Monthly Archives: November 2018

The Loss of a Loved Community Member

The “floxie” community lost a wonderful person last week. His name is Marc Thavenot, and Levaquin killed him. Mark struggled with fluoroquinolone toxicity for three years. He fought for his life every day of those three years. However, in November 2018 he lost his battle.

Officially, his cause of death was suicide. But the truth of his situation is much more complicated than the simple label of “suicide.” I suppose that all suicides have more to them than simply someone taking his or her own life. There is always a back-story.

Marc’s back-story is that he was tortured by a combination of fluoroquinolone toxicity (Levaquin), benzodiazepine damage, and Lyme Disease. On his web site he described his situation:

“In October 2015 after I had a fall and broke my hand i was put on a drug called Valium which is a benzodiazepine for anxiety and insomnia. Then 3 weeks later I was given an antibiotic called Levaquin for what the doctor thought was a stubborn ear infection. Little did I know that not only are these two drugs dangerous by themselves but are contraindicated when given together and risk for toxicity goes up tremendously. Upon taking the second dose of Levaquin, day number 2, I awoke at 4am with the most terrifying symptoms one can imagine. I felt the most horrific impeding doom, burning all over, ringing in my ears, blurry vision, panic, anxiety and fear unlike anything i could have ever imagine. For the next couple weeks these symptoms persisted along with the most brutal insomnia one can imagine with no sleep for days on end. Having already been dealing with having Cerebral Palsy my entire life this was just life shattering yet I had no idea what was yet to come. A couple months of this and things began to get worse with hallucinations, blood pressure spikes, body temperature deregulation, bone pain, shortness of breath, adrenal crashes, immune system crashing, GI problems, food sensitivities, rashes, teeth pain. It was just absolute hell everyday and i was completely unable to function and no doctor could figure out what was wrong.”

For three years Marc dealt with these issues and more. One of the more devastating symptoms that Marc dealt with was tinnitus that ruined his ability to do his job as a music producer and sound engineer.

Marc tried many things that he hoped would help his situation. Tragically, none of the things he tried cured his fluoroquinolone toxicity, benzodiazepine damage, or Lyme disease.

Perhaps with more time some of his symptoms would have faded, or maybe a cure for fluoroquinolone toxicity, benzodiazepine damage, or Lyme disease would have been found. Perhaps the thing that would have helped Marc to turn a corner toward healing would have come in a few more months, or a few more years. Tragically, we won’t know if solutions would have come to Marc. His time here is over, and that is so, so, so horribly sad.

Like many, maybe most, people, I struggle to find the right words to say both to a person who is suicidal and about a person who has committed suicide. I am not equipped emotionally, nor do I have the right training professionally, to say the “right” things to/about people who are suicidal. So, I have steered away from the topic, and suggested that people reach out to suicide prevention hotlines and mental health professionals. I still suggest both of those things. The National Suicide Prevention Hotline can be accessed through http://www.suicidepreventionlifeline.org/ and 1-800-273-8255. The people who answer the Hotline calls have tools and resources to help steer people away from suicide, and I hope that people use the Hotline as a resource. However, I’m bothered by my own suggestion that suicidal people “reach out.” I’m bothered by the suggestion because Marc DID reach out. He reached out to to many of us in the floxie community, including me. He asked questions and he sought advice, and he was given guidance to the best of our ability. But nothing helped, and his health continued to decline until he couldn’t take the pain any longer. Now he’s gone. I wish I had done more to help Marc. I wish I had known the right thing to say to him, or the right advice to give him that could have possibly shifted his path. I wish he was still here.

I know that there are others in the floxed community who feel guilt over not “doing more” to help Marc. I’m sure that you all did what you could. I did. But I wish I had done more, and I feel bad about not doing…. I don’t know…. more. But as a friend pointed out, why are we feeling guilt while the people who gave Marc the drugs that killed him feel no guilt or remorse about their role? The pharmaceutical company creators of Levaquin, the FDA (or the equivalent on Trinidad and Tobago), the doctors, etc. played an active role in poisoning Marc, but most of them have no idea, and they feel no guilt, while we do, and Marc is gone.

I hope that Marc’s family and friends know that the thoughts and prayers of many people throughout the world who “knew” Marc through the fluoroquinolone poisoned community are with him and them. He was clearly loved, and he is missed.

Levaquin, benzodiazepines, and Lyme disease killed Marc. He was tortured by the illnesses brought on by these pharmaceuticals for years, and I can’t say that I don’t understand how they could lead to his suicide. But, with all the love and respect in the world to Marc and his loved ones, can I please encourage all my floxed friends reading this to not go down the same path? Death is permanent. With death there is no hope or chance of healing. For every day that you are alive, there is a chance that healing will occur. There is the chance that discoveries will be made that will lead to cures. There is a chance that your body will cross a threshold toward healing. There is a chance of joy. There is a chance of love. There is life. There is hope.

