A couple of weeks ago, I got sick and self-medicated myself for two days with a course of ciprofloxacin (or Cipro) until I got a chance to talk to my primary physician. She agreed with my tentative diagnosis and prescribed a full course of Cipro.

Now, I had used Cipro before. In fact, whenever the family travels on vacation, we pack it in case we get a case of “turista.” I viewed it as necessary and commonplace as packing some ibuprofen for pain.

So I was surprised when my doctor cautioned me against strenuous exercise because a major side effect has been recently identified: tendinitis, and worse: tendon rupture. Having gone through the agony of Achilles tendon rupture during a marathon race, and surgery for a ruptured biceps tendon, her warning put the fear of God in me. Indeed, when I got the Cipro bottle, the first thing that tumbled out of the package was a warning about tendon problems. I decided to investigate.


Fluoroquinolones—great drugs

achilles tendon rupture
Achilles tendon rupture

Cipro belongs to the fluoroquinolones family of antibiotics. They are one of the most commonly prescribed classes of antibiotics. The reason for their popularity with physicians and patients alike is their broad-spectrum anti-bacterial activity and their high tissue distribution.

These drugs are generally well-tolerated, and adverse reactions are relatively uncommon; nonetheless, if they do occur, they are pretty unpleasant.

Fluoroquinolones were reported to cause dysglycemias (hyper and hypo-glycymia), cardiac arrhythmias, neuropsychiatric events, corneal perforation (topical application only, and by another fluor ofloxacin, not cipro), and most important to exercise fanatics: tendinitis and tendon rupture. The most common tendon to be affected is Achilles tendo but other tendons are fair game as well.


Cipro and collagen

It is still largely unknown, but a good guess is that since tendons are almost purely collagen, Cipro must either interfere with the production of collagen or cause its destruction. To find out which it is, we can actually play a bit of a biochemical detective game.

Collagen’s half-life, meaning its turnover rate, is extremely long; it takes months to completely replace collagen molecules with newly-synthesized ones. As a matter of fact, collagen has the longest half-life of all the tissues.

So if tendon rupture was caused by interference with its synthesis, it would have taken weeks or months to occur. In fact, tendon problems can surface within days, or even within hours of taking the drug.

The alternative possibility, destruction of existing collagen, is consistent with the acute occurrence of tendon problems. Although we don’t have in vivo evidence, there are suggestive in vitro experiments. If macrophages are incubated in the presence of fluoroquinolone drugs, they secrete enzymes called matrix metalloproteinases that have an interesting activity—they breakdown collagen molecules.

Admittedly, this has been shown in Petri dishes, and we are far more complex than laboratory dishes. Still, the report on corneal perforation says that it happened when a fluoroquinolone was applied topically to the cornea—quite similar to the petri dish experiment. And yes, the cornea is made mostly of collagen.


Why mainly tendons?

retinal detachment
Retinal detachment

Indeed why? Collagen is the most ubiquitous molecule in the body. It makes up the skin, the dermis that underlies the skin; it anchors all the internal organs; it forms tendons and ligaments. And that’s only a partial list.

What makes tendons so special? I couldn’t come up with a good answer to that question. Other collagen disorders, such as structural mutations, result in widespread and debilitating effects. Why not the fluoroquinolones?

I think that it is a matter of awareness. The realization that these antibiotics can affect collagen is relatively recent. Adverse effects of these antibiotics will be treated now with a much higher index of suspicion. Just this week, we were treated to an article in JAMA titled “Oral Fluoroquinolones and the Risk of Retinal Detachment.” The exact mechanism is unknown, but the retina is attached to the cortical vitreous by a complex matrix of collagen fibers.


Should you take fluoroquinolones?

The answer is a resounding YES. The drugs are extremely effective, and very safe. These adverse effects sound scary, but they are rare. If you exercise, be aware of your body; stop when you experience the first signs of joint, muscle or tendon pain. And as always, talk to your doctor.

Dov Michaeli, MD, PhD
Dov Michaeli, MD, PhD loves to write about the brain and human behavior as well as translate complicated basic science concepts into entertainment for the rest of us. He was a professor at the University of California San Francisco before leaving to enter the world of biotech. He served as the Chief Medical Officer of biotech companies, including Aphton Corporation. He also founded and served as the CEO of Madah Medica, an early stage biotech company developing products to improve post-surgical pain control. He is now retired and enjoys working out, following the stock market, travelling the world, and, of course, writing for TDWI.


  1. Okay, this concept will be immediately rejected. Most of you won’t even consider it. So take it or leave it. Regardless, this seems to be the most effective healing remedy known to man. It’s called dry fasting. I already know what your’e thinking. No fucking way. But if you’re willing to at least explore any/all options, please contact me at mcleblanc87@gmail.com. I’m not kidding. at least let me explain.

