Tag Archives: moxifloxacin

New Fluoroquinolones in the Pipeline

The most commonly prescribed fluoroquinolones are Cipro/ciprofloxacin, Levaquin/levofloxacin, Avelox/moxifloxacin, and Floxin/ofloxacin. Almost every “floxie” that has been poisoned by fluoroquinolones in the last 15 years has taken Cipro/ciprofloxacin, Levaquin/levofloxacin, Avelox/moxifloxacin, or Floxin/ofloxacin. However, there are many other quinolones and fluoroquinolones that have been developed. Here is a list:

First-generation:

Second-generation:

  • ciprofloxacin (Cipro) -Still on the market. Millions of prescriptions dispensed annually worldwide. 
  • enoxacin (Enroxil, Penetrex) – withdrawn from the market
  • fleroxacin (Megalone, Roquinol) – withdrawn from the market
  • lomefloxacin (Maxaquin)  – withdrawn from the market
  • nadifloxacin (Acuatim, Nadoxin, Nadixa)  – withdrawn from the market
  • norfloxacin (Lexinor, Noroxin, Quinabic, Janacin)  – withdrawn from the market
  • ofloxacin (Floxin, Oxaldin, Tarivid) – Still on the market. Millions of prescriptions dispensed annually worldwide. 
  • pefloxacin (Peflacine) – withdrawn from the market
  • rufloxacin (Uroflox) – withdrawn from the market

Third-generation:

  • balofloxacin (Baloxin) – withdrawn from the market
  • grepafloxacin (Raxar) – withdrawn from the market
  • levofloxacin (Leflox, Cravit, Levaquin, Tavanic) – Still on the market. Millions of prescriptions dispensed annually worldwide. 
  • pazufloxacin (Pasil, Pazucross) – withdrawn from the market
  • sparfloxacin (Zagam) – withdrawn from the market
  • temafloxacin (Omniflox) – withdrawn from the market
  • tosufloxacin (Ozex, Tosacin) – withdrawn from the market

Fourth-generation:

  • clinafloxacin – Not withdrawn from market, but not commonly available
  • gatifloxacin (Zigat, Tequin) – Tequin removed from the U.S. market, but other forms remain available.
  • gemifloxacin (Factive) – Currently available. More commonly prescribed outside of the U.S.
  • moxifloxacin (Acflox Woodward, Avelox,Vigamox) – Still on the market. Millions of prescriptions dispensed annually worldwide. 
  • sitafloxacin (Gracevit) – withdrawn from the market
  • trovafloxacin (Trovan) – withdrawn from the market
  • prulifloxacin (Quisnon) – withdrawn from the market

Despite the fact that 22 of the 29 quinolones listed above have been removed from the market, and the fact that there is an updated black box warning label (the most serious warning possible on a pharmaceutical), that notes that the fluoroquinolones remaining on the market can cause permanent disability, several pharmaceutical companies are busily developing new fluoroquinolones.

Some of the fluoroquinolones in development include:

  • Delafloxacin (Baxdela) – Delafloxacin/Baxdela is being developed by Melinta Therapeutics, and is currently undergoing Phase III trials. It is supposed to be more effective at treating MRSA and other bacterial infections that are currently resistant to other fluoroquinolones. Melinta says that delafloxacin/Baxdela has a “favorable safety profile,” but, frankly, I don’t believe them. Bayer says that Cipro has an excellent safety profile, but thousands of people have been injured, disabled, and killed by it. Delafloxacin/Baxdela will be effective against gram-positive, gram-negative, atypical and anaerobic bacteria–meaning that it will be a broad-spectrum antibiotic that will kill all microorganisms in its path. I understand that MRSA is a serious, and potentially deadly infection, and that it may be appropriate to use an extra-powerful fluoroquinolone in cases of life-or-death. However, as an extra-strong fluoroquinolone, with an increased scope of bacteria that it kills, it will be a dangerous, and deadly for some, drug. I hope that delafloxacin/Baxdela will be reserved for treating life-threatening MRSA infections, and that it will not be prescribed for treatment of simpler or less dangerous infections.
  • JNJ-2Q – JNJ-2Q is being developed by Furiex Pharmaceuticals, who have licensed JNJ-Q2 from Janssen Pharmaceuticals, a unit of Johnson & Johnson. Like delafloxacin/Baxdela, JNJ-2Q is being developed for the treatment of MRSA, and it is also a particularly strong and potent fluoroquinolone. Again, I hope that it is only used for deadly MRSA infections.
  • Nemonoxacin (Taigexyn) – Nemonoxacin/Taigexyn, developed by TaiGen Biotechnology Company, is currently undergoing phase III trials in the U.S. However, it has already reached the market in Taiwan, Russia, Commonwealth Independent States, Turkey, mainland China, and Latin America. It is also more effective against MRSA than the fluoroquinolones that are currently on the market, and it is more potent than ciprofloxacin, levofloxacin, and moxifloxacin. Not-so-fun-fact – Nemonoxacin has been fast-tracked for approval by the FDA.
  • Zabofloxacin – Zabofloxacin was discovered by Dong Wha Pharmaceuticals and licensed to Pacific Beach BioSciences for development. It is currently undergoing clinical trials. “The spectrum of activity of zabofloxacin includes bacterial strains that are responsible for most community-acquired respiratory infections. Phase III clinical studies are currently ongoing at Dong-Wha for the treatment of patients with acute bacterial exacerbation of chronic obstructive pulmonary disease.” (source)

Be aware that these new fluoroquinolones are in the pipeline. Know their names so that you can avoid them.

I’m not sure how anyone else’s medical record works, but when I asked my doctor to put that I am allergic to fluoroquinolones on my medical record, her computer system wouldn’t allow her to do so. Instead, I had to list all of the fluoroquinolones that I wanted to avoid individually. I suggest that you tell your doctors not only that you can’t have fluoroquinolones, but that you can’t have Cipro/ciprofloxacin, Levaquin/levofloxacin, Avelox/moxifloxacin, and Floxin/ofloxacin specifically. And, when they reach the market, I suggest that you add Baxdela/delafloxacin, JNN-2Q, Taigexyn/nemonoxacin, and zabofloxacin to your list of drugs that you cannot tolerate.