I hope for strength for each of you. I hope that you get through fluoroquinolone toxicity. I hope that your body, mind, and spirit heal. I hope that you maintain hope, and that tomorrow (or the next day, or the day after that) brings the healing that you are hoping for.

I hope that Marc’s loved ones know that he touched the lives of many people throughout the world. He is missed, and our community is in mourning.

*****

Marc’s friend Nicholas asked me to share this message. It includes Marc’s last message.

Marco and I were friends since we met in 1999, best friends since 2002. We had a business together and we helped each other through some tough times and eventually, unwillingly, we were forced to dissolve the business for economic reasons and a shift in the landscape of home studios. It wasn’t easy. We had our differences of opinion and that coupled with other developments in my own life caused us to grow distant for a while though we frequently spoke via phone and message. We overcame our differences, our defunct business, and leaned on each other again and became brothers.

Over the last 3.5 years of him suffering we visited when we could, but spoke at least 3 or 4 times a week minimum for 30 mins to 3 hrs depending on how he was feeling. During the last 2 months, we spoke every day. I am recovering from my own issues, and I always hoped that he was doing the same, but it never came to pass.

Most people couldn’t endure watching him suffer. It was my honour to do so and help him through it, but to all who feel a ‘how’ just know, he understood. He often lamented that all those that surrounded him before had disappeared, but he knew how hard it was to watch someone suffer. He held no grudges.

Above all he wanted me to pass on this message so that people could know what he went through, what this drug, this dangerous ‘last resort only’ drug that is still treated like it was Panadol, did to him.

He was suffering from brain fog, which will be evident in his writing. I think it brings the message home with greater strength…

Marc’s words:

I wanted to write to you to thank you for all that you have done. Not once did I think that you didn’t do everything possible for my well being

The more I understand of my situation the more I realize I’m stuck in a very complicated viscous cycle. Iv just had a lot of trauma in my life that Iv struggled to let go of and it’s not because I have not tried but because it’s trsuma I have to relive everyday from young I was in pain and it was a physical and emotional struggle to do simple daily tasks even though I didn’t show it I certainly felt and I kept strong and pushed through. This built up trauma eventually weakens ones immune system and emotional health which I why I struggled so much with depresseion even though I didn’t show it as much

My accident breaking my hand was another trauma that started the ball rolling and then having surgery introduced anesthesia that also did not help the situation. Then came the final blow the levaquin which obviously damaged me in very serious ways I’ll never know for sure but I know was never the same after taking that drug.

I cannot begin to describe pain Iv felt everyday with having to live with CP. it was agony that existed both emotionally and physically. Then getting floxed and experiencing absolute nightmare symptoms daily And then to have so much taken away and have having fought to heal only to get worse and relapse due to who knows what. Fq toxicity is no joke and it has been just too much for me to deal with I have no life. This is not living.