  2. This is why magnesium is essential in treating the mess left by Cipro. From Drugs.com:

    “Ciprofloxacin and magnesium salicylate should not be taken orally at the same time. Products that contain magnesium, aluminum, calcium, iron, and/or other minerals may interfere with the absorption of ciprofloxacin into the bloodstream and reduce its effectiveness.”

  3. I was prescribed Cipro for UTI in February and immediately noticed pain in my right biceps. The drug made me feel so awful, not just because of the pain in my arm, that I stopped taking it after a few days. I am 60 years old. Apparently, my doctor should not have prescribed this drug to me. Three months later, I still have the biceps pain and am unable to do normal activities.

  4. It is precisely this attitude in doctors that causes undue suffering for so many patients who put their trust in them. Dr. Michaeli uses terms like “relatively uncommon” and “sound scary” when referring to adverse effects- as though it is silly to worry about them. As though those of us who have them are just the unlucky few…
    I was poisoned by ONE 750mg dose of the floroquinolone Levaquin. “Pretty unpleasant,” as this doctors says, doesn’t even begin to cover what I went through or what most people go through with these “rare” reactions. He also doesn’t mention the fact that this drug passes the blood/brain barrier and can significantly affect the central nervous system, causing neuropathy, anxiety, paranoia, and a myriad of other hellish symptoms- all of which I had from ONE DOSE! The fact that I was given this drug quite flippantly in the Urgent Care for a “suspected” kidney infection (turned out to be a stone with no infection at all), is proof that doctors are not doing right by their patients. And this doctor is one of them. Rare? From 1997-2015, reported adverse reactions from Cipro and Levaquin to the FDA were 199,767 and 3,667 reported deaths. Two years have gone by, so I’m guessing the number is up. Considering an estimated 10% of patients who experience side effects actually report them, the number is not so rare at all. And when you are the one suffering, those numbers do not matter. Doctors (like this one, I’m guessing) prescribe this like it’s candy. They need to wake up and remember their oath to “DO NO HARM.”
    If you are considering the safety of this drug, do not listen to doctors! Do your homework. Those of us who have suffered the consequences of trusting our doctors are paying the price for it. Taking any floroquinolone is like playing Russian Roulette with your life. It may not kill you, but it can most certainly damage it, and possibly forever. If only doctors would prescribe it for what it was meant to be used for antibiotic resistant pneumonia and anthrax! I hope this doc has learned something.

    • Fluoroquinolones can indeed be dangerous, and the FDA has updated its warnings. But this actually shines a light on the fact that medicine is still an art, not an exact science. So how did drugs of this class get approved by the FDA? Drugs have to go through rigorous testing, where every side effect, every adverse event has to be recorded, and if serious, immediately reported. In the last phase of trial, phase 3, thousands of patients are enrolled, and statistical analyses applied to the data. From personal experience I can attest to the extreme rigor that the FDA applies to examining the raw data and the statistical analysis. So with all this rigorous process, how is it that side effects, some previously known but rare, and some new, occur after the drug is released to the market? There are several answers. First, clinical trials are conducted under very close observation; in a way, patients get an extraordinarily good care. Once a drug is marketed there is obviously a lower level of patient care. So why didn’t those “new” side effect show up during the trial? One reason is size. In a trial the number of patients is in the thousands. Once a drug is released, it is in the millions. And with such an increase of the population (many thousands of times the population in the trial) you are bound to uncover undetected side effects. Not to discount the severity and heartbreak of patients’ suffering, even if they number in the thousands, as a percentage of the total number of people taking the drugs it is pretty low.
      this sounds pretty cold, but I think to be constructive we need to think what can, and should be done to remedy the situation.

      Some of the comments hit the nail on head: we may not know the extent of the problem because of under-reporting. The FDA actually requires a post-marketing surveillance for every approved drug (phase 4), but very few drug companies actually carry them out. How could they get away with it? It comes, as always, to money. FDA budget is a favorite target of some politicians. To compound the problem, congress in its wisdom intends to force the FDA to accelerate the approval process, not by increasing the FDA staff, but forcing them to relax their criteria for approval. If you think FQ is a problem, brace yourself for a barrage of toxic drugs released to the market.The U.S. dodged a bullet with Thalidomide because of a persistent staff member who refused to budge in the face of political and drug company pressure. Relaxing the criteria for approval is playing Russian roullette. On the other side of the equation, drug companies, realizing the non-enforcement of post-marketing surveillance, save a lot of money by ignoring the requirement for rigorous post market surveillance. Money and politics intertwined -anything new?
      More specifically, one of the commentators suggested that there might be a genetic predilection to reacting to FQ. I totally agree. The severity of the side effects in thousands of patients on the one hand and the complete safety of the drugs in the millions who have taken it on the other hand “smells” to me like a genetic factor is in play here.

