Antibiotics and tendon ruptures—anyone know about that??

[Garga]

So...I got cellulitis and the doctor put me on doxycycline. I was glad it wasn’t cipro because I know that cipro can cause tendon ruptures.  It was my own fault, I suppose, for not looking more carefully and realizing that doxy can cause the same problem.  So...here I am 5 days into taking it and worried about my tendons.

I can’t find any information to know what to DO with this knowledge. Do I treat myself super carefully for the next few days?  Months? Years?? I take martial arts classes which have us kicking things.  I can skip the kicks for now and just do some of the other types of moves...but for how long?  

The articles I read talked a lot about runners. I don’t do running and martial arts isn’t about running (except to knock someone down and then run away to safety if you’re attacked 😄 ). So am I relatively safe if I don’t take up running?

Does anyone have real life experience with this or even know where to point me to get more practical information?  So far, I can only find high level articles about it without much more info beyond, ‘Yeah, these drugs can cause tendon ruptures...” aaaand that’s all they tell me.  

 

EDIT: the reason she went with such a powerful drug is that the cellulitis started in my nose and is on my face.  She said that some people are carriers of MRSA and if I am, it could cause troubles so she gave me the powerful drug. 

 

Edited February 3, 2020 by Garga

[Garga]

You know what....maybe I’m jumping the gun.  This article talked about doxy causing the ruptures, but when I look at a bunch of other articles, it’s not talking about the doxy.  And when I look at the FDA information about doxy, it doesn’t mention the tendon stuff at all.  

So...maybe I’m ok?  

All that’s left is the embarrassment of having cellulitis on my nose. My nose is getting better, but it was looking pretty awful for a while.  It’s still bright red and the skin is flaking.  Very unattractive, but better than how it looked last week.  At least it’s looking like maybe I won’t have ruptured tendons to go along with it. 

[Bambam]

I have no idea, but I'm very glad you aren't on cipro! That is bad stuff!

Random factoid - when one of mine went on a study abroad trip, the school prescribed something for traveler's tummy so they could all have that in their luggage. I never looked at the script, because it just never occurred to me. Turns out it was Cipro! I was like, WHAT? Luckily my kid never had any tummy troubles. 

[Garga]

22 minutes ago, Bambam said:

I have no idea, but I'm very glad you aren't on cipro! That is bad stuff!

Random factoid - when one of mine went on a study abroad trip, the school prescribed something for traveler's tummy so they could all have that in their luggage. I never looked at the script, because it just never occurred to me. Turns out it was Cipro! I was like, WHAT? Luckily my kid never had any tummy troubles. 

What were they thinking??!  Ack!

[kbutton]

It's the fluoroquinolone family that tends to contribute to tendon ruptures. I have been on it, and I didn't have a tendon rupture, but I had a lot of tendon trouble for a LONG time afterward. I didn't know it caused the problem when I complained about it to my DH. He knew about the connection already, so I am pretty sure I wasn't responding to an idea planted in my head.

The bigger lesser known problem is that in some individuals, they can cause aortic rupture or aneurysm. The risk hangs around for a while, but I don't know if they have solid data on how long or if they have data on repeated use in people's backgrounds and how that plays out long-term. Some groups of people should basically never have them unless we're talking sepsis. 

See this article: https://www.fda.gov/drugs/drug-safety-and-availability/fda-warns-about-increased-risk-ruptures-or-tears-aorta-blood-vessel-fluoroquinolone-antibiotics

Quote

Fluoroquinolones should not be used in patients at increased risk unless there are no other treatment options available.  People at increased risk include those with a history of blockages or aneurysms (abnormal bulges) of the aorta or other blood vessels, high blood pressure, certain genetic disorders that involve blood vessel changes, and the elderly.

...

Before starting an antibiotic prescription, inform your health care professional if you have a history of aneurysms, blockages or hardening of the arteries, high blood pressure, or genetic conditions such as Marfan syndrome or Ehlers-Danlos syndrome. 

So, I think that elderly in this instance is around 70 or older. Sometimes in medical speak, elderly means over 55 or 60. 