Everyday since since I took that drug levaquin iv felt unattached, like my Head was filled with cotton and I couldn’t focus. every bit of sleep I got which was minimal I woke up to me extremities feeling like they were being crushed and burning. The main symptoms that were horrific with adrenal surges and BP spikesc of 210/110. Then it would drop to low 90/50. I have internal vibration that felt like if I was hooked up to a low voltage shocking station. I have severed moods swings with crying fits for no reason, my body felt heavy like someone filled me with lead. I feel completely exhausted but couldn’t sleep because i felt this pressure in my back my head that squeezed my head almost like if I had a parasite octoputus like thing in my head. Everyday I have severe abdominal pains that would feel like someone stabbing me with a knife. My mid and lower back would ache feel tense. I had several parts of my body feel numb and go completely week on a daily basic. My teeth would ache everyday. My jaw would be tense. My ears suffered horrible as they would be extremely sensitive to sound and burn life fire inside. I have nerve pain all over my body . I have stabbing bone pains in shins and arms. My vision is double blurry and not what It was. My chest feels like someone sucker punched me in the soloplexus. I have skin burning all over which feel so bad sometimes even taking a shower hurts. I feel like I’m out of my body with extreme brain brain fog fatigue and pressure all over my body and when I push to do anything I feel pressure all over my body with fatigues like some sucking energy out of me get worse. fingernails hurt and have arthritis like symptoms that make it hard to type play guitar etc. I have severe digestive issues with bloating constipation food intolerances. I can’t tolerate the sun or groups of people which makes going out or liming with friends almost impossible. My ears click with damaged euststion tubes so I hear things louder and sounds like resting a glass down on a table or a speaker phone would hurt my ears and I would hear audible distortion in my ears if I tried listening to music even at very low levels. All of these symptoms and more iv have endured from the day I took those pills. It’s now over 3 years and I still experience all of them in groups randomly everyday. Lack of sleep and depression have been a huge challenge as iv been not able to work feel joy do daily activities etc. fq toxicity is no joke and it ruins lives. Iv had countless doctors tell me it’s in my head it’s anxiety disorder. Bullshit. Cause after 2.5 years of hell I went on to antianxiety medication which barely helped. Except I feel more sedated but still can’t sleep. Fq toxicity can include damage of receptors in the brain that are responsible for managing our neurotransmitters. It can cause dna damage. Vegus nerve damage. Totally destroy your microbiome. Damage to mitochondria which is your main cells Responsable for energy production. It can damage immune function and send you body into extreme fight or flight which it did for me. Allowing infections viruses etc to wreck havoc as they have the oppertunity. After extensive testing in my journey to try and heal. I’m positive for Lyme , babesia , Scarlett fever, ebstein bar, cmv, herpes hsv 1 7 and 8, hpv. Rubella and a collection of parasites. What I did find out was I didn’t get my cerebral palsy from lack of oxygen at birth which usually leads to full body defects and speech problems. I had a different cp which is common with cmv virus infection in the nervous system. This would explain all my life I struggled with being unable to relax and have an easy time with relationships because my nervous system was compromised. It was difficult for me to be social. Well thing is the levaquin I took activated that virus and made it much worse along with everything I mentioned above so my cp got worse I now I’m forced to walk in crutches. Fq toxicity damages cyp450 liver engine pathways which responsable for metabolizing herbs drugs etc. no longer can I take pain killers thc or several other things that could have helped ease my suffering. This has affected me greatly as it’s affected my detox pathways and left me unable to detox like a normal person. Which creates a very toxic environment in your body which leads to more symptoms due to leaky gut and poor methylation.
These are things doctors are commonly unaware of and is why Iv had no real help because there really is no solution to what iv been going through. After 3 years and I’m actually worse off now after everything I’ve tried I really don’t know what else to do. All I know is life is absolute torture everyday and a struggle and I never knew someone could feel so bad. Only one who has experienced this could ever possibly get it.

I want everyone to know that there is so much more to what’s was going on with me that I would take a lifetime to explain. But the pain and torture that I go through nigh and day over and over again is just too much for one to endure. So please if your reading this don’t be angry or mad or sad or hurt because you think Iv done a bad thing. Know that I’m free of the worse pain and torture that I could ever imagine and please feel a sense of ease knowing that I no longer suffer. I know I’m my heart that my soul is in a beautiful place. And that it was just stuck in a sick body.

Fluoroquinolone Toxicity Awareness Friday

Today, Friday November 9th 2018, is the first Fluoroquinolone Toxicity Awareness Friday. Please join me, and other fluoroquinolone toxicity awareness advocates, in spreading the news far and wide about the dangers of fluoroquinolones, and the devastation and destruction that fluoroquinolones have brought to too many lives.

Mark A Girard, fellow fluoroquinolone victim and advocate, posted this on his Facebook page(s):

Please join in as we do all sorts of things to raise awareness about FQs. We chose the final Friday before Antibiotic Awareness Week (Nov 12-19) so that people remember what they saw or read or heard when they see something else about antibiotics in the media. This is a genuine grass roots effort to get the help we need and deserve and to prevent others from suffering similar damage. We are hoping people will reach out to the media, to government agencies, to their friends and families and so on. We will be discussing all sorts of things people can do and of course everyone is encouraged to contribute in their own unique ways. Use your skills and your imagination and help us to build an annual tradition that makes a difference in more people’s lives each November. If you want, you can continue with awareness efforts all week long with me, but we are hoping to get something going where we all do something on Friday, whether it is to tell your story on your timeline or to share a favourite article, newscast or meme. It’s a Horton Hears a Who situation so please take some time and add your voice to the shouting and maybe they will finally hear us loud and clear. Thanks!

Please feel free to copy and paste it into your status, or, if you’re Facebook friends with Mark, please share it. Or you can let your friends and family know about Fluoroquinolone Toxicity Awareness Friday by sharing this post.

Some suggested things to share are:

  1. Amy Moser’s VIRAL post, “This Antibiotic Will Ruin You
  2. Popular and influential news story – CBS Los Angeles, “Southland Firefighter Says Popular Antibiotic Poisoned His Body, His Life
  3. Popular and influential news story – WSB TV 2 Atlanta, “Local woman says popular antibiotic killed her husband
  4. In-depth investigative report – PBS Frontline Investigation, “Certain Antibiotics Spur Widening Reports of Severe Side Effects
  5. News story out of Europe – Daily Mail, “Antibiotics got rid of her chest infection – but Jane says they destroyed her health
  6. Story in the well-respected journal, Nature, “When antibiotics turn toxic
  7. New York Times column, “Popular Antibiotics May Carry Serious Side Effects
  8. Popular post on Floxie Hope, “FDA Announces that Permanent Peripheral Neuropathy is to be Added to Warning Labels for Fluoroquinolone Antibiotics
  9. Popular post on Floxie Hope, “New Study Finds that Ciprofloxacin Depletes Mitochondrial DNA
  10. Popular post on Floxie Hope, “Letter from Bayer to Doctors Regarding Cipro and Avelox

There are links to hundreds of other articles and news stories on the “Links & Resources” page of this site.

