Ever since we sued the FDA for failing to respond to our August 2006 petition to increase warnings about the risk of tendon rupture with fluoroquinolone antibiotics, we’ve received a lot of valuable feedback from people who’ve had problems with these drugs, which include Cipro and Levaquin. Actually, “a lot” is a pretty big understatement: we’ve been downright flooded with the tales of drug-induced misfortune that have poured in through email, over the phone and by regular old snail-mail.

The good news? The FDA responded to our lawsuit by slapping fluoroquinolones with a black box warning – the strongest warning the FDA can request. The agency also required manufacturers to produce special Medication Guides that explain the risks and benefits of the drugs in language intended for patients.

The news we aren’t so happy about? The federal agency disagreed with the other essential part of our petition: that drugmakers should send physicians a Dear Doctor letter informing them of the side effects their patients might encounter with these drugs. But we are in it to win it, so we are now considering another lawsuit to force the FDA to require companies to send warning letters to doctors, since the agency has admitted that doctors are not adequately warned about these largely preventable tendon ruptures.

While we wait for the agency to see the light, I thought I’d try to answer one question that I’m sure is on the mind of everyone who has suffered tendinitis as a result of these drugs: When will I get better?

Unfortunately, there isn’t a clear, concrete answer to that question, but we do have some information that may be helpful.

A review of fluoroquinolone safety published in the Southern Medical Journal says “Even with early diagnosis and management, tendinitis heals slowly,” but also that “The mean recovery time reported is from 3 weeks for tendinitis to 3 months for a tendon rupture.”

The logical follow-up question is, of course, how do people recover from fluoroquinolone-induced tendon injuries?

Regrettably, there does not seem to be an easy answer to this question either — at this time there is no miracle cure that offers instantaneous relief to patients suffering from the symptoms of tendon damage.

But the Southern Medical Journal authors state that most patients can expect “complete recovery … if rupture is not present.” And while you wait for your body to heal itself, treatment is fairly intuitive: stop use of the fluoroquinolone and have your doctor switch you to another antibiotic; rest your tendons; use anti-inflammatory drugs for pain (being careful not to exceed daily limits); elevate your leg (if the pain is in your Achilles’ tendon); and ice the affected areas. Patients frequently use splints or crutches while they recover.

So the good news is that although some unlucky patients might require surgery, the odds are that, if you’ve been hurt by Cipro (or any of the fluoroquinolones, for that matter), you can probably expect your body to heal itself with “2 to 6 weeks of non-weight-bearing activity.” In other words: take a load off.
Anyone who experiences unexpected tendon pain while taking a fluoroquinolone antibiotic should stop taking the drug immediately, call their doctor and rest. For those of you who are interested in learning more about fluoroquinolone antibiotics – or any of the roughly 600 prescription and over-the-counter drugs our experts in drug safety have evaluated – can find out more by subscribing to www.WorstPills.org today.

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Comments

  • Kate,

    I fail to understand why another lawsuit would be required when the first lawsuit addressed the issues regarding the Dear Doctor Letter. Perhaps I am mistaken here but is not the first lawsuit still pending? Or has Public Citizen withdrawn that suit? Please don’t tell me that this ridiculous response from the FDA was found somehow to be adequate.

    The Southern Journal article you are referring to is once again grossly mistaken and puts a ridiculous spin on these issues. It has been over eight years in my case and the tendonitis continues unabated. And I am far from the exception. These drugs are crippling people for life…a number of patients DO NOT heal in two to three weeks as claimed by this article. We are NOT recovering after two to six weeks of doing nothing either. Year after year we continue to be in misery and nothing the doctors do is of any value whatsoever. Any number of studies has shown this to be a persistent injury in some cases that does not respond to treatment.

    That has to be the most outrageous statement made to date (recovering after two to six weeks) regarding these reactions. That and the number of reports being cited by the FDA. When is the medical community going to get it through their heads that the patient is at risk of being crippled for life?