My big problem with this lovely piece of news is that most people don't realize they have a family history of aneurysms because "we don't autopsy enough people" (a nearly direct quote from a specialist who was speaking at a patient symposium at The Cleveland Clinic). Even among recognized groups like Marfan or EDS, a lot of people don't know they have it--specialists estimate that half of people with Marfan Syndrome don't know they have it.

Doctors have been late to get on board with identifying aneurysms because 1.They thought they were rare (they are not), and 2. Outside of emergency surgery, the surgical risks were really great for a long time (now people have election surgery all the time, and they have extremely good data on outcomes for lots of patient populations). A shocking number of cardiologists are misinformed about aneurysms. There is treatment that helps prevent growth, and there are lots of safer surgical options now.

Frustratingly, there aren't really guidelines for screening people who've been on these drugs, which I find unbelievable since so many people don't know their risk and therefore aren't able to speak up about it. If you have a first degree relative with one, you're at risk; if you have more distantly related family members with one, you are still at risk, but it drops considerably. If you have a heart murmur, and the cause has not been assessed, it is one of the few symptoms an aortic aneurysm will exhibit (usually very late in the game)--they mostly just grow silently. Obviously, many murmurs are not connected to aneurysms too.

We have a ton of aneurysms in my extended family--first and second degree relatives and then also relatives that are farther out--like cousins several times removed. No one realized how extensive this history was until I noticed a trend on FB posts among distant relatives and started digging into family history. Even family members with heart defects that contribute to aneurysms were not being told they were at risk (and one had two when he got screened for something else). It's insane. 

Okay, off my soapbox, but here are some good places to get information:

https://www.marfan.org/

https://www.johnritterfoundation.org/

http://online.wsj.com/public/resources/documents/PulitzerKH04052004.htm (Pulitzer prize winning articles for explanatory journalism on the "surprising prevalence of aneurysms")

Happy Heart Health/Marfan Awareness month, lol!

[matrips]

Levoquin is a big one for tendon issues.  I was on it 2 days and started having issues. (Also for cellulitis I’m nose)z. That’s when I found out about the dangers of the fluoroquinile (sp?) series of antibiotics. I put all of them on an allergy sensitive list and ask for the old time antibiotics.

[matrips]

I can look it up but what’s the story on cipro?  I know my mom was super allergic to it, along with many antibiotics.

[daijobu]

I have rosacea, and after some trial and error I was put on doxy after I developed cellulitis on my face.  It cured the cellulitis and also worked like a charm on my rosacea.  Huzzah!

Later, I started to experience pain in my biceps tendon.  (I write a lot as a tutor, and I knit and crochet, and I used to play tennis, so this arm gets a lot of use.)  I couldn't figure out what was causing the pain. I went for weeks favoring my left (non-dominant) arm, writing with my left hand, trying to rest my right arm as much as possible.  No improvement.  

Then one day, completely at random I read a NY Times article about antibiotics and tendon problems.  O  M  G!  

I discontinued the doxy immediately.  (I had basically been taking it chronically for months because I was afraid of a recurrence of my rosacea, and I didn't think I had any side effects.)  Within days my tendon pain went away.  A few weeks later my rosacea returned.

Now I play a game where I take as little doxy as possible to keep my rosacea symptoms minimized, while trying to avoid pain in my biceps tendon, which I still have.  If I reduce my frequency of doxy, the rosacea flares up, and my tendon feels better.  I've been meaning to contact a dermatologist and see about an alternative.

But I'm convinced the association between doxy and tendon problems is real.  I found a scientific article about how it interferes with regenerating collagen fibers or some such I didn't understand.  I also hear that in the elderly it can manifest as achilles tendon rupture.  oy.  

[PrincessMommy]

I have been on Cipro and Flagyl together 3-4x and haven't had a rupture (knock on wood).  

I know it's a possible problem, but I think it's pretty uncommon unless you're much older, IIRC.  I know I asked my DIL about it. who is a licenced PT.  She was not overly worried about that side-effect for me.

I have not heard about it for doxycylcline, but I'm less familiar with it. 

Edited February 4, 2020 by PrincessMommy

[geodob]

Cipro is part of the family of Fluoroquinolones. Which can not only cause tendon damage, but also permanent nerve damage.
 

[Carol in Cal.]