Please share these, and anything else that brings attention to the devastating effects of fluoroquinolones, on social media, with your friends and family, with influential news organizations, with politicians, etc. Get the news out far and wide – THANK YOU!

*****

Letter to the EMA

Following is a letter that I (Lisa Bloomquist) wrote to the European Medicines Agency (EMA) Committee for Medicinal Products for Human Use (CHMP). The CHMP will be reviewing fluoroquinolones starting on November 12, 2018, and they will make recommendations for use, marketing, and restriction of fluoroquinolones. Please consider sending a similar letter to them before 11/12/18. Contact information for all CHMP members can be found HERE

Dear CHMP Reviewers,

Thank you for thoughtfully reviewing fluoroquinolones and for considering the following information.

Fluoroquinolone antibiotics are causally associated with tendon ruptures, serious psychiatric disturbances, blood-sugar irregularities, peripheral neuropathy, autonomic nervous system dysfunction, disabling multi-symptom chronic illness, and many other symptoms that are both listed on the US FDA warning labels and noted in the many patient reports that can be found in published case-reports, testimonials provided by victims, and anecdotes. The devastating and disabling effects of fluoroquinolone antibiotics were brought to the attention of the EMA during the PRAC hearing on the 13th of June 2018.  It is my hope that you have listened to the patient testimonials presented to the PRAC, and that you are familiar with the severity of fluoroquinolone toxicity symptoms. In this letter, I will present some mechanisms through which fluoroquinolones lead to the symptoms noted above. I hope that you take these mechanisms into consideration when reviewing fluoroquinolones and making a judgement about their marketing and availability.

Fluoroquinolone Damage Mechanism 1 – Topoisomerase Interruption

The US FDA warning label for ciprofloxacin notes that, “The bactericidal action of ciprofloxacin results from inhibition of the enzymes topoisomerase II (DNA gyrase) and topoisomerase IV (both Type II topoisomerases), which are required for bacterial DNA replication, transcription, repair, and recombination.”

Fluoroquinolones are topoisomerase interrupters, and thus, as intended, they disrupt the process of bacterial DNA and RNA replication.

Though it is claimed that fluoroquinolones disrupt bacterial DNA not human nuclear DNA, this argument does not take into consideration the importance of bacterial DNA in human health, the fact that mitochondrial DNA is similar in structure to bacterial DNA, or the potential for promiscuous binding of fluoroquinolones to human nuclear DNA.

Fluoroquinolone Damage Mechanism 2 – Depletion of Mitochondrial DNA

Several studies have noted that fluoroquinolone antibiotics deplete mitochondrial DNA. In “Ciprofloxacin impairs mitochondrial DNA replication initiation through inhibition of Topoisomerase 2” (1) it is noted that:

“Loss of Top2β or its inhibition by ciprofloxacin results in accumulation of positively supercoiled mtDNA, followed by cessation of mitochondrial transcription and replication initiation, causing depletion of mtDNA copy number. These mitochondrial effects block both cell proliferation and differentiation, possibly explaining some of the side effects associated with fluoroquinolone antibiotics.”

Similar findings were published in 1996 in the article, “Delayed cytotoxicity and cleavage of mitochondrial DNA in ciprofloxacin-treated mammalian cells” (2).

Fluoroquinolone Damage Mechanism 3 – Increase in ROS and depletion of antioxidants

The study, “Oxidative Stress Induced by Fluoroquinolones on Treatment for Complicated Urinary Tract Infections in Indian Patients” (3) notes that fluoroquinolones decrease superoxide dismutates (SODs) and glutathione, and increase lipid peroxide levels.

