Mitigating Fluoroquinolone Damage

What if a loved one must take a fluoroquinolone because it is the only option available to save their life? How do they avoid getting “floxed” and experiencing the devastation that fluoroquinolones have brought to too many lives?

Undeniably, there is a range of reactions to fluoroquinolones – from people not reacting badly at all, to people being permanently disabled and in excruciating pain, and everything in between. If a loved one must take a fluoroquinolone because it is the only viable option, is there any way to push them toward the “not hurt” end of the spectrum?

Who Gets Floxed?

At this time, no one knows what makes someone susceptible to getting “floxed.” No one knows why some people tolerate fluoroquionlones well but other people don’t. No one knows why an individual can tolerate fluoroquinolones fine at one time, but have a horrible reaction another time. No one knows what genetic predispositions contribute to some people getting hurt by fluoroquionlones.

The epidemiologists say that the risk of fluoroquinolone-induced tendon ruptures is higher in those over the age of 60. However, there are many “floxies” under the age of 60, and many of them suffer from tendon ruptures and other musculoskeletal problems.

It is hypothesized in, “Fluoroquinolone Antibiotics and Thyroid Problems: Is there a Connection?” that, “anyone with any underlying genetic predisposition, or possibly harboring a subclinical, latent, or silent endocrinopathy might be ‘pushed over the edge’ into full blown clinical pathology” by fluoroquinolones. But I have a friend who is over the age of 60 and who has thyroid problems, as well as osteoporosis, who recently took a course of Cipro and was fine afterward. I saw her yesterday and she is doing well. I would have thought that she would have been predisposed toward an adverse reaction… but she wasn’t.

As a strong and athletic 32 year old who had no history of illness, I certainly didn’t think that I was predisposed to having an adverse reaction to Cipro, but it happened. Cipro made me sick for a while.

There seems to be a certain amount of “Russian Roulette” going on when one takes a fluoroquinolone. There aren’t any tests to determine who will react poorly to fluoroquinolones, and even known risk factors only sometimes make a difference. Some people seem to get lucky, while others get very, very unlucky. I realize that attributing adverse reactions to bad luck and “Russian Roulette” is a frustrating non-answer, but, unfortunately, that’s where we’re at right now – the land of frustrating non-answers. Welcome to being a floxie.

Despite the seeming randomness of adverse reactions, there is sufficient evidence that people who are over the age of 60, athletes, those who have a history of psychiatric illness, those with a history of benzodiazepine withdrawal, people who regularly use NSAIDs, people using corticosteroids, people who have an existing autoimmune or endocrine disorders, those who are immunocompromised, and people who have a mitochondrial disorder (in any of its manifestations, including ME/CFS and fibromyalgia) should avoid fluoroquinolones if at all possible. (More about this can be found in the post, “Don’t Take Cipro, Levaquin or Avelox If….” on Hormones Matter.)

When it’s the Only Option

Given that few people think that an adverse drug reaction will happen to them, and that antibiotic resistance is reducing the number of safe antibiotics available to treat many infections, many people are stuck with fluoroquinolones being the only option available to them.

If this is the situation for you (yes, I do realize that many/most floxies would rather die than take a fluoroquinolone again, but that’s not the case for everyone) or a loved one, is there anything that can be done to mitigate the damage done by the drug?



Mitigating Fluoroquinolone Damage

Studies have noted that magnesium and vitamin E can mitigate some of the damage done by fluoroquinolones. In, Musculoskeletal Complications of Fluoroquinolones: Guidelines and Precautions for Usage in the Athletic Population, it is noted that:

“Pfister et al [25] studied the effects of oral vitamin E (tocopherol) and magnesium supplementation on ciprofloxacin-associated chondrotoxicity. Juvenile rats were divided into 4 groups: those fed a normal diet, a vitamin E– enriched diet, a magnesium-enriched diet, or a diet enriched with both vitamin E and magnesium. These diets were initiated 10 days before the rats were given ciprofloxacin. Two days after fluoroquinolone exposure, cartilage samples from the knee joints were histologically examined, and cartilage and plasma concentrations of magnesium, calcium, and vitamin E were measured. Fluoroquinolone-associated cartilage changes were observed in all groups, but the supplemented groups showed significantly less change, with the magnesium and vitamin E combination group demonstrating the least change. Both plasma and cartilage concentrations of magnesium and tocopherol were significantly higher in the supplemented groups than in the animals that received the normal diet, which supports the potential role of magnesium deficiency in the pathogenesis of fluoroquinolone-associated chondrotoxicity.”