  5. I am four years out from taking levaquin and not able to hardly even take my dogs for a walk. My mitochondria have been damaged by this drug. The only reason my tendons held together during this time is I knew how to supplement them. They started on absolute fire right after taking levaqun. Why would anyone take these drugs when other much safer alternatives are available. By sharing my story, I was able to stop a friend from taking levaquin and prednisone (an even more dangerous combination) this week, she asked her doctor for different antibiotic. But anyhow, sure take levaquin if you want to risk severe debilitation, debiliting fatigue, all over severe pain, major GI upset which lead to H. Pylori and C. Diff in my case, insomnia, absolute exercise intolerance, brain fog so bad you think you have dementia, food intolerances-i cannot eat nightshades anymore and have to be very careful with my diet. I realize not everyone will react to these drugs in this manner but is it worth the risk to patients if another kind of drug will treat their illness successfully?

  6. Worldwide, we countless numbers who have been poisoned by the fluoroquinolone ‘ antibiotics’ are existing in excruciating pain, pain that is SO severe, that it actually has NO word in ANY language which is strong enough to describe it, OR do it justice , These so called ‘ antibiotics’ are extremely dangerous drugs , in fact they come straight from HELL! .
    Unfortunately, they can all too often drag you straight back down there with them, & then leave you there, often for many many years, and this can ALSO be permanently.

    They are actually failed chemo drugs MASQUERADING as antibiotics, they are Topoisomerase inhibitors.
    If you look this up, you will find that every other drug described as such IS chemotherapy, as such they cannot tell the difference between bacterial DNA & our own, & they do systemic indiscriminate damage to ALL body systems.
    These symptoms are NOT ‘ SIDE effects ‘ in the usual sense, as is usually described by our Drs & understood by patients, ( the phrase ’side effects ‘ being just an attempt by Big pharma to try to mask the damage their various allopathic drugs cause, ie ‘ nothing to see here ‘ , as trivial, of no consequence, actually drugs have EFFECTS, they are not ‘ side effects ‘ ), when it comes to FQs, the Iatrogenic injury caused by them is a completely different animal, it is instead DIRECT DAMAGE to the body & brain, & at a DNA mitochondrial level.
    This damage is cumulative, & it is being caused from the very first dose you take … happening invisibly, unnoticed at first ’ under the radar ‘, it will ONLY show noticeably / visibly when enough damage has occurred,. That tipping point into fluoroquinolone toxicity hell on earth is different for everyone .. whether that be just the one dose … or maybe many many courses down the line. The risk of serious iatrogenic injury, it ALSO applies to EVERY MODE of administration of FQ.

    Stopping the FQ when you develop symptoms, as is stated in the literature, this unfortunately is closing the stable door after the horse has bolted, it makes absolutely NO difference whatsoever, as once you have experienced noticeable / visible symptoms, it’s sadly much too late. The damage is already done, you are floxed, & right now, there is NO reversing this damage, & also NO cure for FQ toxicity / FQAD available.

    The so called fluoroquinolone ‘ antibiotics ‘ are classed by the FDA as dangerous drugs, the FDA having yet again updated the warnings, this time admitting they CAN & DO cause multi-systemic permanent irreversible Iatrogenic injuries, yet this important information is STILL not getting out to so many Drs in the USA, & we are finding when it does, that some of those Drs are SO brainwashed by Big Pharma, that they are not even believing these official updated warnings.
    Of course, elsewhere in the world our Drs are still completely clueless, so they are STILL worldwide being prescribed in completely the wrong circumstances, for simple infections, suspected infections, uncultured infections, prophylactically, i.e. before operations etc to date .

    This prescribing of a FQ for a non existent infection happened to me, it happened NOT just once, but TWICE ! . I was prescribed them for a suspected uncultured infection it later turned out I actually did not even have, in fact I was prescribed them MANY times before I finally joined the dots. And EVERY TIME I was prescribed them, it was with NO INFORMED CONSENT WHATSOEVER, as a result of this lack of informed consent I am now permanently & irreversibly damaged.

    It is VERY important to note the following : Serious Iatrogenic Injury caused by the FQs is actually NOT rare at all, instead we who are the FQ poisoned are just the INVISIBLE ONES.
    We walk around day after day, COUNTLESS NUMBERS of us, ( that’s if we CAN still walk at all ) MISdiagnosed instead with various other conditions. With labels such as Fibromyalgia, CFS/ME, attached, with a label of ‘ allinyourheaditis ‘ or labelled with various autoimmune conditions, some of us are also labelled with ‘ severe mental illness ‘ , fluoroquinolone toxicity symptoms mimic MANY MANY things. Those less affected ( as yet ) are often just told it is ageing, sadly, the list of misdiagnoses, it just goes on & on .. ad infinitum.