I find the dissonance between the people who review drug safety, and the people that approve new drugs, both of whom are within the FDA, to be a bit mind-boggling. How could the Antimicrobial Drugs Advisory Committee decide that the current warnings on fluoroquinolones are inadequate and that they shouldn’t be prescribed for sinus infections, colitis or UTIs, or chronic bronchitis because they are too dangerous, while another part of the FDA fast-tracks the approval of Taigexyn/nemonoxacin, an even more powerful fluoroquinolone antibiotic? Do they not speak to each other? I can’t fathom that there is not at least some overlap between the Antimicrobial Drugs Advisory Committee and the people who approve new antimicrobial drugs. Are there people at the FDA who are screaming about these new fluoroquinolones that are about to enter the market, and noting that they are horribly unsafe? Or, did the Antimicrobial Drugs Advisory Committee just update the warning labels on existing fluoroquinolones to shut up patient advocates (you and me)? Is there massive cognitive dissonance at the FDA? Because it certainly appears that there is. The people at the FDA, and the Antimicrobial Drugs Advisory Committee specifically, pretend to acknowledge the dangers of fluoroquinolones, and pretend to do something about those dangers, while still thinking that it’s appropriate to approve new, stronger fluoroquinolones for public use. It’s mind-boggling.

There is constant repetition of some mantra along the lines of “fluoroquinolones have an excellent record of safety and efficacy” among drug-makers, drug-regulators, and drug prescribers – despite a massive amount of evidence to the contrary. The list of quinolones/fluoroquinolones above clearly shows that 22 of the 29 drugs have been removed from the market–many because of serious safety concerns. Yet, new, more powerful, fluoroquinolones are entering the market, in part because, for some odd reason, Cipro and Levaquin are seen as “safe.” They’re not safe though. They cause permanent disability and death. The upcoming fluoroquinolones will be worse.

I hope that the new fluoroquinolones that are coming to market are only used to treat life-threatening MRSA infections, but I have no faith that that will be the case. These new fluoroquinolones will be marketed as being bigger/better/faster/more powerful than safer alternatives, doctors will prescribe them, and patients will suffer because of them. Hopefully I’m being too pessimistic, and some prudence will be shown in the prescribing of these dangerous drugs–I doubt that though.

Just be aware of the dangers of fluoroquinolones–both old and new, and protect yourself and your loved ones. Share information about the dangers of fluoroquinolones with your friends and family, and let them know that fluoroquinolones should never be used unless there are no viable alternatives, and the infection is life-threatening. These new fluoroquinolones are more powerful, and more dangerous, than the fluoroquinolones that are currently on the market, and the ones that are on the market are pretty horrible. They should all be avoided like the plague.

 

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Letter from Bayer to Doctors Regarding Cipro and Avelox

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The above letter, from Bayer to health care professionals reads:

August 22, 2016

IMPORTANT DRUG WARNING

Subject: Important Changes in the Avelox (moxifloxacin hydrochloride) and Cipro (ciprofloxacin) Complete Prescribing Information – New Limitations of Use and Safety Information for Fluoroquinolones

Dear Health Care Professional:

Bayer HealthCare Inc. and Merck & Co., Inc. would like to inform you of imprtant changes to the prescribing information for fluoroquinolone antibiotics for systemic use in the United States, including Avelox (moxifloxacin hydrochloride) and Cipro (ciprofloxacin).

Limitation of Use and Safety Information for Fluoroquinolone Drugs

To communicate important safety information for fluoroquinolone antibiotics, the U.S. Food and Drug Administration (FDA) has requested that all license holders of these products, including Bayer for Avelox and Cipro, implement a class label change.

These labeling changes provide for revisions to the Indications and Usage section of the package insert to include a new limitation of use statement for acute bacterial sinusitis, uncomplicated urinary tract infections, acute uncomplicated cystitis, and acute bacterial exacerbation of chronic bronchitis, to reserve systemic fluoroquinolones for treatment in patients who have no alternative treatment options. In addition to the Boxed Warning, Warnings and Precautions, and Information for Patients sections of the package insert and the Medication Guide have been revised to include information regarding the risk of disabling and potentially irreversible serious adverse reactions of tendinitis and tendon rupture, peripheral neuropathy, and central nervous system effects that can occur together in the same patient.

The labels of fluoroquinolones already had a Boxed Warning for tendinitis, tendon rupture, and worsening myasthenia gravis. The labels also included warnings about the risks of peripheral neuropathy and central nervous system effects. Other serious risks associated with fluoroquinolones are described in the labels, such as cardiac, dermatologic, and hypersensitivity adverse reactions. This information about the risk of disabling and potentially irreversible serious adverse reactions is based on the FDA’s review of postmarketing adverse event reports from the FDA Adverse Event Reporting System (FAERS). This safety information was discussed at a November 5, 2015 joint meeting of the Antimicrobial Drugs Advisory Committee and the Drug Safety and Risk Management Advisory Committee.

Prescriber Action:

Health care professionals should not prescribe systemic fluoroquinolones to patients who have other treatment options for acute bacterial sinusitis, acute bacterial exacerbation of chronic bronchitis, acute uncomplicated cystitis, and uncomplicated urinary tract infections. Health care professionals should encourage patients to read the Medication Guide that describes the safety issues associated with fluoroquinolones. The Medication Guide is required to be given to the patient with each fluoroquinolone prescription. Stop fluoroquinolone treatment immediately if a patient reports serious side effects, and switch to a non-fluoroquinolone antibacterial drug to complete the patient’s treatment course.

Reporting Adverse Events:

Health care professionals are encouraged to report adverse events to FDA’s MedWatch reporting system by visiting www.fda.gov/medwatch or calling 1-800-FDA-1088.

If you wish to request further information for AVELOX, please contact Merck National Service Center at 1-800-526-4099. If you wish to request further information for CIPRO, please contact Bayer Service Center at 1-888-842-2937.

Please refer to the accompanying Important Information about AVELOX and CIPRO for complete indication and other important risks. Please also see the enclosed Prescribing Information, including BOXED WARNINGS and Medication guide for AVELOX and CIPRO.

Bayer HealthCare is the license holder for AVELOX and CIPRO. Under terms of a marketing agreement, Merck markets AVELOX in the United States.