Does that mean that magnesium and vitamin E should be taken along with fluoroquinolones to mitigate damage? Maybe. It should be noted that magnesium inhibits fluoroquinolones both for better and for worse, and that the magnesium may decrease the ability of the FQ to fight the bacterial infection.

Additionally, it is noted in “Bactericidal Antibiotics Induce Mitochondrial Dysfunction and Oxidative Damage in Mammalian Cells,” that:

“Mice treated with clinically relevant doses of bactericidal antibiotics similarly showed signs of oxidative damage in blood tests, tissue analysis, and gene expression studies. This ROS-mediated damage could be reversed by the powerful antioxidant N-acetyl-l-cysteine (NAC) without disrupting the bacteria-killing properties of the antibiotics.”

Since NAC doesn’t disrupt the bacteria-killing properties of the antibiotics, it’s a better bet (IMO).

It is also noted in Musculoskeletal Complications of Fluoroquinolones: Guidelines and Precautions for Usage in the Athletic Population, that:

“A mitochondrial-targeted form of ubiquinone (MitoQ) demonstrated a larger protective effect than did untargeted ubiquinone. Oxidative stress frequently occurs in the mitochondria [22], and fluoroquinolone-induced oxidative damage to mitochondria in tenocytes and chondrocytes has been reported [26].”

Some “floxies” have found MitoQ to be helpful in healing fluoroquinolone-induced damage. Perhaps it can also prevent the damage from occurring.

If a loved one of mine had to take a fluoroquinolone, I would try to get him or her to load up on magnesium before-hand, and I would try to get vitamin E, NAC, and MitoQ into him/her while the FQ was being administered.

I certainly wouldn’t claim to know for sure that they would be safer while taking those antioxidants, but it’s worth a try.

Russian Roulette

People should be aware of the dangers of fluoroquinolones, and they should know that there is a certain amount of Russian Roulette that is being played with every pill administered. For better or for worse, I don’t think that people really understand fluoroquinolone toxicity until it happens to them. As scary as it is for those of us who have been hurt by fluoroquinolones to stand by and watch while our loved ones take these pills, some of us will have to do just that at some point. Maybe some of the fluoroquinolone-induced damage can be mitigated by the supplements mentioned above. I hope so.


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14 thoughts on “Mitigating Fluoroquinolone Damage

  1. Heidi Sussmann February 25, 2016 at 10:22 am Reply

    Article below does not also mention the contraindication of using fluoroquinolones for those on ‘prednisone’ (corticosteroid). This is even stated in the first black-box warning, along with being over 60 years old.

    • Lisa Bloomquist February 25, 2016 at 10:25 am Reply

      Indeed, FQs are contraindicated for those using corticosteroids. I’ll add it.

    • Elise April 24, 2017 at 4:19 pm Reply

      So what do you do if you have adrenal issues and have to take steroids?? I might have to do that and I’m screwed now right??!!I’m worried

      • L April 24, 2017 at 5:07 pm Reply

        I would NOT take steroids…there are natural ways to combat adrenal problems, like using adaptogens. I would URGE you to see an integrative physician or naturopath.

  2. Linda February 25, 2016 at 10:57 am Reply

    In his book, Dr Cohen actually suggests taking magnesium while taking a flq (if you must) and just taking them four hours apart.

  3. Lynda Smith February 25, 2016 at 11:34 am Reply

    I was over 60 (72), athletic (dancing at an advanced level for two hours per day), healthy, but not taking corticosteroids or NSAIDS at the time I was floxed. My symptoms have been quite severe since taking ciprofloxacin on March 13, 2015. Some days are worse than others. I don’t know if anyone has tried Zyflamend Whole Body but I remember that years ago, before New Chapter sold out to Procter & Gamble in 2012, it was a very effective anti-inflammatory. It may be that this product has not been altered by P & G. Referencing those who have been symptom-free after taking a fluoroquinolone, it may be that in some cases, the effects may simply not show up for many years (fibromyalgia, chronic fatigue syndrome, Sjogrens syndrome, etc.) And while most all of us who have been floxed are taking a variety of supplements, we’ll never know for sure which ones may be attributed to our eventual recovery. One thing I know for certain: I can easily tell the difference between those symptoms caused by aging and those caused by the ciprofloxacin. This site has been a lifesaver for those of us who have been floxed – thank you, Lisa.

