I’m not a doctor. If you want to know exactly what medications you should or shouldn’t take given your personal medical history, please ask your doctor. Please also know that these are not hard and fast rules for every floxie. Given that there is so little research into fluoroquinolone toxicity, there aren’t many definitive rules for what pharmaceuticals people can and cannot take post-flox. Following is information though, and with information, perhaps you can make a more informed choice about which drugs to take and which ones to avoid.
From the Cipro/ciprofloxacin warning label:
- Corticosteroid drugs increase the risk of tendon ruptures (in the black box warning).
- “Ciprofloxacin is an inhibitor of human cytochrome P450 1A2 (CYP1A2) mediated metabolism. Co-administration of ciprofloxacin with other drugs primarily metabolized by CYP1A2 results in increased plasma concentrations of these drugs and could lead to clinically significant adverse events of the co-administered drug.” Drugs metabolized by CYP1A2 include Alosetron/Lotronex, Caffeine, Clozapine/Clozaril, Flutamide/Eulexin, Frovatriptan/Frova, Melatonin, Mexiletine/Mexitil, Mirtazapine/Remeron, Olanzapine/Zyprexa, Ramelteon/Rozererm, Rasaglinie/Azilect, Robinirole/Requip, Tacrine/Cognex, Theophylline, Tizanidine/Zanaflex, Triamterene/Dyrenium, Zolmitriptan/Zomig (Source).
- “Concomitant administration with tizanidine is contraindicated”
- “Concomitant administration of ciprofloxacin with theophylline decreases the clearance of theophylline resulting in elevated serum theophylline levels and increased risk of a patient developing CNS or other adverse reactions.”
- “Ciprofloxacin also decreases caffeine clearance and inhibits the formation of paraxanthine after caffeine administration.”
- “Ciprofloxacin should be avoided in patients with known prolongation of the QT interval, risk factors for QT prolongation or torsade de pointes (for example, congenital long QT syndrome , uncorrected electrolyte imbalance, such as hypokalemia or hypomagnesemia and cardiac disease, such as heart failure, myocardial infarction, or bradycardia), and patients receiving Class IA antiarrhythmic agents (quinidine, procainamide), or Class III antiarrhythmic agents (amiodarone, sotalol), tricyclic antidepressants, macrolides, and antipsychotics.”
- “Altered serum levels of phenytoin (increased and decreased) have been reported in patients receiving concomitant ciprofloxacin.”
- “Hypoglycemia has been reported when ciprofloxacin and oral antidiabetic agents, mainly sulfonylureas (for example, glyburide, glimepiride), were co-administered, presumably by intensifying the action of the oral antidiabetic agent (see ADVERSE REACTIONS). The concomitant administration of ciprofloxacin with glyburide has, on rare occasions, resulted in severe hypoglycemia.”
- “Probenecid interferes with renal tubular secretion of ciprofloxacin and produces an increase in the level of ciprofloxacin in the serum.”
- “Renal tubular transport of methotrexate may be inhibited by concomitant administration of ciprofloxacin potentially leading to increased plasma levels of methotrexate.”
- “Metoclopramide significantly accelerates the absorption of oral ciprofloxacin resulting in shorter time to reach maximum plasma concentrations.”
- NSAIDs – “Non-steroidal anti-inflammatory drugs (but not acetyl salicylic acid) in combination of very high doses of quinolones have been shown to provoke convulsions in pre-clinical studies.”
There are many conditions that may (or may not) be related to fluoroquinolone toxicity that have “drugs to avoid” lists. Here are some of them:
- Myasthenia Gravis list of drugs to avoid
- Drugs that increase the QT interval
- G6PD Deficiency list of drugs to avoid
- Porphyria list of drugs to avoid
- Drugs that deplete magnesium
- Drugs that deplete iron
- Fluorinated Pharmaceuticals
- Drugs that contain carboxylic acid
There are a lot of questions about timing of drug administration that neither I, nor anyone else to my knowledge, know the answers to. It’s right there on the warning label that concurrent administration of ciprofloxacin and NSAIDs can induce convulsions (seizures), but does that mean that people who have taken ciprofloxacin in the past should avoid NSAIDs in the future? There is anecdotal evidence that NSAIDs should be avoided by floxies, but some people seem to handle them fine, and that’s valid anecdotal evidence too. When might it be safe for a floxie to take the drugs listed above? I don’t know the answer to that.
Another question that I don’t know the answer to is – Do adverse reactions to fluoroquinolones either uncover or cause another syndrome? Some of the possible syndromes that fluoroquinolone toxicity may or may not be related to are G6PD Deficiency and porphyria. Both G6PD Deficiency and porphyria can be brought on by adverse reactions to drugs. It’s possible that fluoroquinolone toxicity is related to these diseases, but I haven’t seen much evidence to support that assertion (so please just take it for what it’s worth).
I encourage everyone reading this to read the entire warning label for any drug you are prescribed, go over the potential benefits and risks with your doctor, and look up any drug you’re prescribed on www.askapatient.com and http://www.peoplespharmacy.com/. After that due diligence, I wish you luck with whatever decision you make. Know that fluoroquinolones are more dangerous than many, maybe most, drugs, and that sometimes pharmaceuticals are necessary, so try not to be too anxious about having to take one.