Sincerely,

Dario F. Mirski, M.D.

Senior Vice President and Head Medical Affairs Americas

Bayer HealthCare Pharmaceuticals, Inc.

Enclosures: AVELOX and CIPRO Full Prescribing Information

 

The Avelox and Cipro prescribing information can be found HERE and HERE.

 

I’m honestly feeling speechless right now–I have no idea how to respond to this. The letter speaks for itself. I never thought I would see the words, “Health care professionals should not prescribe systemic fluoroquinolones to patients who have other treatment options for acute bacterial sinusitis, acute bacterial exacerbation of chronic bronchitis, acute uncomplicated cystitis, and uncomplicated urinary tract infections,” or that doctors and patients alike should be warned of “disabling and potentially irreversible serious adverse reactions” of fluoroquinolones, or that, “the risk of disabling and potentially irreversible serious adverse reactions of tendinitis and tendon rupture, peripheral neuropathy, and central nervous system effects that can occur together in the same patient,” from Bayer. But, there it is, on Bayer letterhead–a letter to health care professionals regarding the real, serious, often permanent risks of fluoroquinolones.

I hope that this letter is being distributed far and wide, and that it reaches every doctor, P.A., nurse, and other medical provider in the country.

I hope that Johnson & Johnson sends out a similar letter regarding Levaquin (levofloxacin).

I hope that doctors heed these warnings, and stop prescribing fluoroquinolones outside of life-threatening situations.

I hope that these letters do something other than mitigate the risks and losses that Bayer anticipates from lawsuits having to do with the updated Cipro and Avelox warning labels.

I hope that some of the motivation for this letter is Bayer wanting to do the right thing and warn patients and health care providers alike about the dangerous side-effects of their drugs.

I hope that we in the “floxie” community can celebrate this. I see this letter as a very big deal. When I started this site in 2013, I didn’t think that I would ever see a letter like this. It, along with the warning label changes that prompted it, should be celebrated.

 

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Can Fluoroquinolones Activate Mast Cells?

What is the connection between fluoroquinolone toxicity and mast cell activation / histamine intolerance? Can fluoroquinolones trigger mast cell activation and histamine intolerance?

The symptoms of mast cell activation are similar to those of fluoroquinolone toxicity. According to Mastocytosis Society Canada, the symptoms of mast cell activation are:

skin lesions or sores, skin rash, spots, redness, hives, persistent fatigue, itching, flushing & severe sweating, joint, bone pain, headaches, tachycardia (racing heartrate), eyes tearing/dry, eye pain, persistent body/tissue pain, difficulty exercising, vertigo, episodes of low body temperature, unexplained Vitamin B12 deficiency, scents/odors/chemical reactions, difficult menses (females), numbness & tingling in face and extremities, skin feels on fire, unexplained anxiety, sudden drops in blood pressure, fainting, persistent diarrhea, vomiting, unexplained weight loss, cognitive impairment, sinus problems, chest pain, vision problems, hair loss, mouth sores, nausea, swelling & inflammation, odd reactions to insect stings, anesthesia difficulties, anemia, thyroid problems, decreased bone density, unexplained weakness, shortness of breath, sunlight sensitivity, temperature (hot/cold) sensitivity, difficulty with foods, drinks, anaphylactoid reactions, anaphylaxis, gastrointestinal pain, bloating, unexplained medication reactions, enlarged liver/spleen, liver/spleen/bladder/kidney pain, enlarged lymph nodes, frequent urination, recurring infections, neuropathic pain, constipation, iron deficiency, unexplained bruising, bleeding, malabsorption, intermittent tinnitus or hearing problems.

That’s a pretty comprehensive list of fluoroquinolone toxicity symptoms too. (Though, as I discussed with Dr. Wahls in episode 14 of The Floxie Hope Podcast, all of the multi-symptom, chronic diseases of modernity have more in common with each other than they don’t, and should probably all just be categorized as cellular dysfunction disorders and treated similarly.)

Several floxies who have been able to get a diagnosis from a doctor have come back with a diagnosis of mast cell activation, or a disease that is related to mast cells. For example, one floxie friend’s doctors have diagnosed him with eosinophilia, a disorder that is related to mast cells and histamine intolerance. Other floxies have been diagnosed as histamine intolerant, and instructed to go on a low-histamine diet. As noted above, many floxies have symptoms of mastocytosis, and it is possible that fluoroquinolones activate mast cells and trigger mastocytosis.

Mast cell disorders are considered to be rare, but, according to Mastocytosis Society Canada, “escalation in the prevalence of these patients worldwide has resulted in a flurry of medical research ongoing in numerous countries. This indicates that these disorders may not be rare, but rather have been commonly misidentified and unfortunately for patients worldwide, commonly undiagnosed. Since approximately 2005, every year there are new theories, classifications, and adjustments to the mastocytosis definitions due to escalation of patients presenting with these disorders worldwide.”

I found the following information connecting fluoroquinolones and mast cell activation / mastocytosis:

  • From the International Journal of Tissue Reaction’s article, Effect of levofloxacin and ciprofloxacin injection on permeability of the tail vein in mice and skin microvasculature in rats, “These results suggest that LVFX and CPFX increase vascular permeability through the induction of histamine release from mast cells in rodents.” (LVFX is levofloxacin and CPFX is ciprofloxacin.)
  • From the Journal of Pharmacy and Pharmacology’s article, Characterization of Histamine Release Induced by Fluoroquinolone Antibacterial Agents In-vivo and In-vitro, “Intravenous injection of levofloxacin and ciprofloxacin at 1–10 mg kg−1 produced dose-related elevations in plasma histamine level in anaesthetized dogs. In contrast, levofloxacin was devoid of plasma histamine increment in anaesthetized rats at 100 mg kg−1, whereas ciprofloxacin at the same dose caused endogenous histamine release. Levofloxacin and ciprofloxacin induced non-cytotoxic secretion of histamine from all mast cells tested in a concentration-dependent manner, whereas rat skin and peritoneal mast cells were thirty- to one-hundred-times less sensitive to the effect of fluoroquinolones as compared with the canine skin mast cells.” Note that in studies beagle puppies have been made lame by fluoroquinolones.
  • From the Archives of Toxicology’s article, Differential response of mast cells separated from various organs and basophils of dogs to the fluoroquinolone antimicrobial levofloxacin, “Histamine releases induced by the fluoroquinolone antimicrobial levofloxacin (LVFX) were investigated using mast cells separated from various organs and peripheral basophils of dogs, being the most susceptible species to quinolone derivatives, in both in vivo and in vitro systems. An intravenous infusion of LVFX at 30 mg/kg over a 30-min period produced endogenous histamine release from 5 min, and a maximum at 30 min, in which the plasma LVFX concentration was approximately 50 µM. A close correlation (r=0.87, n=20) between histamine and LVFX concentrations in plasma during the infusion was observed. In the in vitro study, LVFX at 30 µM or more caused histamine release from mast cells separated from the liver and skin, but not from the gastric mucosa, lung, and peripheral basophils. More exactly, the liver mast cells were most susceptible to LVFX among the organs tested. On the other hand, compound 48/80, a prototype histamine liberator, elicited the histamine release from the liver or skin mast cells at 10 µg/ml, and the calcium ionophore A23187 at 1 µM exhibited the histamine release from the mast cells derived from all organs examined. Histochemical analysis revealed that the liver and skin mast cells had positive reaction for both alcian blue and safranin staining, but the gastric mucosa and lung mast cells were only positive for alcian blue staining, indicating that LVFX preferably activated the connective tissue-type mast cells rather than the mucosal-type mast cells. The degranulation of the liver and skin mast cells brought about by either LVFX or compound 48/80, unlike the calcium ionophore A23187, was blocked by pretreatment with pertussis toxin, suggesting the involvement of pertussis toxin-sensitive G proteins. The results obtained from the canine experiments strongly suggest that LVFX induces histamine release from the connective tissue-type mast cells distributed mainly in the liver, somewhat in the cutaneous tissue, through the activation of pertussis toxin-sensitive G proteins.”

The articles noted above are all from animal studies, not human studies, but they show that fluoroquinolones can activate mast cells and histamine release in mammals, and it’s reasonable to think that they may do the same things to humans that they do to dogs. Also, the similarity between fluoroquinolone toxicity symptoms and mastocytosis symptoms, though not a smoking gun, indicate that further studies of the affects of fluoroquinolones on mast cells should be done.

A few good resources for people with mastocytosis, and it’s possible that floxies are in that category, are:

  1. Dr. Theoharides web site
  2. Mastocytosis Society Canada web site
  3. The Low Histamine Chef web site
  4. Alison Vickery’s web site

I suspect that mast cells are profoundly affected by fluoroquinolones and that mast cell activation is a big part of fluoroquinolone toxicity. The potential options, and mechanisms for fluoroquinolone toxicity, are mind-boggling. Add mast cell activation to the list.

 

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Fluoroquinolones and Mercury Poisoning

I recently received a message from a floxie friend that raised an interesting question. My friend asked:

Have you ever heard that FQ antibiotics can release stored toxins like mercury into the body? It has been two years since Cipro for me, and one month ago they found out I am highly mercury poisoned. But before I took Cipro, I was okay. The doctors are guessing that I have been mercury poisoned for a long time but somehow it is showing up in my blood now. Since the symptoms of Cipro toxicity and mercury poisoning are about the same, I’m wondering if they’re related.”

Over the years, several people have raised the question of whether or not fluoroquinolone toxicity is related to mercury poisoning, but I hadn’t heard of test-documented increases in mercury levels after taking fluoroquinolones until my friend sent me the message above.

The symptoms of mercury poisoning are similar to those of fluoroquinolone toxicity. The symptoms of mercury poisoning are:

skin rashes and dermatitis; mood swings; memory loss; mental disturbances; muscle weakness; nervousness, irritability, and other emotional changes; insomnia; headache; abnormal sensations; muscle twitching; tremors; decreased cognitive functions; peripheral neuropathy and more.

According to Dr. Thomas Nissen, “ Symptoms of mercury toxicity are many and varied, since mercury can both reach and affect nearly every cell in the body! Systemic (overall) effects can occur for this reason. The particular symptoms you experience first depend on your own genetic weakest links and on other toxic suppressors.”

Similarity of symptoms does not necessarily mean that two disorders are one in the same. For example, Chronic Lyme Disease and AIDS have similar symptoms, but that doesn’t mean they’re the same diseases. But it’s still interesting to explore the possibility of fluoroquinolone toxicity being related to mercury poisoning.

I searched for journal articles about the effects of quinolones on mercury. Unfortunately, I didn’t find much information. Most of the information I have is anecdotal and stems from me attempting to understand fluoroquinolone toxicity (with zero background in biochemistry), so please take this information for what it’s worth.

Fluoroquinolones have been documented to chelate magnesium and iron from cells. I wonder if mercury in the body is bound by these minerals, and then gets released into the body when the fluoroquinolone chelates the necessary mineral from the body (or when the quinolone binds to the mineral, stealing it from whatever it’s currently bound to).

Dr. Nissen points out that mercury can displace other minerals in the body, and that mineral displacement can cause serious health problems:

Replacement reactions, also called fight for site, occur when mercury (usually with a +2 charge) grabs the biological spaces which should be filled by necessary minerals. Symptoms that can be caused by a deficiency of minerals displaced by mercury include:

  • Magnesium: irregular heartbeat, receding gums
  • Iron: anemia
  • Copper: anemia, thyroid dysfunction, impaired digestion
  • Zinc: anorexia nervosa, loss of taste and smell, loss of appetite, low libido, PMS
  • Iodine: thyroid dysfunction”

For floxies, I wonder if the fluoroquinolone begins the cycle of mineral replacement. Fluoroquinolones chelate minerals, then mercury binds to the site that was vacated by the mineral, then mercury toxicity leads to chronic health conditions.

There are many “drug muggers” out there – drugs that deplete vital minerals and nutrients from the body. I wonder if all the drugs that deplete necessary minerals from the body are opening people up to mercury poisoning.