  4. Kathy March 4, 2016 at 8:19 pm Reply

    taking NAC before & during might help too. Unfortunately, I hadn’t had enough education about FQ before I ended up needing it for a resistant bacterial infection. “The deleterious effects of bactericidal antibiotics were alleviated in cell culture and in mice by the administration of the antioxidant N-acetyl-L-cysteine or prevented by preferential use of bacteriostatic antibiotics. This work highlights the role of antibiotics in the production of oxidative tissue damage in mammalian cells and presents strategies to mitigate or prevent the resulting damage, with the goal of improving the safety of antibiotic treatment in people.”

    • Linda March 4, 2016 at 10:40 pm Reply

      Dr Cohen, in his book, suggests taking magnesium 4-6 hours apart from the flq. That way it doesn’t interfere with the drug but also keeps the mag in your body.

      • Kathy March 5, 2016 at 11:44 am Reply

        Yes, magnesium depletion is an issue too, but it appears from this study that the DNA damage from FQs is alleviated (at least in mice) by the use of NAC. Magnesium would still be needed to prevent rhabdomyolysis, muscle pain and kidney damage.

        • Linda March 5, 2016 at 1:12 pm

          just repeating what I read….don’t know about the NAC

        • Kathy March 5, 2016 at 1:19 pm

          I never want to take FQs again, but if I ever “have” to, as proven by a bacteria culture, I’d sure be taking NAC too. If you like reading and researching, take a look at the article in the link I posted. It’s at least some hope 🙂

  5. Bruce Niss July 30, 2016 at 4:53 pm Reply

    In the article you cited ( “Bactericidal Antibiotics Induce Mitochondrial Dysfunction and Oxidative Damage in Mammalian Cells,) it appears that, since production of ROS is THE main source of mitochondrial and tissue damage, anyone having a higher production of ROS or greater pre-existing damage from ROS (elders, athletes, etc.) would have a higher risk of side effects. Also, supplementation with magnesium also attenuates the bactericidal effects of the fluroquinolones, so use of more NAC, in this case, would be indicated rather than magnesium.

  6. Ryan August 28, 2020 at 12:29 pm Reply

    I will be taking Avelox for a resistant bacterial infection. No other treatment options are left to try. I plan to supplement with NAC, MitoQ, Vitamin E and Vitamin D both during and after. I’ll take magnesium upon completion of the course. How long should I continue supplements after completion, assuming I don’t show floxie symptoms? I know there is no known answer; I’m just looking for suggestions. Thanks.

    • L August 28, 2020 at 12:56 pm Reply

      I’ve been off here for a while, and don’t plan on returning, so please no replies. I won’t respond. I am still struggling with breathing issues to where I feel like i am suffocating on and off throughout the day. Found out I had mold sickness and MARCoNS, but treatments don’t seem to be helping. Two and half years now of this nightmare, after feeling not too bad for a few months since my Cipro poisoning in 2015. I suspect more nerve damage and also that the cipro made me more reactive to the mold. So, just too stressful to be on here, BUT..

      I did want to respond to you Ryan. Sorry you have to take Avelox. A couple things I want to mention…depending upon the location of the infection, it is quite possible it is protected by a biofilm (eg in the sinuses, gut) So before Avelox you might want to try another antibacterial along with something that breaks the biofilm. Here is more detailed information.

      Also, if you do end up taking the avelox…you mentioned taking magnesium after treatment. Dr Cohen, in his book, suggested that if you do have to take a FLQ, it may help diminish the negative side effects by taking magnesium 4 hours apart from the antibiotic. (I have no idea where the book is since I have been living out of boxes since april, when I fled the mold, or I would give the exact quote. But I do remember this very specifically.) Good luck.

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