    Any Dr, any medical professional who believes that these so called ‘ antibiotics’ are ‘ safe & effective ‘ is actually NOT seeing what is literally in front of their eyes, their fluoroquinolone damaged patients. Our Drs have been misinformed for around 30 years by Big Pharma re the true seriousness of the toxic profile of these drugs , the real dangers of the fluoroquinolone ‘ antibiotics ‘ these Drs who believe the FQs are safe are sadly living on a different planet, in a different reality system.
    As I mentioned above, the fluoroquinolone ‘ antibiotics ‘ are Topoisomerase inhibitors, they are failed CHEMO DRUGS, & in fact they are SO VERY dangerous, that they should only EVER be prescribed as a LAST RESORT ‘antibiotic’. This means used when ALL other antibiotic options available for the bacterial strain concerned have been tried FIRST , ALL of these antibiotic options have failed, & the patients death is the ONLY other alternative to them.

    Anyone reading this who is willing to keep on taking these so called fluoroquinolone ‘ antibiotics ‘ , simply because they have taken them before / several times, & as yet nothing untoward has happened to them, because they are ‘ feeling fine ‘ , they have noticed no adverse reaction to them, they have no symptoms from the use of them at all, please note as I mentioned above. The fluoroquinolone ‘ antibiotics ‘ cause DNA damage, mitochondrial toxicity / dysfunction, this means the damage is happening out of sight, where you cannot see it & cannot feel it ‘ at first,’ under the radar ‘ .
    To continue to take take fluoroquinolone ‘ antibiotics ‘ dose after dose, course after course, this is literally playing Russian roulette with your life. The same as with any game of Russian roulette, please keep in mind that there is always one bullet in that gun you are holding, & speaking as someone who has been existing in this horror story for almost as long as the FQs have been on the market, believe me … it DOES have YOUR name on it.

    There are many other antibiotics, & many many times an alternative to them can be found.
    If you are told that a FQ is the ONLY choice available for you, make sure that you have had a culture done, & you know the bacterial strain concerned, then do your OWN research into other suitable options.
    Keep in mind that antibiotics WERE of course around BEFORE the FQs arrived on the scene, ask yourself WHAT did they prescribe before FQs arrived on the market for my condition ?, & for those people who have had an immediate allergic reaction to FQs in the past, of course our Drs MUST accept they must NEVER be prescribed them again, & so they have no choice but find an alternative …… & they invariably do so.
    if they can find alternatives to a FQ for these people, then they should ALSO be able to do this for you.

    Please google fluoroquinolone toxicity / ( FQAD ) fluoroquinolone associated disability, research topoisomerase inhibitors, LEARN what your Dr DOES NOT know, & therefore is NOT telling you about these very dangerous drugs
    You might wish to reconsider after doing so, whether you wish to continue to risk pulling that particular trigger, as it just might NEXT time you take them, or perhaps just a few more doses / courses down the line, completely devastate as you know it your ONE & ONLY precious life .


  7. Just spoke with my daughter’s college physical therapist. Major university in to 10 every year, very up on science of physical performance. She said they don’t hold athletes out while on cipro. Also she called the team pharmacist who said the main risk is for patients over 60 or w kidney damage.

    Since only a few have stated their ages above, I wondered about differences in effects with age groups.

    • The following is a quote from an excellent article by Jane Brody in the NYT. https://well.blogs.nytimes.com/2012/09/10/popular-antibiotics-may-carry-serious-side-effects/:

      Fluoroquinolones carry a “black box” warning mandated by the Food and Drug Administration that tells doctors of the link to tendinitis and tendon rupture and, more recently, about the drugs’ ability to block neuromuscular activity. But consumers don’t see these highlighted alerts, and patients are rarely informed of the risks by prescribing doctors.

      Follow the link to tendinitis, which is especially relevant to people engaged in sports. There is no age limit to the side effects that I am aware of.

    • Many of the more than 9,000 members of a fluoroquinolone toxicity support group are young people, young athletes, in the 20s, 30s, 40s, and they suffer the same tendon problems as the older people. Don’t believe for a minute that the risk is rare and mostly in people over 60. That is not the reality of these antibiotics.

  8. Don’t take Fluoroquinolones unless it’s a life and death scenario without any other alternative antibiotics.

    I was a 26 year old athlete and student and now my life is ruined due to severe tendon pain after just 10 days of Ciprofloxacin. Very very nasty stuff which should be reserved for severe cases only.

  9. I used Cipro in the past (3 times). I did not connect the symptoms to any side effects of the drug until now.

    Yesterday I used only one dose of cipro (500 mg) to treat a basic pain during urination (the doctor was not even certain about the cause of the pain and all the tests were normal, but she prescribed the drug anyways).

    After one dose, I have felt super dizzy and weak. I have a brain fog, I cannot concentrate. After making a search over the internet and reading all the horror stories, I decided to immediately stop using this medicine. I am young, in my early 30s.

    I recall my previous experience with Cipro:

    When I was in my mid-20s, I used Cipro to treat food poisoning and diarrhea. I could still remember the pain I endured. My entire body was shaking. At that time I thought Cipro was helping me to fight against the bacterias or viruses, but later I realized that my body was actually fighting against Cipro. I also had the worst nightmares during that time.