There are a variety of factors that determine how well one’s body can deal with mercury. Genetic factors such as MTHFR mutations (which play a role in determining how well a person deals with toxins) certainly play a role, as do an individual’s antioxidant levels. Many floxies have MTHFR mutations, and fluoroquinolones have also been shown to deplete glutathione and other antioxidants. Some floxies, including Richard and the author of Say Friend and Enter, have dealt with mercury poisoning issues as well as fluoroquinolone toxicity issues. Obviously, people who suffer from fluoroquinolone toxicity are less adept at metabolizing and clearing fluoroquinolones than those who take Cipro, Levaquin and Avelox without ill effects. Perhaps floxies are less able to handle other toxins, including heavy metals, as well.

There are a variety of mercury detoxification protocols that you can find online. Dr. Mercola’s protocol seems like a good place to start – http://www.mercola.com/article/mercury/detox_protocol.htm. He suggests:

  1. Avoid sugar, milk, grains and processed foods
  2. Eat foods that increase glutathione
  3. Take probiotics and eat probiotic rich foods
  4. Supplement magnesium
  5. Supplement chlorella
  6. Supplement MSM
  7. Eat garlic and cilantro
  8. Supplement minerals
  9. Make sure that you have sufficient hydrochloric acid levels to absorb minerals from your food
  10. Supplement vitamins C and E
  11. DMPS therapy

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Please note that chelation therapies (DMPS) can be dangerous and they should not be done without the direct supervision of a doctor. They can be hard on the kidneys, so they should also not be done unless absolutely necessary. Be careful, please!

As I noted earlier, this post is about possible connections, not established facts. Fluoroquinolones are not documented to have anything to do with mercury toxicity according to the journals I could find. The symptoms of fluoroquinolone toxicity and mercury poisoning are similar though, and given that fluoroquinolones have been documented to have profound effects on cellular mineral homeostasis, I think that it’s a hypothesis that’s worth exploring.

Post-script – If anyone reading this gets their mercury levels tested, please let me know what the tests say – I’m quite curious. Thank you!

Post-post-script – I wanted to point out some comments that Jason recently made on the floxie hope home-page about mercury. He has done extensive research on the topic and what he has to say is certainly valuable:

Toxic Metals and other Toxic substances (like Cipro…) are a HUGE issue, and as I guess you have gathered a mouth full of Mercury is bad situation to be in, and a major potential cause of Brain Fog and many many more issues for someone. This can be grossly exaggerated with someone with a MTHFR Gene issue, since they will NOT be able to detox Metals, Fluorides, Chlorine’s, and all the other Toxic Waste/Toxic Metals/Chemicals that we are subjected to on a daily basis properly, thus they will build up in the body and make the person more and more unwell. Since you are in the USA, for $99 the 23andme test is definitely a “no-brainer” in my opinion if you have not done it already, to find out if you do have these issues or not, on top of potentially being toxic in Mercury and other Metals.

Pretty much every living person has a toxic burden, Metals, Halides, and more; many people are able to keep it low enough to be healthy because their Methylation pathway works properly, actively detox, etc but others are not so lucky, and are even more unlucky if they do not realize this is the cause of most/all their issues. There was a whole bunch of discussion on Genes and the 23andme test last page starting from post 2 if you are interested in finding out more about this important part of someone’s health.

I would suggest to find a good ND, but be very careful with “Challenge Tests”. Many of them will want to give you a dose of DMSA or something else like DMPS, EDTA, etc and often the doses are VERY big, and quite dangerous (a big dose will ensure high levels show up on test, ensuring more money for them since you will “need” treatment = dangerous greed tactic). DMSA will mobilize several toxins in the body all at once, and if a person’s toxic load is large enough the body will not be able to handle all the poison being in the system at one time, and terrible damage can result. If you google Andy Cutler you will see he recommends not doing a challenge test at all, many people are following his advice and his Protocol for detoxing the body of Metals, he believes it needs to be done is slow safe fashion, which makes sense to me.

I myself am a little torn on the “testing issue”. I had a hair test done for Metals and Minerals which is what many people recommend you do to find out your toxic load. The things is it does NOT give you the whole picture, it is really telling you what the body is “expelling”, it is NOT telling you what your body is potentially harboring, since many of the Metals are hidden/stored in the body in Fat Cells, like the Brain, and if not mobilized they just sit there and screw you over, and will not come out in the hair, thus your hair test could say you are “low” in Uranium, or Nickel, but in fact you are not low, you are just not efficiently expelling/detoxing it at the time of the test. However, if the test shows you are high in something, there is a good chance you are actually too high and your body is trying to detox the excess of which some of it ends up in the hair. So these levels that show up, are somewhat dependent on if someone has a Methylation issue also, since poor Methylators are poor detoxer’s potentially skewing the results.

Having said all that, it is one of the best tests to do for this, and highly recommended to do regardless to find out what your Mineral profile looks like, though I still think there might be some viability of a “safe challenge test”, which would be as described above only with a smaller safer amount of a Chelator given right before a Urine test. Yet the reliability of the Hair test for Minerals is too somewhat questionable, out of the 100 or so labs around the USA that do these tests, 98 of them WASH the hair before doing the test. The trouble with this is many of the Minerals are water soluble, so washing the hair with a mild detergent and acetate like most do can skew the results of many of the Minerals. Google “Dr. Wilson Hair Test” and you will see more of what I am talking about. You will also find recommended ND’s on his site that use the one good lab in the USA that do not wash the hair.

This is all my opinion, one that is shared but none-the-less where I stand on the whole thing. I apologize for not giving a “Clear” solution, but this is frankly because in my opinion there isn’t one. As a result, for many years I did “nothing”, I now regret this and don’t recommend that course of action either. For yourself, my unprofessional recommendation is to “not” have a challenge test done, especially with Mercury still in your mouth, also do NOT take any chelators, and avoid Cilantro too, as this crosses the Blood Brain Barrier and taking this can bring Metal from the Mouth/Body right into the Brain. Doing the Hair test is a good idea, it will give you at least some idea on what is going on in your body, and if we are to believe Dr. Wilson, a VERY good idea, he has written a very long book on Hair Tests (his Mentor invented the idea) and how to interpret them, one I wish I had, but there is a lot of info on his website and ARL Labs website (the one he recommends) about how to interpret the results, and a good ND will hopefully be educated on these methodologies. Regardless of the results, if you can afford it if I was you I would find a good Huggins Dentist (trained in removing Mercury fillings safely) asap and start getting those removed. I had one that was “cracked”, and have no doubt it has caused me issues. Good luck, if you do have a heavy toxic load please be patient in its removal.