    A recent review of the MedWatch database, deleting the duplicate case report numbers, shows 468 ruptures with Levaquin alone, and an additional 171 for Cipro, being reported to the FDA. 639 reports total over the past twelve years, and this does not even include all of the other fluoroquinolones, let alone all of the reports made from 1962 (Nalidixic Acid, which was also associated with joint problems) to 1996, which were ALL excluded from MedWatch. Forty-four years worth. Nor does this include all the bizarre medical terms used to describe such a rupture and all of the different foreign names for the same drugs.

    Sorry to be on such a negative rant here but this is infuriating. The advice to call your doctor is pointless. Just about every patient who does this is being told ‘it cannot be the drug’ and instructed to keep taking the medication. The NUMBER ONE complaint of those who suffer an adverse reaction to a fluoroquinolone drug is the fact that their doctors REFUSE to associate such reactions to this medication. Of over 400 patients responded to a survey on the fqresearch site and 99% of them indicated that their physicians knew NOTHING about these adverse drug reactions, and refused to believe that the drug could possibly be responsible for their problems.

    The same goes for the advice to stop the medication when tendon pain presents. By then it is far too late. The damage has already been done; otherwise you would not be in pain. This is as frivolous as suggesting to close the barn door after the horses have run off. What possible good would come from that?

    Already physicians have indicated that they have no intention of changing their prescribing habits as a result of this box being drawn around an existing warning. And the drug reps are spinning this as no big deal. The warning has always been there so this is nothing new in the least. Only problem is the fact that treating physicians don’t bother to take the time to even look at the package inserts, let alone read them.

    And where might I ask are the Black Box warnings for all of the other horrendous, and even fatal side effects of this class? The list would not even fit in this comment box. FATAL Liver, Kidney and Heart damage, irreversible peripheral neuropathy, disfiguring rashes, toxic psychosis, the list just goes on and on and on.

    Though the victims honestly appreciate Public Citizen’s efforts, this warning is a slap to the face as far as we are concerned. Far TOO LITTLE, far too late. It will be years before such warnings are even made available to the public, as the FDA did NOT mandate that these warnings be sent to all the pharmacies to replace the existing package inserts. All of the drugs in the pipeline will have to be exhausted first, as well as the stockpile of existing package inserts before these new warnings even see the light of day.

    We are just now seeing the warnings that were added four years ago regarding
    Peripheral Neuropathy (irreversible nerve damage), Heart Problems (prolonged QT Interval / Torsades de pointes), Pseudomembranous colitis, Rhabdomyolysis (muscle wasting), Steven Johnson Syndrome, as well as concurrent usage of NSAIDs contributing to the severity of these reactions.

    Feb 14, 2008, Bayer was reported to be sending letters warning doctors in Europe regarding severe and even fatal liver reactions as well as SJS and TEN in patients taking its Avelox antibiotic. Perhaps you failed to notice, but there were no such letters sent here in the States and Bayer has indicated that they have no intention of doing so either.

    We have waited two and one half decades and this all that the FDA is willing to do? Draw a box around a grossly inadequate and frivolous warning and then refuse to tell the treating physician that they have done so? And you had to sue them in Federal Court to even get them to do that? Thanks, but no thanks. NO where near adequate in the least. Again we state: “far too little, far too late…”

    Mr. David T. Fuller
    Director
    Fluoroquinolone Toxicity Research Foundation
    http://www.fqresearch.org

    • deborah

      I cannot believe that this medical journal would seriously claim that most people can expect to be cured within a few weeks.
      I have tendonitis in both tendons, which continues more than TWO YEARS after I took Cipro. The area below the tendons is swollen and both tendons are tender and painful, especially first thing in the morning. I have given up running, and given up walking any more than short distances. I have thrown out all my high heels. This is more than two years after I took Cipro! I doubt that these cases are being properly reported or monitored, since in my case when I called the medical center which prescribed me with Cipro, to tell them that I had serious pain in my tendons, they just sounded surprised, and said someone would call me back. No one ever did.
      I am possibly permanently crippled as a result of taking Cipro. I do not believe that including the phrase “and in rare cases might cause tendon damage” in the numerous side effects listed on the medication should absolve the manufacturer of responsibility. Why are they not looking into the frequency of this, and possible treatments for it? It is complete nonsense to say that the tendonitis is likely to clear up within a few weeks, when there are so many people who appear to be permanently damaged.