10 hours ago, daijobu said:

I have rosacea, and after some trial and error I was put on doxy after I developed cellulitis on my face.  It cured the cellulitis and also worked like a charm on my rosacea.  Huzzah!

Later, I started to experience pain in my biceps tendon.  (I write a lot as a tutor, and I knit and crochet, and I used to play tennis, so this arm gets a lot of use.)  I couldn't figure out what was causing the pain. I went for weeks favoring my left (non-dominant) arm, writing with my left hand, trying to rest my right arm as much as possible.  No improvement.  

Then one day, completely at random I read a NY Times article about antibiotics and tendon problems.  O  M  G!  

I discontinued the doxy immediately.  (I had basically been taking it chronically for months because I was afraid of a recurrence of my rosacea, and I didn't think I had any side effects.)  Within days my tendon pain went away.  A few weeks later my rosacea returned.

Now I play a game where I take as little doxy as possible to keep my rosacea symptoms minimized, while trying to avoid pain in my biceps tendon, which I still have.  If I reduce my frequency of doxy, the rosacea flares up, and my tendon feels better.  I've been meaning to contact a dermatologist and see about an alternative.

But I'm convinced the association between doxy and tendon problems is real.  I found a scientific article about how it interferes with regenerating collagen fibers or some such I didn't understand.  I also hear that in the elderly it can manifest as achilles tendon rupture.  oy.  

I take Azithromycin for rosacea, successfully.  I can’t take doxy because it causes depression in me, really bad ‘it hurts to be alive’ depression, but I did not know that it also contributed to tendon problems.

I took Cipro for an outer ear infection years ago, and had pain in my upper arm/bicep area, so I told my doctor I thought I was sensitive to it and we stopped it.  But very shortly after that I was walking across the dining room and a tendon in my leg ruptured.  I had drop foot for a couple of months until it healed.  I have never been able to build up real strength and flexibility since then; honestly I’m so wrecked it’s a real shame.  But I think I dodged a worse bullet—-it is associated with detached retina problems as well, and I had been taking ofloxycin drops (same drug family as Cipro) for eye infections (which are recurrent because I have ocular rosacea), and didn’t have that problem.  I got my eye doctor to switch me to something else outside of that family.  Doctors are really not at all tuned in to this problem AFAICS.

[kbutton]

4 minutes ago, Carol in Cal. said:

Doctors are really not at all tuned in to this problem AFAICS.

I think a lot of doctors have this idea that it won't happen to their patient or that their reasons for prescribing always rise to the level of necessary use. 

That said, I live in a MRSA hotspot, so that probably makes a difference locally.

[matrips]

3 hours ago, Carol in Cal. said:

I dodged a worse bullet—-it is associated with detached retina problems as well, and I had been taking ofloxycin drops (same drug family as Cipro) for eye infections (which are recurrent because I have ocular rosacea), and didn’t have that problem.  I got my eye doctor to switch me to something else outside of that family.  Doctors are really not at all tuned in to this problem AFAICS.

Oh my!!  That eye drop medicine sounds very familiar.  I had eye infections one summer a couple years ago, and the following year I had two laser surgeries for retinas that were tearing 😳. I blamed it on a fall, and that could still be the reason.  But I didn’t even think about antibiotics other than oral pills.

[Carol in Cal.]

19 minutes ago, matrips said:

Oh my!!  That eye drop medicine sounds very familiar.  I had eye infections one summer a couple years ago, and the following year I had two laser surgeries for retinas that were tearing 😳. I blamed it on a fall, and that could still be the reason.  But I didn’t even think about antibiotics other than oral pills.

I had had surgery where they scrape off your cornea and let it grow back on its own in the hopes that it will stick better to your eyeballs, and used the drops for about a month afterwards.  The surgery was unsuccessful so I keep getting erosions and sometimes infections.  I’m really glad that I switched to another antibiotic, but wow, I took that stuff for a LONG time.

[matrips]

2 minutes ago, Carol in Cal. said:

I had had surgery where they scrape off your cornea and let it grow back on its own in the hopes that it will stick better to your eyeballs, and used the drops for about a month afterwards.  The surgery was unsuccessful so I keep getting erosions and sometimes infections.  I’m really glad that I switched to another antibiotic, but wow, I took that stuff for a LONG time.

It’s scary what you don’t know as risks.