Fluoroquinolone Damage Mechanism 4 – Neurotransmitter disruption and GABA inhibition

Fluoroquinolones are known to inhibit the activity of the neurotransmitter GABA, and to disrupt other neurotransmitter activities. The article, “Ciprofloxacin-induced neurotoxicity: evaluation of possible underlying mechanisms” (4) notes the following in its abstract:

Ciprofloxacin (CPX) is a fluoroquinolone antibiotic used for treating respiratory, urinary tract, gastrointestinal and abdominal infections. There are only a limited number of studies related to neurological adverse effects of this drug in therapeutic doses. Therefore, in the present study, we aimed to investigate the influence of CPX, when administered at pharmacological doses, on behavioral parameters of rats and the probable underlying mechanisms. CPX was administered in single oral daily doses of 20 and 50 mg/kg for 14 days in rats. CPX-induced depression and anxiety were evaluated by modified forced swimming test and elevated plus maze test, respectively. Also, spontaneous locomotor activity and motor coordination were assessed by activity cage and Rota-rod apparatus. Effects of CPX administration on brain serotonin, dopamine, γ-amino-butyric acid (GABA), glutamate, adrenaline and noradrenaline levels were determined by high performance liquid chromatography (HPLC) analysis. Contribution of oxidative stress to the changes induced by CPX administration was evaluated by measuring brain catalase, superoxide dismutase, glutathione (GSH) and malondialdehyde (MDA) levels. Our results indicated that depression-like and anxiety-like behaviors were observed only in the 50 mg/kg CPX-administered group with simultaneous decreases in the brain serotonin and GABA levels. In addition, in the brain homogenates of CPX-administered groups, increased MDA as well as decreased GSH and catalase activity with respect to their controls, indicated enhanced oxidative stress and weakened antioxidant defense system. In conclusion, repeated pharmacological doses of CPX were found to induce neurological toxicity. Also, altered brain neurotransmitter levels and increased oxidative stress observed in our study were thought to be the possible underlying mechanisms of ciprofloxacin-induced neurotoxicity.

Several studies, including “Benzodiazepine tolerance, dependency, and withdrawal syndromes and interactions with fluoroquinolone antimicrobials” (5) have noted that fluoroquinolone toxicity symptoms mimic those of benzodiazepine withdrawal.

Fluoroquinolone Damage Mechanism 5 – Depletion of Magnesium and Iron

The article, “Integrins on joint cartilage chondrocytes and alterations by ofloxacin or magnesium deficiency in immature rats” (6) notes that, “Recently, we showed that magnesium deficiency induces lesions in knee joint cartilage from 5-week-old rats that are very similar to ofloxacin-induced cartilage defects. We concluded that quinolone-induced arthropathy is probably due to chelation of magnesium and thus a deficit in functionally available magnesium in joint cartilage (Stahlmann et al. 1995).”

The article, “Nonantibiotic Effects of Fluoroquinolones in Mammalian Cells” (7) notes that, “Here, we show that the FQ drugs norfloxacin, ciprofloxacin, and enrofloxacin are powerful iron chelators comparable with deferoxamine, a clinically useful iron-chelating agent.”

Both cellular magnesium and iron are necessary for multiple enzymatic reactions, and they are necessary for health. Fluoroquinolones deplete both magnesium and iron, and may deplete other crucial minerals too.

Fluoroquinolone Damage Mechanism 6 – Microbiome Destruction

The importance of the gut microbiome has recently been uncovered. As a powerful class of antibiotics, fluoroquinolones disrupt the balance of gut microbiota in many ways. The consequences of gut microbiome disruption are now being uncovered. A disrupted gut microbiome has been linked to various diseases from Parkinson’s to Autism.

Fluoroquinolone Damage Mechanism 7 – Fluorine

Fluoroquinolones are fluorinated drugs, and it is known that fluorine displaces iodine, an element that is essential in the synthesis of thyroid hormones. Excess fluorine is linked to skeletal fluorosis (8), lowered IQ (9), and other health maladies. A significant amount of information about the harm that fluoride does can be found on the Fluoride Action Network web site, www.fluoridealert.org.

Additionally, it is recommended that the question of whether fluoroquinolones are metabolized into fluoroacetate be explored further.

Fluoroquinolone Damage Mechanism 8 – Thyroid Hormone Disruption

A significant amount of information about the connections between fluoroquinolones and thyroid hormone disruption can be found on the web site www.fluoroquinolonethyroid.com, and a summary of the connections can be found onhttp://www.hormonesmatter.com/fluoroquinolone-antibiotics-thyroid-problems-connection/.

Thyroid hormone disruption can lead to multi-symptom chronic illness, and most people suffering from fluoroquinolone toxicity would classify their illness as both multi-symptom and chronic. The connections between fluoroquinolone antibiotics and thyroid hormone disruption should be explored further.

Fluoroquinolone Damage Mechanism 9 – Epigenetic Changes

The article, “Epigenetic side-effects of common pharmaceuticals: A potential new field in medicine and pharmacology” (10) notes that:

“Interestingly, extensive changes in gene expression were found in articular cartilage of rats receiving the quinolone antibacterial agent ofloxacin, suggesting a potential epigenetic mechanism for the arthropathy caused by these agents. It has also been documented that the incidence of hepatic and dysrhythmic cardiovascular events following use of fluoroquinolones is increased compared to controls, suggesting the possibility of persistent gene expression changes in the liver and heart.”