  • Brenda

    David,
    All I can say is you have said a mouth full. You could not have said it any better. Those of us who ARE damaged by these drug’s it is a little to late for us.And you will if ever find a Dr to say the antibotic is the cause of ALL of the problem’s we are having. I was on Cipro for 6 year’s daily 500 mg . I am a kidney transplant reciepient and 6 year’s ago i went in the hospital and ended up in a coma for 5 1/2 week’s.
    The Dr does not even know why.It could have been from the Cipro i had been on and off of in the year’s before. Or at the time I was in the hospital.But I do know I almost died from something. I am not on Cipro anymore .And the only reason I was on it is because my transplant Dr’s put me on it as a pervenative to help me from ever getting or as sick if I ever did. And I have been on Cipro 1000 mg a day at time’s when I was sick at home. There is a lot of people who this may not have effected and Thank God for that but the one’s of us that has been has a long hard road in front of and a painful one. If we evenmake it to the end of the road. It may be a dead end road…..

    Brenda

  • quin

    how about addressing my eleven years of hell ffrom levaquin!!! the tendons, tendonosis, peripheral neuropathy, neerve damage and i know plenty of people who have the brain toxicity…. i have been all over the u.s. and no one has any solutions!!! they say there is too much damage to operate…nice, huh??? if you had perisited in 8/1996 the petition to the fda, myself and thousands of others would not be in the shape we are in…. i thank god for my illinois state representative and the il attorney generals office for getting the ball rolling.(AGAIN)… i am still in contact with them, as is my illinois state rep is also…. fda has still not responded to the illinois atorney general’s petition of may 2005…. my BIG question to you… why did you not follow through with all of this in your first petition???? you could have saved thousands of people their quality of life…. even calls to you went un-answered…even after all the petitiones i have collected..(they are heart breaking) and trying to get a telephone call from you or and i even mentioned to your secretary i would fly to present to you all that i had of the VICTIMS of this class of drugs went un-answered…… at least my state rep and the illinois attorney general’s office listened to me and continue to do so and we are still working together on this….

  • quin

    sorry for the typo’s….. i was typing too fast and my blood as i am frustrated with you… i subscribe to your publications and now another suit???? i have a ton of material, but to be ignored by you is disgusting….

  • quin

    sorry for the typo’s….. i was typing too fast and i was seeing red as i am frustrated with you… i subscribe to your publications and now another suit???? i have a ton of material, but to be ignored by you is disgusting….

  • ciprovictimalso

    You talked the talk, but didn’t do the walk. You aren’t who I thought you were. You’ve lost my respect along with others who have been injured by these medicines.

  • Mike

    This is crazy. I can’t believe lawyers aren’t circeling like sharks. Thousands of people like me damaged for life. Doctors can’t help us if this huge problem is covered up. Thank god for the internet .

  • Now that it is October 1st, where are the black box warnings do I can call my physician and at least complain about feeling like a 120 years old bag of bones. Unfortunately for those sufferers like me, we will continue to stay wide awake all night because of Cipro induced insomnia, our ears will be constantly ringing, we will have panic attacks, suffer with the pain of peripheral neuropathy and a dozen other permanent side effects that never made it to a black box. And yes, all the doctors I have seen think I am a mental case. But we know it is the Cipro. Hardly a silver lining… We need public citizen to keep this in the press…Please help us at least retain our dignity if we can’t be cured and our pain cannot be relieved.

  • Shells

    Only one word.

