Ask your doctor for a cure for traveler’s diarrhea, or any number of bacterial infections, and the first line of defense will often be a prescription for Ciprofloxacin (Cipro). Athletic individuals, in particular, have sound reason to push back when offered this drug for their ailment.
Cipro is the most prescribed member within a family of antibiotics called fluoroquinolones. The FDA requires all drugs within this family to carry the stringent “black box warning” on the package insert indicating there is reasonable evidence of a serious health hazard associated with them. What is the hazard associated with Cipro?
Tendinitis and tendon rupture
Tendinitis is swelling and pain in the fibrous tissue that connects muscle to bone. Tendon rupture is a partial or full tear.
The Achilles tendon, behind the ankle, is statistically the most vulnerable to Cipro induced rupture. This tendon bears the stress of propelling our full body weight forward in walking. Pain or rupture of this tendon seriously impacts your mobility. If your passion lies in activities that involve explosive power from your feet while sprinting, cutting, jumping, or charging up a mountain you are demanding a high level of tensile strength in your Achilles tendons.
Researchers theorize that Cipro breaks down the collagen throughout the body. Collagen is what gives connective tissue its strength and structure. A 2015 study implicates Cipro in Aortic Aneurysm which is rare but life threatening. The lining of the aorta – the largest artery in the body – is made of collagen.
The FDA warning states “These problems may affect tendons in your shoulder, your hand, the back of your ankle, or in other parts of your body.” Essentially any tendon where there is repetitive stress from your favorite activities can be at risk: those of the shoulders of swimmers and throwers, knees of hikers and skiers, and elbows of golfers and tennis players.
It is alarming when you consider how miscalculated Cipro’s role might be in causing tendonitis. The onset of Cipro related tendon problems can be from a few hours after your first dose to six months after taking your last dose. The longer the time span, the less likely one would connect their pain to the drug, so the relationship is probably higher than statistics would indicate.
There are compounding factors that increase risk of Cipro induced tendon problems:
- Being over 60 years of age when tendons tend to be weaker due to lower levels of collagen in the tissue
- Concurrent use of corticosteroid medication which in itself is known to weaken tissue
- Participation in vigorous exercise
- Pre-existing tendon disorder
- Diabetes mellitus when circulation is compromised
The fluoroquinolone family of antibiotics is especially good at penetrating bone, tendons and cartilage; if that is where your infection is, it may be the best choice. But in conditions where the infection resides in your gut, bladder, or sinuses there is certainly an antibiotic other than Cipro that can cure you.
Cipro nearly quadruples your risk of tendon rupture. Any time your doctor prescribes it, ask if there is a safer alternative. Why take unnecessary risk of interrupting your active lifestyle?
Chien-Chang Lee, M. S., Meng-tse Gabriel Lee, P., Yueh-Sheng Chen, M., & al, e. (2015). Risk of Aortic Dissection and Aortic Aneurysm in Patients Taking Oral Fluoroquinolone. JAMA Internal Medicine, 1839-1847.
Trevor Lewis, M. M. (2014). Fluoroquinolones and Tendinopathy: A Guide for Athletes and Sports Clinicians and a Systematic Review of the Literature. Journal of Athletic Training, 422-427.
US National Library of Medicine. (2017). Ciprofloxacin. Retrieved from Medline Plus: https://medlineplus.gov/druginfo/meds/a688016.html