Additionally, the published letter, “Hereditary Neuropathy Unmasked by Levofloxacin” (11) notes that a course of levofloxacin triggered Charcot-Marie-Tooth disease in a patient. Charcot-Marie-Tooth disease is thought to be a purely genetic disease, but the possibility exists that fluoroquinolone antibiotics are unmasking the disease.

Fluoroquinolone Damage Mechanism 10 – Increased MMP Expression

The article, “Ciprofloxacin enhances the stimulation of matrix metalloproteinase 3 expression by interleukin‐1β in human tendon‐derived cells” (12) notes that, “Ciprofloxacin enhances the stimulation of matrix metalloproteinase 3 expression by interleukin‐1β in human tendon‐derived cells.” This increase in MMP expression may have deleterious effects on all collagen and connective tissues.

Other potential damage mechanisms for fluoroquinolones include triggering mast cell activation, post-hepatic syndrome and liver damage, oxalate overload, extreme sensitivity to quinolones in the environment, calcium and/or potassium channel shifts, and many other possibilities. (http://fluoroquinolonethyroid.com/book_page/additional-mechanisms-to-consider/)

Exactly why some people experience devastating adverse reactions to fluoroquinolones is unknown. However, it is known and well-documented that fluoroquinolones cause a myriad of serious and severe adverse effects. I ask you to please thoughtfully consider each of the above mechanisms for fluoroquinolone damage when evaluating fluoroquinolones.

Thank you for your thought and consideration.

Sincerely,

Lisa Bloomquist

www.floxiehope.com

Durango, Colorado

USA

 

References:

  1. Anu Hangas, Koit Aasumets, Nina J Kekäläinen, Mika Paloheinä, Jaakko L Pohjoismäki, Joachim M Gerhold, Steffi Goffart; Ciprofloxacin impairs mitochondrial DNA replication initiation through inhibition of Topoisomerase 2, Nucleic Acids Research, Volume 46, Issue 18, 12 October 2018, Pages 9625–9636, https://doi.org/10.1093/nar/gky793
  2. Delayed cytotoxicity and cleavage of mitochondrial DNA in ciprofloxacin-treated mammalian cells. J W Lawrence, D C Claire, V Weissig and T C Rowe. Molecular Pharmacology November 1, 1996, 50 (5) 1178-1188.
  3. Oxidative Stress Induced by Fluoroquinolones on Treatment for Complicated Urinary Tract Infections in Indian Patients. V Talla and PR Veerareddy. J Young Pharm. 2011 Oct-Dec; 3(4): 304–309. doi:  [10.4103/0975-1483.90242: 10.4103/0975-1483.90242]
  4. Sinem Ilgin, Ozgur Devrim Can, Ozlem Atli, Umut Irfan Ucel, Erol Sener & Ilkay Guven (2015) Ciprofloxacin-induced neurotoxicity: evaluation of possible underlying mechanisms, Toxicology Mechanisms and Methods, 25:5, 374-381, DOI: 10.3109/15376516.2015.1026008
  5. Benzodiazepine tolerance, dependency, and withdrawal syndromes and interactions with fluoroquinolone antimicrobials. Br J Gen Pract. 2008;58(550):365-6.
  6. Integrins on joint cartilage chondrocytes and alterations by ofloxacin or magnesium deficiency in immature rats. Förster, C., Kociok, K., Shakibaei, M. et al. Arch Toxicol (1996) 70: 261. https://doi.org/10.1007/s002040050272
  7. Badal S, Her YF, Maher LJ. Nonantibiotic Effects of Fluoroquinolones in Mammalian Cells. J Biol Chem. 2015;290(36):22287-97.
  8. Skeletal fluorosis in relation to drinking water in rural areas of West Azerbaijan, Iran Ali Akbar Mohammadi, Mahmood Yousefi, Mehdi Yaseri, Mohsen Jalilzadeh & Amir Hossein Mahvi Scientific Reports volume 7, Article number: 17300 (2017)
  9. Prenatal Fluoride Exposure and Cognitive Outcomes in Children at 4 and 6–12 Years of Age in Mexico. Morteza Bashash et al. Published:19 September 2017CID: 097017https://doi.org/10.1289/EHP655
  10. Epigenetic side-effects of common pharmaceuticals: A potential new field in medicine and pharmacology. Antonei B. Csoka and Moshe Szyf. Medical Hypotheses Volume 73, Issue 5, November 2009, Pages 770-780.https://doi.org/10.1016/j.mehy.2008.10.039
  11. Panas, M., Karadima, G., Kalfakis, N., & Vassilopoulos, D. (2011). Hereditary Neuropathy Unmasked by Levofloxacin. Annals of Pharmacotherapy, 45(10), 1312–1313. https://doi.org/10.1345/aph.1P786
  12. Ciprofloxacin enhances the stimulation of matrix metalloproteinase 3 expression by interleukin‐1β in human tendon‐derived cells. Anthony N. Corps et al. Arthritis and Rheumatology. Volume46, Issue11. November 2002 Pages 3034-3040. https://doi.org/10.1002/art.10617

 

EMA Decision on Fluoroquinolones – Next Steps

The EMA (European Medicines Agency) review of fluoroquinolones is ongoing, and your input is requested/needed.