    CRIMINAL

    • Jo West

      I agree with you on the diagnosis as “CRIMINAL” I took ciro in Jan of this year and am still suffering from it. I have tendonitis that does not go away also I have places on my back and my buttocks which I can hardly stand as I sit all time. Something NEEDS TO BE DONE.I have to be in a wheel chair because I had polio in 1952 and now this is something the is almost unbearable.

  • Peggy Conroy

    Any treatment found for cipro tendon damage?

  • Peggy Conroy

    Finding an antidote for Cipro damages (our dog is practically crawling as a result of this treatment) is the action all should be puching. I spoke to both Schering-Plough and Bayer about this and they said no research is being done in their labs or anywhere that they know about! This, to me, is the most criminal of attitudes.

  • All credit to Public Citizen for forcing the FDA to take action, but the Dear Doctor letters are also needed. It is incorrect to for the Southern Medical Journal authors to state “complete recovery … if rupture is not present.” Once severe tendinitis has occurred the affected tendon is weakened for life, and it is significantly more likely to be re-injured in the future. I am not a medical professional, but I write as someone who has acute Achilles tendinitis in both legs (arising after a course of cipro), and can no longer ride a bicycle without re-injury.

  • sarah puttonen

    I took cipro and it ruined my life I was a healthy 27 year old 6 month ago and than i got a mild bladder infection .. they gave me cipro .. 3 days later i couldnt walk and felt like i was dying. I had to cancel my wedding drop out of school and cant really leave my apartment now. so.. who is responsible. I cant work and am loosing everything because of this.

    sarah.putt@hotmail.com

  • Rick Lamber

    I was wondering where this short list of comments ended up as it is now 2011 and a gap of three years since the last entry?
    The question, unanswered, was what to do for those affected?

  • Daniel

    I’m just posting to give some hope to those who are suffering from cipro induced tendonitis. I took 4 pills and in the days that followed was not even able to sit because simply resting my legs on my tendons was too painful.

    It is now 2 weeks later and I am able to walk around a bit. I expect to fully recover in another week or two. I just hope there aren’t any other long term effects.

  • Aymee

    Well it only took like 3 days to destroy my baby momma….I had knee surgery on tues the 20th and have been carrying her to the bath and toilet….she’s totally immobile….crazy pain and to top it off we have a 21 month old lil girl…..so we’ll both be cripple soon enough from this terrible drug !!!! The ER didn’t even want to consider a reaction from cipro sounds typical to me now…any advice at all would be soooooo helpful ?????? Davincitattoo@cfl.rr.com

  • cyprostruck in PG,BC Canada

    I took cyprofloxacin for less than a week 2 yrs & 3 months ago. I started to have joint pain a few days after starting the drug, called my doctors office and they told me to keep taking it and that the symptoms would go away. I am still unable to do any physical activity as any exerted part of my body begins to swell, I then get a sticky film of my bodily fluids coming out of my pores due to the swelling that then turns into a nasty rash where my skin starts flaking off. It’s gross & uncomfortable. I can no longer do my Pilates, swimming, going to the gym. I cannot paint a wall. I had to buy a food processer to chop veggies, but peeling them does my hands in anyways. The doctors solution is to put me on the drug Celebrex. Have you read the side effects on this one? I am lactose intolerant and there is lactose in the drug. I have a history of acid reflux and one of the most dangerous risks is possible stomach bleeding. I guess that office did not learn to keep me away from drugs? I refuse to take it. I’m damaged enough already. I am in Canada and there is no black box label on cyprofloxacin here. Suing would have put me at risk of losing 75000 which I did not want to risk. I was told there is no record of a case being won in Canada for this type of case…pretty tough with no precedence. No one seems to give a rats ass to make the pharmaceutical co. be accountable for what this drug is doing to people. I thought of calling a documentary channel or W5. This will be the only way to light a fire…is to get media attention…get on a talk show? Dr Oz? Why doesn’t he help us? Sounds like a plan eh? NOT!!!!! No channel will risk losing their million dollar buys they get from the pharmaceutical companies. They are the ones who rule the airwaves. If the CEO of Bayer gets cyprostruck or his kid, maybe they’ll consider doing some research to help all of us who have been cyprostruck. How do you spit in text …anyone know? Signed, cyprostruck in Prince George, BC.,Canada. anneinpg@hotmail.com Please only contact me if you have a game plan or a cure