AND

I think the most popular is the Andy Cutler Protocol, which is a very slow/safe but PITA method, and uses synthetic Amino Acid Chelators DMSA, DMPS and also ALA all in small doses on a very strict time schedule due to their half lives. Lots of info on net about this you will see, chelators are bought from company out of Africa IIRC, there is a good Yahoo support group/forum where people answer questions etc (poorly organized unfortunately)

There are some others of note, and some are opposed to Cutler method such as Dr. Lawrence Wilson http://drlwilson.com/articles/chelation.htm (very good website with a TON of info on everything health). EDTA can be used, Dr. Mercola has made some suggestions like using Cilantro and others, funny enough Cutler warns against using EDTA and Cilantro, for potentially valid reasons, confusing the issue further. 😦

I think the best course of action for someone depends on many things. Do they still have Mercury fillings? Do they have the MTHFR & other mutations in their Genes? (found out with 23andme test) How big is their toxic load?

The first course of action is always to get fillings removed safely, and then getting a Hair metal/mineral test done. To me getting the 23andme test for $99 should be done too, for reasons I noted on FH. Then with that done, and with that information a suitable course of action can be recommended (I sound like a bluddy Naturopath here….) If someone has a huge toxin burden, I think the Cutler method makes sense, but the MTHFR could complicate this. If someone is moderately toxic, Cutler method might still be good, or a combination of ideas might be good enough, again depending on the MTHFR issue. If someone is only mildly toxic, they should for sure address the MTHFR issues first and foremost, which would help the body alleviate the burden on it’s own (of course with a MTHFR issue someone is likely NOT going to have small burden, depending on their age and exposures of course). Also with smaller toxic burden, things like Cilantro, Wheat Grass and regular exercise and Saunas should be enough to bring the burden down, assuming they limit their future exposures.

I hope that helps, unfortunately the waters are a little muddy on this, not unlike Cipro poisoning.

Just a final note that these are only my “untrained” opinions. Toxic load is a serious wide-spread issue, causes very serious health issues, and removal has to be taken very seriously and not “toyed” with, someone needs to put their trust in a professional or do a whole lot of research. There are many complicating factors, such as Candida overgrowth (something DMSA potentially stimulates), MTHFR & other Genes, current past/health problems of the person and things like condition of Liver/Kidney’s, Cancer, FQ toxicity, etc. (Emphasis added by Lisa.)

I also forgot to mention Spirulina & Chlorella, although I did mention Dr. Mercola, and this is 2 things he advocates. They are also something Dr. Sircus recommends (along with a few others, see link), here is a good article on the whole topic here: http://drsircus.com/medicine/essentials-natural-chelation

He actually gives a LOT of accurate advice in this article in my opinion, like his notes on ALA which are important, and note what he says about Magnesium too, which applies 10 fold to a Floxie with Heavy Metals. He notes that some studies found Chlorella on its own, did not seem to chelate anything effectively. However when used with Cilantro, it does, and this makes perfect sense to me because Cilantro is a “mobilizer”, it irritates the Metals stored and Chlorella is a “binder”, it is extremely absorbent and will bind to Metals to help them exit the body and not be “re-absorbed” once they are mobile, which is critical. Done wrong, the Metals from one area can mobilize and then be re-absorbed in other areas causing great oxidative damage like to the Brain.

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Fluoroquinolones Deplete Iron and Lead to Epigenetic Changes

In my ciprofloxacin toxicity recovery story I note that:

I take a low dose iron supplement – only 5 mg. – daily. The brand of iron supplement that I use is Pur Absorb, but I’m guessing that other low-dose iron supplements will work equally well. Within just a couple days of starting taking the iron supplement, my energy levels increased dramatically. I could walk a mile without being exhausted afterward. In addition to improving my energy level, the iron supplement seems to make my muscles and tendons more supple and malleable. When my tendons are feeling tight, a dose of iron helps to loosen them up – within just a couple hours. Too much iron is really bad for you, so please be careful with supplementing it (ask your doctor, yada yada), but it helps me immensely.”

I’ve always wondered why iron helped me to recover from fluoroquinolone toxicity. In some ways, it didn’t make sense – iron is an oxidant (according to a doctor friend, it’s a bit more complicated than that, and in some situations iron can be an antioxidant and in others it can be an oxidant), and antioxidant supplements are what help most floxies. Also, iron is a component of the Fenton Reaction, and the Fenton Reaction is where, “Iron(II) is oxidized by hydrogen peroxide to iron(III), forming a hydroxyl radical and a hydroxide ion in the process. Iron(III) is then reduced back to iron(II) by another molecule of hydrogen peroxide, forming a hydroperoxyl radical and a proton. The net effect is a disproportionation of hydrogen peroxide to create two different oxygen-radical species, with water (H+ + OH–) as a byproduct.” Basically, iron can “donate or accept free electrons via intracellular reactions and help in creating free radicals.” Free radicals are ROS. Some of the nastiest ROS are created in the Fenton Reaction – hydroxyl radicals and hydroperoxyl radicals. According to “Oxidative Stress Induced by Fluoroquinolones on Treatment for Complicated Urinary Tract Infections in Indian Patients,” fluoroqinolones increase the production of ROS, and it has been postulated (by myself and others) that the mechanism for fluoroquinolone toxicity is an excess of ROS wreaking havoc on all systems of the body.

So, why did iron make me feel so much better?

It’s a question that has perplexed me for years.

Answers to that question can be found in the article, “Non-antibiotic effects of fluoroquinolones in mammalian cells” which was published in the July, 2015 issue of The Journal of Biological Chemistry. In this post I will highlight some of the more interesting findings from “Non-antibiotic effects of fluoroquinolones in mammalian cells.” All excerpts from the article are quoted and italicized.

Here we show that the FQ drugs Norfloxacin, Ciprofloxacin, and Enrofloxacin are powerful iron chelators comparable to Deferoxamine, a clinically-useful iron chelating agent.”