On June 13, 2018, the EMA’s Pharmacovigilance Risk Assessment Committee (PRAC) heard testimony from Europeans who suffered from fluoroquinolone toxicity, and on May 10, 2018, the PRAC issued their recommendations. (You can read and view the patient/victim testimonials HERE, HERE, and HERE, and you can read the PRAC’s recommendations HERE.) The next step is for the Committee for Medicinal Products for Human Use (CHMP) to consider the recommendations of the the PRAC on the safety of medicines on the market and recommend changes to the EMA. The CHMP will recommend changes in the marketing of fluoroquinolones, or may even recommend suspension or withdrawal of fluoroquinolones from the market. You can read more about the role of the CHMP HERE.

I would like to encourage everyone who has been hurt by fluoroquinolones to contact the CHMP so that they can take your testimonials and information into consideration when making their decisions and recommendations. Contact information for the CHMP members can be found HERE. I recommend that you send an email with a brief version of your personal story, along with information and references from the articles about fluoroquinolone toxicity that can be found in the “research” section of the Links & Resources page on this site or elsewhere on the internet to both the CHMP Chair (Harald Enzmann) and the Vice-Chair (Bruno Sepodes) I plan to send a letter that contains a combination of the information in the post, “What is Fluoroquinolone Toxicity” and the information that is found in the ebook, Hacking Fluoroquinolones (I’ll post my letter once I write it). You are welcome to use anything I (Lisa Bloomquist) have written on this site, or in my guest-posts on other sites, in your letters to the CHMP.

The CHMP meeting starts on November 12, 2018, and it is recommended that you send your emails to the Chair and Vice-chair of the CHMP as soon as possible.

Miriam Knight, a fluoroquinolone toxicity victim advocate, co-founder of Quinolone Toxicity Support UK, and an administrator for Fluoroquinolone Toxicity Victims in Europe, has written the following letter, and you are welcome to use it as a template. 

Dear Chair, Vice-chair and other members of the Committee for Medicinal Products for Human Use,

We in Europe wish to express our strong concerns regarding the recent recommendations made by the PRAC following their lengthy review into the side effects of Quinolones and Fluoroquinolones. We understand that the recommendations have now been passed to the CHMP for your opinion. We are very disappointed in the findings so far.

Representatives of this group and also individual members from across the EU were invited to speak at PRAC’s Public Hearing in June. From the EMA website we understand that “Contributions at public hearings inform the committee’s decision-making”. Even after taking part in the teleconference last week we are unable to find any evidence in the recommendations that our written and spoken interventions have in any way been used to inform the PRAC’s decision making.

Our main concern is that the evidence which we and others have provided regarding the damage Fluoroquinolones cause to human mitochondrial DNA (MtDNA) has been totally ignored. This evidence has been in the public domain since 1993 (1,2,3), yet is not mentioned in any of the license applications, SmPCs or PILs. Both the summary of the Public Hearing and the recommendations from the review fail to mention it, despite the overwhelming evidence. We despair that the Agency charged with safeguarding Public Health cannot see the huge danger in licensing products that physically damage humans. We hope that the CHMP and the Pharmacogenomic Working Party will at least understand the implications of this mechanism of action and will take the time to study ALL of the available evidence.

The Medical Profession seem to have a problem understanding how and why the Fluoroquinolone class of antibiotics have such wide ranging effects on some patients, indeed most are unable or do not believe patients when they are told of these side effects even with written and recorded evidence (4). It is clearly within the remit of the Pharmacogenomics Working Party to provide advice to the CHMP on general and product-specific matters relating to pharmacogenomics, although perhaps this aspect of the review was beyond the scope of the PRAC.

Not only do Fluoroquinolones have an effect on MtDNA but they also disrupt the metabolic processes of both our mitochondria (e.g. the TCA cycle) and also our cells (5,6). Again, the evidence for this has been glossed over by the PRAC’s recommendations, despite the many testimonies at the Public Hearing attempting to convey the sheer agonising horror inflicted by these drugs.