I hope this helps!
Oh my God, feel so dumb! Never questioned the doctor. If only does not help! I was using iltrypthone and read some where that it was bad. I stopped. What about Tylanol (sp) ??
I will stop the melatonin. There must be some huge lesson in all this.
Thank you
Lisa, What good does genetic testing really do for floxies? Who gets this information? So many profiles are the same; drs that deny problem, adding drugs to the mix and lack of family support/understanding. Makes you wonder – has anyone surveyed state, age, size of city, etc?
I can’t believe that they include prednisone in black box warnings but then do NOT list it in the list of drugs causing significant adverse effects! Perhaps to make it more difficult to sue if /when something other than a ruptured tendon happens? Argh. (Interestingly though, if you go to drugs.com, it lists that combination as having “major interaction,” that is, the risks outweigh the benefits.
Great article Lisa. Thanks. Janea, do not blame yourself! You should be able to trust your doctors, and everyone acts like you can but unfortunately, you cannot. It’s a big charade with trillions of dollars at stake. Best wishes to all of you!
what about taking TYLENOL.??? Like ibeprofen is it negative for pain with Cipro poisoning??
Pain is so hard to endure……Can’t sleep much….
More advice please,
Janea
Sent from my iPad
We must not ignore the possibility that FQ side effects are fluoride (flo) poisoning enhanced by lifelong fluoride accumulation from many increasing sources such as fluoridated water, dental products and fluoridated drugs. Our medical professionals are untrained to recognize fluoride poisoning. I know because I have thyroid and parathyroid disease after 60 years of fluoride consumption including HF fumes at work, that is improving as evidenced in lab reports by avoiding fluoride. I suffer from dental fluorosis, kidney stones, bone ash from total hip replacement measured 1500 ppm fluoride, X-ray evidence of calcified ligaments (skeletal fluorosis) and painful arthritis and degenerative hip and spine. Be aware! Stop water fluoridation as well as get an understanding of the accumulative potential of fluoride poisoning including from fluoridated drugs. Susan Kanen, Biochemist, formerly with Army Corps of Engineers at DC Dalecarlia Water Treatment Plant, whistleblower to lead in drinking water. Fluoride Free Alaska
https://www.facebook.com/groups/fluoridefreealaska/
I agree Linda.
In fact their have been issues much further back in time, way back past the original non fluorinated Quinolones. Our symptoms can actually be found in various patterns in various drugs all with that QuinoLINE nucleus in common, right back to synthetic Quinine, itself which is also a very dangerous drug.
IMHO, there is something VERY wrong with that QuinoLINE nucleus.
There are imo multiple causes for our issues, some have bigger parts to play than others, the added fluorine which enhances the bioavailable of the active ingredient of the FQ, thus allowing it into places in the body it has never been before, & also creating far easier access through the blood-brain barrier is imo one of many.
I feel as you do, this has just made a very dangerous drug even more dangerous, it has enhanced the severity & to an extent the potential damage because of the above. The neurotoxicity, a hallmark of various fluorinated drugs is well known of course. Another problem also being, that the FQs are based on Nalidixic acid, itself a known listed documented carcinogen, which of course would also not help matters one little bit.
Fluorides of course are extremely toxic to any living thing, cumulative general protoplasmic poisons. Best avoided by every living creature on this planet, as much as humanely possible … period.
How can we persuade Governments from fluoridating our water supplies?
So because we had a bad reaction to cipro we can not take any of those?? I just got put on Zyprexa now I’m scared and I wonder if that is why on week 2 I have been feeling weird like heavy and off balance and have to sit down and my heart feels like it flutters…so we can take no antipsychotic medications ever??? Please get back to me soon very worried…thank you so much
LIsa this site continues to help. I am post floxing about 21 months. IT took about four months for the affects of Levaquin to abate and I feel very lucky. I had neuropathy and leg weakness, fatigue and brain fog. I would be teaching and feel dizzy. It did go away. The fear however is not there of taking any pharmaceutical. I recently strained my back, really bad like all over and have nerve pain because of the stretching and compression from the muscles that need to heal. I need to start physical therapy and to get the inflammation down if I can. I was prescribed a Medrol dose pack, a corticosteroid different a bit from Predasone but not sure how. I did not take this because I am terrified it will trigger something post floxing. My doctors do not understand. I cannot take NSAIDS and have been taking Tylenol but that is not a help for inflammation and it is hard on the liver. I have read about taking Curamin – a turmeric compound for inflammation. Have you oar anyone had luck with this? Any adverse side effects? I am so afraid to take anything anymore. I have done acupuncture and it helps and some massage but I know I could use something to help this along. I did have a reaction to amoxicillin about a year ago and took one dose of Prednisone with no issue and it helped the hives calm almost instantly but I am still very leery of taking this. Again my doctors, three of them have just blown my concern off. Any advice?
Does it mean if someone like me took iboprofen at the same time as cipro there will be less chance of recovery? It’s been 7 months post floxing for me now and I’ve seen hardly any improvement it’s mostly been phychiatrist side effects.
It’s shocking how profoundly this poison can change someones life, from worrying about nothing to constantly checking the ingrediants of everything and avoiding anything that’s not organic ect.
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