From the Guidelines
Levofloxacin (Levaquin) can cause serious musculoskeletal side effects, including tendinitis, tendon rupture, joint pain, muscle weakness, and peripheral neuropathy, with tendon damage being the most concerning effect, particularly affecting the Achilles tendon. These effects can occur during treatment or even months after discontinuation, and patients may experience sudden pain, swelling, inflammation, or hear a popping sound indicating tendon rupture 1. The musculoskeletal side effects of levofloxacin can also include arthralgia (joint pain), myalgia (muscle pain), and muscle weakness. According to a study published in Pediatrics in 2011, the cumulative long-term outcomes of children with musculoskeletal adverse events reported during a 5-year safety study were slightly higher in the comparator treatment group (2% levofloxacin, 4% comparator) 1.
Risk Factors and Mechanism
The mechanism of these effects is thought to be related to the damage of collagen and connective tissue by increasing matrix metalloproteinases and reactive oxygen species, while decreasing collagen production. Risk factors for these musculoskeletal side effects include being over 60 years old, concurrent corticosteroid use, kidney disease, organ transplantation, and previous tendon disorders 2.
Clinical Implications
If you experience any musculoskeletal pain, weakness, or swelling while taking levofloxacin, it is essential to stop the medication immediately and contact your healthcare provider to prevent potentially permanent damage. A study published in Pediatrics in 2006 found that fluoroquinolone-associated tendinopathy in adults is more likely to occur in older patients, patients receiving systemic corticosteroids, and patients with renal disease 2.
Key Points
- Levofloxacin can cause serious musculoskeletal side effects, including tendinitis, tendon rupture, joint pain, muscle weakness, and peripheral neuropathy.
- Tendon damage is the most concerning effect, particularly affecting the Achilles tendon.
- Risk factors include being over 60 years old, concurrent corticosteroid use, kidney disease, organ transplantation, and previous tendon disorders.
- If you experience any musculoskeletal pain, weakness, or swelling while taking levofloxacin, stop the medication immediately and contact your healthcare provider.
From the FDA Drug Label
5.10 Musculoskeletal Disorders in Pediatric Patients and Arthropathic Effects in Animals An increased incidence of musculoskeletal disorders (arthralgia, arthritis, tendinopathy, and gait abnormality) compared to controls has been observed in pediatric patients receiving levofloxacin Tendon rupture or swelling of the tendon (tendinitis). Tendon problems can happen in people of all ages who take levofloxacin tablets. The risk of getting tendon problems while you take levofloxacin tablets is higher if you:
- are over 60 years of age
- are taking steroids (corticosteroids)
- have had a kidney, heart or lung transplant Tendon problems can happen in people who do not have the above risk factors when they take levofloxacin tablets. Other reasons that can increase your risk of tendon problems can include:
- physical activity or exercise
- kidney failure
- tendon problems in the past, such as in people with rheumatoid arthritis (RA).
The musculoskeletal side effects of Levaquin (levofloxacin) include:
- Tendinopathy
- Arthralgia (joint pain)
- Arthritis
- Gait abnormality
- Tendon rupture
- Tendinitis (swelling of the tendon) These side effects can occur in people of all ages taking levofloxacin, with a higher risk in certain populations such as those over 60 years of age, taking steroids, or with a history of kidney, heart, or lung transplant 3, 4.
From the Research
Musculoskeletal Side Effects of Levaquin (Levofloxacin)
The musculoskeletal side effects of Levaquin (levofloxacin) include:
- Tendinitis and tendon rupture, which can result in long-term sequelae, including chronic pain and mobility restrictions, and may warrant surgery 5, 6, 7, 8
- Musculoskeletal complications that involve not only tendon but also cartilage, bone, and muscle 9
- Achilles tendon rupture, which has been reported in several cases, including bilateral ruptures 6, 7
Risk Factors for Musculoskeletal Side Effects
Several risk factors have been identified for the development of musculoskeletal side effects associated with levofloxacin, including:
- Older age (older than 60 years) 5, 7
- Receipt of concomitant corticosteroid therapy 5, 7, 9
- Presence of renal dysfunction 5, 7
- History of solid organ transplantation 5
- Higher doses and longer durations of levofloxacin use 5
Onset and Severity of Musculoskeletal Side Effects
The onset of musculoskeletal side effects associated with levofloxacin can occur within a few days or one month after starting treatment 8. The severity of these side effects can vary, but they can result in serious outcomes, including disability and the need for surgical intervention 6, 8