  • Mark

    I took Cipro 500mg twice a day for only 5 days. I asked my pharmacist about side effects he said it may upset my stomach… A few days later I awoke in the morning with pain in my back/neck and right arm. It was down right painful. A few days after that I left sobbing in bed because the pain was so intense. I then re-read the warning that came with my medication more clearly. It said MAY CAUSE TENDON RUPTURES (most common in persons over 60). No black box warnings that are described here. I went back to my DR. a few weeks after the pain started and mentioned that I was concerned about the Cipro. Of course he said it was not possible as it ONLY EFFECTED ACHILLES TENDONS. He also said it would have happened sometime during the prescribed days. The warning does state that it can appear weeks or months later. Clearly there is a real ignorance to the true side effects of this drug. Where is the BLACK BOX WARNING? My pharmacist knew nothing about it, my paperwork did not display one. I think people need to know the truth about this drug. The risk of complications may be rare, I will bet misdiagnosed is often the case. If there is supposed to be a black box warning it needs to be present with the medication provided to the patient, NOT mixed in with two pages of tightly spaced, ALL CAPPED TEXT, full page width lines lengths that are difficult if not impossible to read.

    • Jennifer

      Mark,
      I am in pain as I type this out with right wrist neck and shoulder pain after 5 days of 500 mg twice a day, July 2-7th. I had taken it with me overseas for traveler’s diarrhea and started at the early onset when 3 of us got sick after 2 days in the country. I only discovered what may be the cause of my acute wrist pain when i looked to see if I could shorten the course as I got better. (Mexico had a different packaging that didn’t call for 10 days). I have seen magnesium may help so I started it while here and stopped the Cipro immediately. I also immobilized it intermittently which helped at night. I hope you get well soon. It seems to be moving in the right direction. I haven’t yet seen my physician as we just got home.

  • Chuck

    So what is the latest on all this? I was prescribed cipro a little less than two years ago. Two days in the pain started (Achilles), and on the third day called my doctor who told me to stop. Of course, I still have problems with the Achilles, primarily on the right side, but I really didn’t think about searching “cure for tendinitis cipro” until a few months ago. I am appalled by what I found. Really, I think all anybody who has been affected like this wants, is to get better. But from reading all these posts, it kind of seems like this has become a forgotten issue in the past four years…or one that has been successfully swept under the rug. Forgotten or ignored by all but the victims, that is. Am I correct about this?

  • Mark G.

    I too suffer terribly from Cipro. It has been about a year now and I have tendinitis in my left achilles tendon, rib pain, permanent tinnitus that drives me crazy and both shoulders and biceps and triceps hurt. The only way to stop these monsters is to sue them. We must launch a class action lawsuit againsty the drug company who has destroyed our lives.

  • ciprovictimalso

    My husband took Cipro twice. His health started declining in his 40′s. By 55 he was dead. His lifestyle was that of living in a recliner and leaving it to go to the restroom which was a challenge on if he would fall or not on the way. That was how he lived his life for the past few years before he died. Was enough done to protect him? Does anyone really want to ask me that?