We understand from the teleconference that the recommendations passed over to the CHMP are more detailed than the brief version that was published prior to the teleconference. We sincerely hope this is so as all we have seen so far is a tenuous nod towards implementing changes with a view to protecting the public. The biggest risk to human health from the Fluoroquinolones is the damage and destruction caused to every cell (6) – which can potentially lead to multisystem problems including organ failure and cancers (4), and which surely outweigh the benefits. The mitochondrial damage also has implications on second generations – something which has yet to be studied. We notice that the PRAC dropped their original proposal to encourage further studies and research to be undertaken with no explanation. We find this decision, along with all of PRAC’s expressed concerns, to be disingenuous, at the least, at most we find it dangerous to future victims as well as present victims.

We cannot urge strongly enough that you fully and properly review all the evidence showing the catastrophic effect Fluoroquinolones can have both physically and mentally (4). A full understanding of why some people are affected immediately while others can tolerate several courses needs to be taught throughout the medical profession. It is simply not good enough to say these effects are “very rare” when it is well known that many people, after experiencing nothing from a first course go on to be affected by a second or third course. Others seem to tolerate repeated courses before just one more tablet sets off a serious reaction. The variety of personal thresholds is believed to depend on the individual’s mitochondrial condition, including either congenital deficiencies or acquired insults.The reality is that if someone takes enough Fluoroquinolones, they will eventually be affected: this cannot be defined as “very rare”. The true figure is unknown and until extensive research is undertaken it will remain unknown.

It is also not good enough to say these effects are “very rare” when it is well known that neither doctors nor patients associate an ADR that occurs weeks or months after cessation of the Fluoroquinolone with that particular drug – yet this is precisely what happens. There are possibly thousands of people who have been affected yet never know; their symptoms often labelled as Fibromyalgia or CFS/ME (which, ironically, have no known cause) or even MS.  Many times we have heard of e.g. eye specialists saying they have prescribed Fluoroquinolones hundreds of times yet no one has reported any problems: why would a patient with sudden muscle or tendon problems go back to their eye specialist? More patients have been seriously affected by Fluoroquinolones than anyone can imagine.

All Medical Professionals, member state Health Agencies and ALL committees working within the EMA have to fully understand the human catastrophe caused by this unique class of drugs (not exactly antibiotics as they have also been used as chemotherapy agents). Until the naïve ‘one size fits all’ approach to medicine is overturned – and this is obviously where the Pharmacogenomics Working Party is essential – innocent patients will continue to be harmed by the innocent doctors who are trying to do no harm.

References*:

1). Acridones and quinolones as inhibitors of ubiquinone functions in the mitochondrial respiratory chain. July 1993 Walter Oettmeier et al
https://pdfs.semanticscholar. org/a9fd/ 33039c3d987093746db40fbd8d7782 f3b078.pdf
2). Delayed cytotoxicity and cleavage of mitochondrial DNA in ciprofloxacin-treated mammalian cells. Nov 1996 Lawrence JW et al.
https://www.ncbi.nlm.nih.gov/ pubmed/8913349
3). Ciprofloxacin impairs mitochondrial DNA replication initiation through inhibition of Topoisomerase 2 August 2018 Hangas et al
https://academic.oup.com/nar/ article/46/18/9625/5088042? fbclid= IwAR0Xu4wIXprB3wF6nBP2EZxWinNm mVvUvjIQ8GPHPaLS81KsxE_ ucJZ99K8
4). Fluoroquinolone-induced serious, persistent, multisymptom adverse effects.
Oct 2015. Golomb B. et al
http://casereports.bmj.com/ content/2015/bcr-2015-209821. full
“…with progression that continued following discontinuation evolving to a severe, disabling multisymptom profile variably involving tendinopathy,muscle weakness, peripheral neuropathy, autonomic dysfunction, sleep disorder, cognitive dysfunction and psychiatric disturbance..”
5). Exploiting bacterial DNA gyrase as a drug target: current state and perspectives
Nov 2011 Frédéric Collin et al.
https://www.ncbi.nlm.nih.gov/ pmc/articles/PMC3189412/
6).Treatment of the Fluoroquinolone Associated Disability – the pathobiochemical implications
Nov 2017. Michalak K. et al .
https://www.ncbi.nlm.nih.gov/ pmc/articles/PMC5632915/

* These few references have been chosen as the most relevant to this letter.  The PRAC tell us they studied over 400 papers before reaching their decision but have not yet told us which 400.  As all scientists know, it is possible to reach any conclusion you like depending on which papers you quote. There are many more than 400 papers available which show the harm that can be caused by Fluoroquinolones.  Perhaps the best way to judge the danger is to work with the actual sufferers (we are either sufferers or carers ourselves) – as Dr Golomb (4) has done.

Thank you, Miriam, for all your advocacy work with the EMA (including the PRAC and CHMP)! And thank you to all who reach out to the CHMP – your advocacy work is appreciated too!

The PRAC recommendations were disappointing for many fluoroquinolone victims and advocates. Hopefully the CHMP recommendations will be stronger and more protective of patients.