    I have been fairly successful in my life even after these 2 full periods of Cipro. However, it is a fact that this drug is a poison and extremely risky. At this point I could only hope that the last one dose would not cause any permanent damage to my health. Please warn everyone. Do not use Cipro for basic issues such as pain in urination. Educate the doctors, they don’t know anything.

  10. I have done three rounds of Cipro the last 7 years. No problem at all. In each case, a bad infection was cleared up that did not respond to another antibiotic.

  11. Hi Dr. Michaeli – I had an adverse reaction to fluoroquinolones. I have done an enormous amount of research on these drugs and have met with doctors at the University of Chicago, who are in agreement with the dangers of fluoroquinolones. These drugs were developed to treat Anthrax and the Plague. They are not safe, therefore, doctors should not be prescribing them, and people should not be taking them. There are numerous alternative drugs available that are safer. Because you are a doctor, please be thoughtful with your recommendations.

    • Just to let you know, some people don’t have alternatives like amoxicillin, penicillin, and ceclor. They have severe and rare interactions with patient. Last year, I had a strand of bacteria that was susceptible to these drugs (penicillin, amoxicillin, ceclor) — and I have severe to deadly reactions to all of these so they put me on something more toxic than cipro, gentamicin, since the strand I had wasn’t susceptible to supra or cipro. More than 5 days of gentamicin creates a higher risk (10-25%) in kidney failure, nephrotoxicity, and ototoxicity (to name a few).

      Everybody’s body chemistry is different and researchers are doing their best to find safer and better antibiotics for super strands (arguably because people don’t finish their prescribed antibiotics). Wash your hands with soap. Shower after exercising. Cover you mouth when you’re sick. Until they’ve been able to find these alternatives and improve the antibiotics we already have, some of us will need drugs like cipro in the interim.

      • You are right. But if you have to take Cipro don’t lift heavy weights and don’t run long distances or sprint. These exercises put heavy stress on the tendons, which in many people are susceptible to strain or even tear.

        • Very interesting info. I’ve been given cipro for a UTI, but I do have a history of tendinitis and corticosteroid use, and I work out / run / lift weights. I guess I’ll be taking it easy the next 6 months.

          I’m wondering if there is anything I could take like herbs or supplements that would coat or protect the tendon or other tissues to protect them from damage? It sounds like it goes to work destroying healthy tissue nearly immediately, then the body can take months to rebuild, and leaves lasting damage that we may not even begin to see all the impacts of…

  12. I’m so interested to read up on all this. I took 4 days worth of cipro for a UTI after other antibiotics hadn’t worked. I wish I’d read up on it before hand. I now have terrible tennis elbow in my right arm – I can’t dress myself easily or even hold a cup of tea, both my feet are really sore on the top and it’s really hard to walk. It’s been only a week since I came off the pills (when I realised to my horror what was happening to me) and I’m very worried. I’m a full time working mum – I actually don’t know how I’ll recover. Has anyone ANY advice on what I can do? Anyone taken any collagen supplementation? I’m willing to try anything as I can’t function like I used to and it’s only been a week… HELP. thank you and support to all others like me. DON’T TAKE THESE, is my advice :-(

    • Vivian, I am so sorry you have had so many devastating injuries from taking these meds. For your ongoing pain and collagen loss you might try a drink containing gelatin & water I have just heard about but haven’t tried as yet. Just read about it today. I will send info back to you if interested. . Good luck & don’t give up !!

  13. Rare means nothing to the ones who have to deal with side effects. I took 5 pills x 1000mg (slow release), and 1 month later I am still having a lot of trouble with my tendons. These drugs should be taken in LIFE or DEATH situations when the person is o.k. with possibly living a different kind of life after taking the medication. For those who love biking, hiking, sports or those who have manual labor type jobs this stuff has the potential to ruin your life. I’m one month in, doing all I can do to recover, but all I can do is walk around my house doing basic tasks (in pain) and ride my bicycle around the block while I watch children bike ride past me.

  14. Sorry about the pain? This isn’t just some residual pain! These people’s lives and health have been RUINED, just as mine has. For me, TWO days of Cipro and I ended up in a wheelchair. I don’t know if this is a coverup or plain ignorance but the medical community needs to GET A CLUE about fluoroquinolones!
    My list of health issues since Cipro is so long I won’t bother listing here, but it has destroyed my health. Destroyed it!
    FIRST – Do no harm…

