So, You Want to Take A Fluoroquinolone Antibiotic?

Every once in a great while I am contacted by someone who, for one reason or another, insists that they must take a fluoroquinolone antibiotic.  Because of this quandary, they inquire if there are ways to mitigate the risk of having an adverse event.  If this describes you, then this article is for written for you.

Caveats

First, I have to throw in the disclaimer that I am not a doctor and any concerns regarding prescription medication needs to be discussed with your doctor.  Second, you also agree to the obligatory disclaimer list on this site.

A Word of Warning

Now that we have the legal caveats out of the way I need to add one of my own.  In my opinion, I would do everything I could to NOT take a fluoroquinolone antibiotic and try to opt for a safer alternative.

Obviously, my opinion is biased, but you need to know that taking the fluoroquinolones is much like playing Russian Roulette. Many people when they pull the trigger are fine, but you never know when the hammer is going to contact a loaded chamber and disaster will strike. 

Another Warning

One thing is for certain, apart from a few exceptions, most individuals have no way of knowing ahead of time if they are going to have an adverse event to this family of drugs.  Also, these drugs are cross-reactive, meaning if you have an adverse event to one member in this family of drugs, you will have an adverse event to another.   There have also been cases of cross reaction between the quinolones and certain antimalarials (quinolines) which are chemical cousins so-to -speak. Additionally, once an adverse event ensues, there is no turning back the clock and reversing what has been done.

And Another Warning

Also, if you have already taken previous courses of fluoroquinolone antibiotics and believed you have been fine, cumulative toxicity is another factor that you must consider.   Please read the article, Cumulative Toxicity of The Fluoroquinolones.  Many people have taken multiple courses of the fluoroquinolones with seemingly no problems, however cumulative toxicity is a very real threat with these drugs that can rear its ugly head.

Hedging Your Bet Against An Adverse Event

Having covered the warnings, I realize that there are many different scenarios that could arise that would lead to your doctor recommending a fluoroquinolone.  Far be it from me, or anyone else for that matter, to contradict what your doctor has deemed necessary for your medical care.  My goal is to inform. 

There are many, many variables that go into a person having an adverse event. Perhaps your genetics and environment make you an unlikely candidate for an adverse event because you are a genetically good metabolizer of chemicals and you live a fairly clean life with low toxic exposure.   Also, short doses may well be tolerable for your body if your metabolism is favorable.

So if you are required to take a fluoroquinolone, or have made the personal choice to take a fluoroquinolone and have been educating in the risk/reward ratio, there are certain steps you can consider during a treatment to reduce the risk (not eliminate) of an adverse event.

1 Adjusting the treatment

Make sure that the dose is adjusted according to your weight. In other words, makes sure the doctor is not giving you a dose that is strong enough to treat an elephant.   We have had many reports of people receiving much larger doses than would normally be deemed correct for their weight.  Bottom line, why take more than what is needed (1).

2Take Magnesium

There is good scientific literature that Magnesium (or the lack thereof) can set the stage for an adverse event.  Conversely, magnesium taken at the same time as taking a fluoroquinolone, interferes with the absorption.  So, to keep your intracellular magnesium levels optimized and to avoid interfering with the fluoroquinolone dose, take magnesium at a separate time during the day.  Many people in our society are deficient on magnesium and this is believed to play a part in adverse events in some people, plus magnesium has a protective role over many tissues (2).

3Drink Water During Treatment

It helps to maintain an adequate hydration of the tissues and facilitate the elimination of the drug and the metabolites through the kidneys, so drink plenty of water to remain properly hydrated.

4Avoid Steroids

Steroid use while taking fluoroquinolones is contraindicated. In other words, do not take any steroids during the treatment with the quinolone family of antibiotics, unless your doctor has deemed it completely necessary. There is research literature and plenty of anecdotal information that steroids dramatically increase the risk of adverse events. I understand that in certain circumstances your physician may have determined that taking a steroid while taking a fluoroquinolone is necessary (combined therapy).  If this is the case, this advice is not to contradict your doctor’s medical advice.  So, disregard this advice if you cannot avoid steroids but maybe discuss this concern with your doctor (4).

5Avoid Non-steroidal Anti-inflammatories (NSAIDs)

They amplify the negative effects of fluoroquinolones, specially the risk of central nervous system occurrences, and neuropathies.  Many people unwittingly take these two together and combining these two dramatically increases the risk of an adverse event (5).  You can also click here to read about Dr. Mark Noble of the University of Rochester, NY who had disturbing findings when researching Levaquin and NSAIDS. 