Fluoroquinolones suck iron out of (chelate) cells just as well as drugs that are meant to suck the iron out of cells (Deferoxamine). Iron is an essential mineral that is critical for transporting oxygen throughout the body. Chelation of iron from cells can be detrimental to health in multiple ways including, “delayed cognitive function, poor exercise performance and lowered immune function. In children, iron deficiency anemia can cause psychomotor and cognitive abnormalities resulting in future learning difficulties.

We show that iron chelation by FQ leads to epigenetic effects through inhibition of α-ketoglutarate-dependent dioxygenases that require iron as a co-factor.”

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Iron depletion leads to adverse epigenetic effects through inhibition of iron-dependent enzymes. This is a very big deal – Fluoroquinolones can change genetic expression (epigenetics) in human cells. Later in the article it is noted that, “This is the first study to show global epigenetic changes induced by FQ antibiotics.” It had been previously postulated in “Epigenetic side-effects of common pharmaceuticals: A potential new field in medicine and pharmacology” (2009) that all fluoroquinolone adverse effects were the result of epigenetic changes, but “Non-antibiotic effects of fluoroquinolones in mammalian cells” describes the first study of human cells that shows epigenetic changes caused by fluoroquinolones. Epigenetics wasn’t even a notion, much less a field of study, when the FDA approved fluoroquinolones, drugs whose mechanism of action is, “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.” Think about that next time you pick up a drug from the pharmacy and assume that it’s safe because the FDA approved it.

Dioxygenases are enzymes that are necessary for aerobic life. Fluoroquinolones inhibit α-ketoglutarate-dependent dioxygenases, which require iron as a co-factor.  Depletion of α-ketoglutarate-dependent dioxygenases leads to changes in how genes are expressed.

Fluoroquinolones were also found to inhibit several demethylases, “enzymes that remove methyl (CH3-) groups from nucleic acids, proteins (in particular histones), and other molecules. Demethylase enzymes are important in epigenetic modification mechanisms. The demethylase proteins alter transcriptional regulation of the genome by controlling the methylation levels that occur on DNA and histones and, in turn, regulate the chromatin state at specific gene loci within organisms.” FQs were found to inhibit “Jumonji domain histone demethylases, TET DNA demethylases, and collagen prolyl 4-hydroxylases, leading to accumulation of methylated histones and DNA, and inhibition of proline hydroxylation in collagen, respectively. These effects may explain FQ-induced nephrotoxicity and tendinopathy.” (emphasis added).

Many possible mechanisms for the tendinopathy and compromised collagen integrity caused by fluoroquinolones have been proposed. It has been suggested that fluoroquinolone caused destruction of connective tissues are due to metalloprotease (MMP) malfunctions, magnesium depletion, and the NO/ONOO cycle. In “Non-antibiotic effects of fluoroquinolones in mammalian cells” it is asserted that iron chelation, and the inhibition of enzymes that utilize iron, are behind the fluoroquinolone-caused musculoskeletal adverse effects:

These results suggest, for the first time, that FQ treatment can cause unanticipated epigenetic effects. Moreover, we suggest that the well-established linkage between FQ treatment and tendinopathy reflects impairment of collagen maturation by FQ. We suggest that it is the inhibition of collagen 4 prolylhydroxylases by FQ mediated iron chelation, and repression of collagen P4H1 and LH1 transcription that underlies the peculiar tendinopathy side effects of FQ antibiotics.”

And:

FQ are potent iron chelators capable of inhibiting 2-KG dependent dioxygenases because of the crucial role of iron in the active site. We show that FQ treatment inhibits collagen maturation. Prolyl 4- hydroxylase and lysyl hydroxylase are iron dependent enzymes essential for the post-translational modification of collagen. Both play central roles in collagen maturation through hydroxylation of proline and lysine residues to mediate collagen cross-linking. Covalent crosslinks are required for the tensile strength of collagen fibers (64). We suggest that it is iron chelation by FQ that accounts for suppressed collagen hydroxylation, giving rise to tendinopathies.”

And:

Additionally, suppression of HIF-1α can have drastic effects on vascularization and energy metabolism in connective tissues, contributing to decreased blood flow in an already hypoxic and avascular tissue. We suggest that these three insults – inhibition of prolyl and lysyl dioxygenases, reduction of P4HA1 and LH1 mRNA levels, and reduced tendon vascularization upon HIF-1α depletion – together account for FQ induced tendinopathies.”

To sum up the excerpts, fluoroquinolones chelate iron from cells, this leads to inhibition of iron-dependent enzymes, which lead to epigenetic changes that result in collagen malformation and tendinopathies. It should also be noted that fluoroquinolones chelate other minerals, including magnesium, from cells, and magnesium-dependent enzymes are inhibited by fluoroquinolones as well.

All doctors and researchers, and the FDA, should note that in chelating necessary minerals from the body, fluoroquinolones are not only inhibiting necessary enzymatic reactions, they’re also changing genetic expression, and that the long list of severe adverse effects of fluoroquinolones may be due to adverse expression of genes. Neither long-term, nor intergenerational effects of fluoroquinolones are currently known.

So… what should floxies do with this information? Personally, I supplement iron and I find that it helps me immensely. Not everyone can, or should, supplement iron though. Too little iron is bad, but too much is also harmful. The prudent thing to do is to get your iron levels tested and to supplement if necessary under the care of your doctor.

When I corresponded with Dr. Maher, one of the authors of “Non-antibiotic effects of fluoroquinolones in mammalian cells,” he noted that, “I would simply emphasize that what we demonstrate in this work involves human cells grown in culture, and lab conditions, and we want to make it clear that these are findings of potential mechanisms of fluoroquinolone antibiotics that could be relevant for patients, but we provide no direct data related to human patients or treatments. Further studies will be required to understand if these or related effects actually occur in people.”

I am thankful to Doctors Badal, Her and Maher for their work on “Non-antibiotic effects of fluoroquinolones in mammalian cells!” Of course, caution should be used when drawing conclusions from their results. Though I shouldn’t draw conclusions about how FQs react in a complex human body from how human kidney cells react in a petri dish, I don’t think that it’s completely out of line to say that the potential implications of this research are huge. The chelation of minerals from cells by fluoroquinolones may be leading to epigenetic changes in the people who take fluoroquinolones. What this means for their health is not currently known.