    • Jane

      jnmcoope,
      I’m so sorry for the loss of your dog. I have a dog damaged by cipro. Fortunately my vet did some research and told me but the damage was done. She was only about 9 lbs; I don’t know dosage. The medication was given when she had her teeth cleaned and she lost a tooth. After a while she began to walk peculiarly but still could get around. I gave her an anti inflammatory thinking she had arthritis. Then one morning I let her outside and as she ran across the yard she fell over; she got up, tried to run and fell again. It was apparent that something was seriously wrong. We had moved from the city where she was previously treated so I took her to a local vet who could not determine what was wrong so I drove back the first vet. He looked at her records & pretty quickly realized what it might be. He seemed to know it was a problem for people. We kept her splinted and immobilized for about a week and she has gradually gotten enough better that she can get around (awkwardly) with major limitations. She experiences pain if too active. It appears that anti inflammatories are contraindicated and that is what exacerbated the problem 6 months after the cipro was given. This has all been heart-breaking since she is still alert and still has the same personality but limited mobility and pain every day and we thought we might have to have her put down. The fact that the vet identified and acknowledged the problem and worked to resolve it somewhat made all the difference in my feelings about it. He also uncovered several other reports of ruptures in people and pets. That was all Feb.-Aug. 2011.
      Now, here’s the kicker: About 5 years ago (2008) I took leviquin for a UTI. No warnings from doc or pharmacist. After a couple of days I was vigorously doing some outdoor sweeping with a large push broom when both shoulders became painful. It was severe enough that I stopped and when I looked it up in a nursing manual I discovered a warning about tendon ruptures in children. I did not take another dose. This allowed me to understand what was happening with my pet. It also still plagues me regularly throughout my joints. When I mentioned it to 2 medical professionals they both told me it was limited to children. So much for the black box.
      Again, I’m sorry for your loss. Our relationships with our pets are like no other.

  • jnmcoope

    do you guys know if Cipro can have the same side affects to dogs??? a vet proscribed this to my dog she was 63 lbs and was taking 500mg 2 times a day… she lost use of her back legs , urine became dark with blood, started having trouble breathing, and right before she died had a seizure… she was sick when we first took her in but didn’t have a fever at all ever and vet didn’t do a cbc to even confirm an infection… he is now telling me there is no way cipro killed my dog but she had alot of the warning side effects to humans… i have been googling but haven’t found alot..

  • Jonathan Guida

    I am a healthy active 31 year old that was on Cipro for about a month. While on the tail end of my cycle I ruptured my achillis. I was playing a sport but I have been playing sports my whole life. Too coincidental for me. This has been a terrible experience.

  • David

    I took cipro a few times for a minor bladder infection and it ruined my life. It’s been over a year since my last pill and I can still barely walk. My leg muscles have wasted away and my cartilage has metled away inside my knuckles, wrists, elbows, knees and ankles. My ribs even crack and pop. Now my achillies tendon on both legs are very thin and getting weaker. I twitch and spasm all day and night and can’t sleep more than 3 hours per night. I have been all over the USA for help. In the past year I’ve seen over 30 doctors and specialists. I’ve spent more than $50,000 in testing and treatments and still in the same condition. Before Cipro I was a marathon runner and bodybuilder. Now I feel like I’m 150 years old in a 37yo body.

  • TC

    I am a 62 yr old male. I have been very active and am in pretty good shape. I was diagnosed with UTI and was put on cipro. After 3 days I awoke to the worst pain I have ever had. (I used to get migraine headaches.) Now I have no use of my right arm. I cannot straighten it out or bend it without severe pain. Went back to the Dr. and had to talk him into some other medication. He didn’t want to believe cipro was the cause. Now, its over a week later and much improvement all though the pain is more manageable. I guess the good news for me is it is in my right arm (yes, I am right handed) and not in my achilles tendon so I can still get around. If there is ever a class action lawsuit, I would like to be part of it. Does anyone know where to report on things like this? Anyway, I am looking else where for something to help.

  • michelle

    took Cipro for 1 week a year ago. had psychotic episodes for 9 months. last fall developed tendonitis in both hand and both feet and my right should ruptured. psychosis has mostly abated but tendonitis and cognitive impairment persist.

    and guess what?

    no lawyer will touch this. Cipro destroyed my life and relationships and I’ve lost hope for recovery and I feel like I should be recompensed, but no lawyer will take my case :(

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