6Watch for other Drug Interactions

Some drugs cause dangerous interactions with quinolones. All are included in the package insert so read the insert, check with a reputable website, or check with your pharmacist. There is quite a great chance that your doctor does not know or has not read it, seriously. (Levaquin, Cipro)

7Avoid Grapefruit

Grapefruit inhibits the actions of the liver enzymes that degrade the fluoroquinolones, so these antibiotics can reach very high concentrations in the blood. As a good preventive measure, eliminate grapefruit from your life, especially if you take other drugs on a regular basis.

8Watch Out for the Effects of Coffee (Caffeine)

Caffeine is a canary in a coal mine forewarning of danger. If caffeine starts to cause you problems such as restlessness, nervousness, disturbed sleep, etc… then it is time to consider that your liver is becoming overwhelmed by the fluoroquinolone you are taking. Some people have used this poor man’s test: Drink some coffee during treatment and watching out for changes.  This supposes that you drank coffee before the treatment and were familiar with the normal effects that caffeine has on your body.

9Ask for Some Tests During Treatment (Especially Long Treatments)

Although what would consider long treatments is kind of subjective, for sake of discussion we will consider in this instance, those that last more than two weeks. You could discuss concerns with your doctor and ask for the normal tests plus the following:

• Liver panel, especially bilirubin
• Pancreas panel
• Muscular enzymes (CPK, aldolase)
• Immunological markers (sedimentation rate and ANA specially, and also IgE to the drug)
• Cholesterol and triglycerides
• Coenzyme Q10
• Thyroid panel, TSH, free T3, free T4, PTH

Obviously not all doctors would be copacetic to allowing such tests to be run during the course of treatment, but in an ideal world it would be wise to monitor for subtle (and not so subtle) changes to your metabolism that would indicate a larger problem. 

10Avoid Strong Sunlight (Ultraviolet Radiation)

Wear appropriate clothing and sunglasses to protect yourself against the photocarcinogenic action of fluoroquinolones.

11Perform Daily Provoking Tests

For example, do some repetitions of raising a weight like a box with the tips of your toes (resting the heels on the floor), or raising a bottle of water with the arm extended. If in a few days a strong tendinitis develops, it is time to bring the concern to stop the fluoroquinolone treatment to your doctor, right away.

Detoxing – After the Fact, Yet Another Warning

In order to bring complete gravity to the decision to take a fluoroquinolone antibiotic I would be remiss if I did not bring up one more point.  I have also had people contact me who have taken a fluoroquinolone and started having an adverse event or a negative set of symptoms.  They have contacted their doctor and he/she has told them to stop the medication and switch to something else.  Their next question is, “how do I get the fluoroquinolone out of my system?”, “Can I detox it out?”  Well unfortunately the answer is no. 

While it is true that there are several substances that can interfere with the absorption of fluoroquinolones such as such as aluminum, magnesium, calcium, iron, and zinc (6), they must be present while the drug is being taken, which would defeat the purpose if you were taking it for its antibiotic properties. There is nothing that I am aware of that can chelate fluoroquinolones, or their metabolites, from the body if you want them removed in haste.

Fluoroquinolones are widely distributed throughout the body with high tissue penetration; that is what they do, and that is what the are good at.   They are a synthetic product that does not ‘detox,’ at least according to the detoxing paradigms of both allopathic or alternative medicine.   I have more about detoxing fluoroquinolones list in my FAQ section, you can read it here. 

Since the fluoroquinolones are manly eliminated by the renal route (non-renal routes to a much lesser extent), staying well hydrated as to flush the remaining drug and its metabolites our of the body though the natural process of elimination, is about the only thing you can do, besides wait and see.   

Conclusion

Obviously if you got this far you certainly read my warnings near the beginning of this article, so there is no reason to rehash them again.   The main purpose of this website is to inform.   Many people in our world today do not have enough information to make informed decisions when taking pharmaceuticals. It is best to have all the information available so that it spurs meaningful discussions with your doctor about the risk/rewards and safer alternatives.  

The choice to take or not no take a fluoroquinolone antibiotic is a personal decision that is based on many factors.   I, nor anyone else, can make the decision for you.  The only thing I can do is to tell you that many, many people have taken these drugs and have regretted the decision.  Many were not informed beforehand.  Knowledge is power, use it wisely.