  15. I was prescribed Cipro in January of 2015. The second day I was taking it (after 2 doses), I woke up feeling like I was hit by a truck, and had very painful, sudden, unexplained onset of acute “tennis elbow” (lateral epicondylitis) in BOTH elbows, that was not the result of any sports or other activity. I immediately grabbed the literature about the drug, because I am usually sensitive to antibiotics, and normally have GI issues when I take any antibiotic. When I read that Cipro can cause tendon damage, I immediately stopped taking it and called my doctor. (A friend of mine had shoulder/arm issues a couple of years ago from taking Levaquin, and I remembered that). I was also alarmed by the stated possible drug interactions with steroids, because I take Flonase every day, and have taken other inhaled corticosteroids for respiratory allergies/asthma in the past. Also, there seems to be a link with thyroid disorders (I am hypothyroid). I should NEVER have been prescribed this. DOCTORS NEED TO PAY ATTENTION WHEN PRESCRIBING! I also recently found out that my 97-year-old Grandma is allergic to fluoroquinolones and breaks out in hives if she takes any of them. So apparently there is a family allergy to these things. Some people will be more sensitive to them than others. Over the past year and a half, I have battled this tendinitis, and it has screwed up my life. I can no longer paddle my kayak or go caving, or play my guitar. I have had to cease or limit other recreational activities that I love. This has affected everything that is ME! It hurts to bathe, get dressed, drive, do the dishes, do laundry, and do other normal, every day activities. I can no longer do any exercise that involves my arms. I can’t sleep through the night, because the elbow pain wakes me up when I roll over on my side. It is affecting my work, as I’m a proposal manager, and am on a computer/mouse constantly, and often work long days. I have spent hundreds and hundreds of dollars on visits to my sports doctor and chiropractor, on elbow braces, compression sleeves, etc. Last year, I broke down and begged for steroid injections that mostly alleviated the symptoms for about six months (but did not actually heal the damage). This year, my sports doc has attempted to treat this with dextrose injections to promote healing, and that seems to have helped a bit, so I’m continuing that. Unfortunately, my right elbow has recently gotten worse from excessive computer/mouse use at work and helping a friend push a stuck truck out of the mud about a month ago. (My friend was even doing the heavy lifting, and this would not normally be excessive activity for me). I start seeing a physical therapist next week, at $50 per visit. The pain, medical expense, and lifestyle limitations that I have been afflicted with as a result of taking TWO PILLS of this poison is horrible! I wish I had the time and money to file a lawsuit about this. Think very carefully before you take ANY fluoroquinolones! And carefully read and consider the side effects of ANY drug that you are prescribed, and discuss them with your doctor and/or pharmacist.

  16. I’ve started my second round of Cipro in a matter of months, but I’m also taking prednisone (3–5mg daily). PLEASE!! If there’s anyone here who’s been injured or disabled from using a corticosteroid and Cipro together PLEASE share with me your story. My pulmonologist says, “Yes. There is an increased risk for tendonitis or tendon rupture when combining the two drugs– but the occurrence is ‘RARE'”. Well, after reading post here and on other sites I’m convinced otherwise. Thanks in advance and I hope everyone recovers. God speed.

  17. I took Levaquin for 14 days. On day 9, I experienced Achilles pain. Both the prescribing ENT and the GP advised I stay on the Levaquin so I did. Fast forward 3 weeks and I am still having tendon issues in my Achilles, hamstrings, hip flexors and elbows. My question is – will this begin to improve and is it likely, or plausible, that I will be able to safely play sports again? If so, what does the normal timeline for recovery look like? Are there any supplements or dietary changes I can make to help my body heal?

  18. The fluoroquinolones are NOT safe drugs, and the side effects are not rare. The answer about whether to take them should be a resounding NO. Dr. Michaeli, thank you for cautioning FQ-takers about exercise, but please revise your last paragraph. It is not enough to stay alert and go off the drugs at the first sign of pain. I went off my Cipro at the first sign of tendon pain, but after just 5 days (10 pills, 500 mg each) I suffered 2 tendon tears, in my peroneal (ankle) tendon and an excruciatingly painful one in my left shoulder. There was no outside trauma to either tendon. Now, 1 1/2 years later, I am still suffering bad tendonitis in 3 body parts. I have endured daily pain, and many physical therapy sessions and am still not recovered, and may never be. Please warn your patients to only take the FQs in a life-or-death situation or if other antibiotics don’t work.

  19. Itvwould be interesting to do a genetic profile to resesrch if some people are genetically prone to these tendon issues. For instance, what is commonly known as double jointed, clinically known as hypermobility syndrome, is a collegen genetic condition. I took cipro a few times years ago with no side effects for diverticulitis, but now 6 years later and close to 60 now after the last treatment, I m afraid to take now (as I am sick again.)

    Any thoughts Doc?

  20. I took Cipro after a kidney infection around 2009. Experienced really bad joint aches after being dosed 500mg twice a day. The pain was debilitating, wasn’t able to sleep through it. My knees felt loose which had me limping for awhile. 7 years later I still experience joint inflammation, I can only guess it’s tendonitis. Oddly, it’s just the left side of my body. Once in a while my left side flares up. I went for a run yesterday and I must’ve went a little too hard but my fingers, wrist, elbow and shoulder on my left side feel like they’re burning. The whole night I just couldn’t sleep. I’d like to have an active lifestyle but this Cipro reaction seems to have put a cap on any progress.