The epigenetic adverse effects of fluoroquinolones were found to be reversible by exposing the floxed cells to iron, and studies have shown that magnesium, vitamin E, MitoQ and NAC can reverse some of the effects of fluoroquinolones, so please have hope, hang in there, and take your mineral supplements (under the supervision of your doctor, yada, yada).

 

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But Antibiotics Save Lives!!!

David Wolfe, a health, eco, nutrition and natural beauty expert (more information about him can be found HERE) posted the picture above on facebook.  He has more than 1,200,000 facebook followers and I greatly appreciate his help in spreading the word about the dangers of fluoroquinolones!  Many people commented on picture and told their story of how fluoroquinolones hurt them.  There are a lot of us out there, and the more the word gets spread, the more likely change is.

As always, there were some nay-sayers.  Honestly, there were a lot more people sharing their stories than there were nay-sayers, and I’m not suggesting that we all gang up on them, but I have some thoughts about the some of the nay-saying comments.  Here are some examples of the nay-saying comments:

“Want to go back to the dark ages before antibiotics?”

“If we didn’t have antibiotics…alot of people would die..”

“People who don’t believe in medicine should live on their own island of ignorance and watch their life expectancy drop to that of their intelligence.”

“Without antibiotics you can’t treat people with bacterial infections. Aka ur screwed. Pls don’t mislead the public. stick to quotes. My sincere request. Please.”

“Antibiotics have saved over 1 billion lives. Mr Wolfe’s irresponsible comments will cause deaths!!”

“WAIT! Are you trying to scare people off antibiotics now??? How many people would have to die of preventable illnesses before you retract this?”

Sigh.  Why do these people think that all antibiotics are the same?  Why do they think that all antibiotics are safe?  Why do they think that warning people about the dangers of fluoroquinolones equates to being anti-antibiotic?  Where is the grey area?  Can’t some antibiotics be appropriate for use in some circumstances but not others?  Can’t different antibiotics have different safety profiles?  Isn’t information about the dangers of drugs valuable so that people can make informed choices?  Doesn’t it matter that fluoroquinolones damage nerves, the musculoskeletal system, the eyes and kidneys?  Can’t that information lead to greater consumer knowledge and informed consent when fluoroquinolones are prescribed?  Can’t the dangers of fluoroquinolones be acknowledged without being “anti-antibiotic?”  Can’t we fight for prudent and appropriate use of all antibiotics (especially FQs) without negating the lives that have been saved by antibiotics (including FQs)?  GREY AREA, folks!  The world isn’t black and white.  Sigh.

A quote from my most recent post, “‘The 21st Century Cures Act’ Is On Its Way – Here’s Why You Haven’t Heard About It” seemed like an appropriate response to a lot of the nay-sayers.  Feel free to use this if you want it:

“A healthy and balanced microbiome (“the ecological community of commensal, symbiotic and pathogenic microorganisms that literally share our body space”) is crucial for all areas of health, and a disturbed microbiome has been linked to all of the diseases of modernity, including mental health disorders, neurodegenerative diseases like Parkinson’s and Alzheimer’s, autoimmune diseases, inflammatory bowel disease and Crohn’s disease, mysterious diseases like fibromyalgia, autism, etc. And while there is acknowledgement of the role that a healthy microbiome plays in these diseases, researchers and journalists alike have been loath to acknowledge the role antibiotics have played in contributing to these diseases of modernity. No one wants to be anti-antibiotic. Everyone knows that antibiotics have saved millions of lives, but that doesn’t mean they are without consequences. And the good that penicillin has done doesn’t mean that all antibiotics are equally safe or effective. I can make a pretty thorough argument that fluoroquinolone antibiotics, like Cipro/ciprofloxacin and Levaquin/levofloxacin, drugs that work by “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,” are at least partially responsible for many of the diseases of modernity (more information can be found HERE, HERE and HERE). Fluoroquinolone antibiotics do not have the same safety profile as amoxicillin, and to assume that they do because both are categorized as antibiotics, is foolish on multiple levels.”

That’s my two cents of a response to the people who say things like the quotes above.  Also, quit giving carte blanche to the pharmaceutical companies if they label their dangerous drug as an antibiotic, because that’s just stupid.

Now I’m done.  🙂

 

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The Floxie Hope Podcast Episode 12 – Elise

Elise Floxie Hope Podcast

 

I had the pleasure of interviewing Elise for Episode 12 of The Floxie Hope Podcast.

Elise shares a lot of valuable information in her podcast.  She goes over her long journey of fluoroquinolone toxicity, and things that she has done to heal, in the podcast.

You can listen to the podcast through these links –

http://www.floxiehopepodcast.com/episode-012-elise/

https://itunes.apple.com/us/podcast/floxie-hope-podcast/id945226010

Elise has generously offered to help anyone who wants to reach out to her –

Elise’s facebook info: https://www.facebook.com/elise.child.5

Email: elisedchild@gmail.com

In the podcast, Elise mentions that her naturopathic doctor, Dr. Cynthia Buxton, has helped her immensely.  Dr. Buxton can be found through this link – http://naturalhealthcarenw.com/?p=346

Elise was also helped by eating for her blood type.  Information about that can be found here – http://www.4yourtype.com/

The TQI diet also helped Elise – http://toquietinflammation.com/

Univera Xtra also helped Elise – https://www.newunivera.com/en-us/search?Text=xtra&Area=Products

Elise also found Cleansing/gut health options to be helpful: https://humaworm.com/, http://www.renewlife.com/herbal-cleansing/paragone.html

Liver support: Elise currently takes a tincture with milk thistle, dandelion, etc.

Elise noted, “I forgot to mention the value of amino acid therapy in my own healing, which can be extremely helpful with depression, anxiety, insomnia, getting off of antidepressants, etc. I feel it is very important to do this with one’s doctor for dosage, length of use and quality of supplements. Amino Acid Therapy Info: (some examples, lots of info out there) http://www.neurogistics.com/thescience/aminoacids.asp, http://www.antianxietyfoodsolution.com/wp/wp-content/uploads/2014/11/Anxiety-mood-emotional-eating-sugar-cravings-mood-quiz-by-Trudy-ScottV2.pdf

If you have any questions about any of these products, please contact Elise.

Thank you for listening to The Floxie Hope Podcast!  Stay hopeful, friends!

 

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