking over the counter NSAIDS (ibuprofen, Motrin, Aleve) with fluoroquinolones may increase your risk of central nervous system effects and seizures.

Don’t get me wrong, these can be life saving antibiotics, but we need to be armed with all of the risks and benefits.

Dr O.

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