    Any luck taking Magnesium? I’ve tried it before but wasn’t exactly consistent.. would like to see if anyone has any experience or if there are any supplements to suggest?

  21. My understanding-based on Internet research-is that supplementing with highly absorbable magnesium will greatly help, in some cases eliminate tendon pain. Look up ReMag (a product) and read. What I would like to know is what choices do I have? 100k colony of kelpsiella p UTI? My cultures showed two “flox” pharmaceuticals and one injection. Suggestions anyone?

    • From Drugs.com:

      “Ciprofloxacin and magnesium salicylate should not be taken orally at the same time. Products that contain magnesium, aluminum, calcium, iron, and/or other minerals may interfere with the absorption of ciprofloxacin into the bloodstream and reduce its effectiveness.”

      Right from the horse’s mouth–Magnesium is an enemy of Cipro. The question is–once absorbed can magnesium DISLODGE it?

  22. I took Levaquin for a sinus infection 5 years ago and experienced severe bilateral achilles pain within two days of the first dose. I’d never before had even mild achilles issues, but it’s continued to haunt me over the last 5 years. I can no longer run distances or tolerate much hill running, and sometimes have totally unprovoked lower leg pain. I’ve also had significant worsening of pain in my hands, shoulders, and spine with a probably rotator cuff injury right now. The drugs are not at all benign, and I agree with others who say that they should only be prescribed if all other options have failed to treat a very serious infection. Combining quinolones with steroids is known to increase the drug’s risks, as does being 60 or older.

    • I am experimenting with roll-on magnesium on calves and feet to see if it will dislodge the Cipro from the tissues in those areas. We’ll see if it works.


  24. To call these adverse side effects “rare” is blatantly irresponsible, and downright incorrect. Thousands, possibly hundreds of thousands, of people who have taken fluoroquinolones have experienced debilitating tendon/joint/nervous system/neurological issues — what is happening is that these cases are being grossly under-reported (e.g. the patient him/herself fails to associate their symptoms to the antibiotic, the doctor fails to make the association (or even outright deny reality and claim the antibiotic couldn’t be responsible, against all reason), or the doctor simply refuses/forgets/doesn’t bother to report the incident to higher authorities). Fluoroquinolones should be a “last resort” antibiotic used in situations where no other safer medication would work — not as a first line of defense. I myself am a victim of these dangerous drugs, which may be surprising to you because I fall outside the “vulnerable categories”: I was a very healthy and young 24-year-old woman who was physically fit, free of any diseases, and most importantly, never had any joint/tendon issues. Five months ago, that all changed when I was prescribed Ciprofloxacin (500mg twice a day for a week) for a UTI. The pain in my tendons started immediately, but I didn’t associate it to the Cipro before ingesting 2000mg of it. Two days’ worth may seem like a small dose, but it did enough damage to my body that, five months later, I am still crippled. I experienced a tear in one of the tendons over the top of my left foot; almost every joint in my body now cracks and pops with the slightest movements; I can no longer kneel on my knees because putting any pressure at all on my kneecaps makes it feel like the tendons in them will snap; my rotator cuff in my left shoulder must have torn as well, because there’s an excruciating sharp pain there, and as a result I have limited mobility and can no longer lift heavy objects with that arm; while I was on the Cipro, my hair fell out in clumps, and five months later most of it still hasn’t grown back, so my hair has thinned considerably as a result; I developed terrible insomnia and continue to have trouble staying asleep; I developed short-term memory loss; the tendons in my hips have become very weak, such that I can’t even lay on my side with feeling like my hip socket will dislocate; I developed TMJ in my left jawbone; a spinal disc in my neck vertebrae seems to have sustained damage, as there is an excruciating sharp pain whenever I turn or bend my neck; and most recently, I have developed a drooping right eyelid and blurry vision (always had good eyesight before) in my right eye. And note that this isn’t even an exhaustive list of symptoms! It is likely that the permanent damage I have sustained is a result of a body-wide destruction of collegen molecules — all from “only” 2000mg of Cipro (granted, I am short and skinnier than a lot of people, so it may have affected me more). I’m stressing over my lack of health insurance, should anything get worse. At the moment, I am considering a lawsuit, especially since the patient information pamphlet I was given made no mention of possible tendon-related side effects (and that they could be permanent), and to stop the medication immediately upon such pain. Had I been sufficiently informed of the risks, I would have requested another class of antibiotics. So to reiterate: no, fluoroquinolones are NOT “safe”!

    • I had a torn retina a few months after ceasing Cipro. The opthamologist thought it was caused by the vitreous gel breaking down because of my age. Maybe, but how can anyone be sure once you’ve ingested Cipro?

  25. I agree with the previous posters warnings of these Fluoroquinolones!! They are very very dangerous and should only be used in life or death situations. They have ruined many many lives. I took Levaquin 8 years ago and ever since have not been able to be in any sunlight for more than 5 minutes without breaking out in a horrible rash, heart races, nausea. It’s horrible. It even happens through my car windows. So you would think I would have realized that the Levaquin caused this, right? Well, I went to many many doctors all with no explanation but all telling me it couldn’t be the Levaquin. Fast forward to a couple months ago and I was prescribed Cipro for a minor infection(I had no clue it was the same class of medication), after 2 doses I was SOOO sick and my whole body aching at every joint. So at this point I began researching and found much more information than I was able to years ago when I was “floxed” for the first time. It’s only been 2.5 weeks since the Cipro but I keep getting new pains in different joints and am terrified of what’s to come. Please people, don’t take it unless it’s a last resort. You never know when you will hit your threshold of tolerance for the drug and there’s no going back once you do. So much of people’s suffering is unnecessary because there are many safer alternative treatments available. People need to be educated and shouldn’t just blindly trust their doctors. I wish I hadn’t.

    • Photosensitivity is one of the known side effects of Ciprofloxacin and other drugs of this group. But normally this effect wanes within weeks of discontinuing the drug. Your case of photosensitivity to Levaquin lasting so long is highly unusual, and very interesting from an immunological point of view. I wonder if a consult with an immunologist at a medical center close to your home is indicated.

      • It most certainly isn’t a “rare” side effect. I think the medical field is truly in denial when it comes to Fluoroquilone Toxicity. Please do your research. Read the stories on FloxieHope.com.

        • Exactly! My life was ruined by Cipro and it’s been going on for 2 years now! I was healthy and athletic before never any tendon issues and then Cipro came into my life and f’ed my whole body up.

          It should only be allowed to prescribe this dangerous drug for confirmed life or death bacterial infections.

          Don’t take it if there are alternatives! Even the FDA has issued a new warning to take alternatives before FQ.

        • There is a support group of over 9,000 members who have been adversely affected by fluoroquinolone antibiotics. Many of them only took 1 or 2 pills before the symptoms set in, including tendon problems. And symptoms can continue to develop for years after stopping, a sudden rupture of a tendon, or 8 tendons, one after the other. Yes, these drugs are dangerous, adverse effects are NOT rare, just rarely recognized as having been caused by the antibiotic the patient just took.

  26. Fluoroquinolones (Cipro, Levaquin, Avelox and others) can be very dangerous drugs. They have killed far more people than some fluoroquinolones (Omniflox (temafloxacin) that have already been taken off the market because they killed three people. They should be restricted for use only in life-or-death situations and when all other antibiotic classes have failed. At a public hearing on November 5, 2015, the FDA voted, almost unanimously, to change the warnings on these drugs, relating to fluoroquinolone associated disability (FQAD).

    To see a video of almost 2 hrs of testimony from 11-5-15 and hear the horror stories of what has happened to people who have taken these drugs, visit this website which has the FDA hearing video testimony:

  27. The tendon/collagen effects are a lot more common place. Local TV, PBS, Major news are starting to pour out. There are thousands of people reporting side effects with FQs. Hundreds of thousands that likely do not know they have a side effect. Rare is not the word, more like under reported. What are the statistics on adverse drug reactions being reported? Whoa… Do the math! I asked my Doctor previously to taking Levaquin and Cipro, do these have any nasty side effects I should know about, his answer, “Eat Yogurt!” I quote !!!

    • Yogurt doesn’t do anything to help the gut after Cipro is done with it. Virtually every good bacterium in the gut is dead. You have to take a probiotic with multiple strains in large doses to overcome it. Bacterial “transplants” would probably be more efficient using a family member’s fecal donation. I accidentally overdosed on the probiotics, experiencing mild side effects from the error, but after about two days I was back to normal. I have experienced plantar fasciitis after taking a course of Cipro for an alleged infection of the prostate. It failed, by the way, to correct the inflammation in the gland, but it eventually went away and the PSA dropped again. Now, the inflammation is back and Urologists swear by Cipro. I need an alternative, so I’m guzzling cranberry juice and trying some now to attempt to get the PSA and inflammation down. I won’t use cipro again.

  28. I think you need to put 2 and 2 together and consider the role that cipro/quinolones may have played in your previous tendon tears. By the time you notice side effects from cipro usually quite a bit of damage has already been done. I truly believe that these drugs should only be used in life and death circumstances. The risks are not worth it. Many many people have had their lives and bodies destroyed by these meds

  29. Good Info! Thanks. My doctor told me not to exercise while on the medication and with it being New Years resolution time I was really disheartened by that and had to know why. I thought Yoga wuld be ok, but after reading the tendon relation I might just take it easy for the next week. Thanks!


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