From the Guidelines
Fluoroquinolones can cause tendon rupture as quickly as within 48 hours of treatment. The risk of tendon damage is increased in patients with a history of tendon disorders related to quinolone use, aged over 60 years, and concomitant use of corticosteroids 1.
Key Points to Consider
- Tendon rupture can occur within 48 hours of treatment and several months after stopping treatment 1
- Increased risk in patients with a history of tendon disorders related to quinolone use, aged over 60 years, concomitant use of corticosteroids
- The mechanism behind this adverse effect involves the antibiotics' ability to alter tendon cell metabolism, increase oxidative stress, and degrade the extracellular matrix that provides structural support to tendons
- Patients taking fluoroquinolones should stop the medication and contact their healthcare provider immediately if they experience tendon pain, swelling, or inflammation
- The risk of tendon damage persists for several months after discontinuing the medication, so patients should remain vigilant for symptoms during this period
Important Considerations for Patient Care
- Medications in this class include ciprofloxacin, levofloxacin, moxifloxacin, and ofloxacin
- The Achilles tendon is most commonly affected, but ruptures can occur in other tendons throughout the body
- Cease all quinolone treatment if tendinitis is suspected 1
- Patients should be aware of the potential risk of tendon rupture and take precautions to minimize their risk, such as avoiding strenuous physical activity and seeking medical attention immediately if they experience any symptoms of tendon damage.
From the FDA Drug Label
Tendon rupture can happen while you are taking or after you have finished taking Ciprofloxacin Tablets USP. Tendon ruptures have happened up to several months after patients have finished taking their fluoroquinolone Tendons are tough cords of tissue that connect muscles to bones Pain, swelling, tears and inflammation of tendons including the back of the ankle (Achilles), shoulder, hand, or other tendon sites can happen in people of all ages who take fluoroquinolone antibiotics, including Ciprofloxacin Tablets USP The risk of getting tendon problems is higher if you: are over 60 years of age are taking steroids (corticosteroids) have had a kidney, heart or lung transplant Get medical help right away if you get any of the following signs or symptoms of a tendon rupture: hear or feel a snap or pop in a tendon area bruising right after an injury in a tendon area unable to move the affected area or bear weight
The exact time frame for when a fluoroquinolone can cause tendon rupture is not specified in the provided drug labels. However, it is mentioned that tendon ruptures can happen while taking or after finishing the medication, and some cases have occurred up to several months after patients have finished taking their fluoroquinolone 2. Key risk factors for tendon problems include:
- Being over 60 years of age
- Taking steroids (corticosteroids)
- Having had a kidney, heart, or lung transplant It is essential to seek medical help immediately if symptoms of a tendon rupture occur. 2 3
From the Research
Timing of Tendon Rupture with Fluoroquinolone Use
- The time frame for fluoroquinolone-induced tendon rupture can vary, but several studies suggest that it can occur within a short period after starting the medication 4, 5, 6, 7.
- A case report found that a 76-year-old man developed bilateral Achilles tendon rupture 18 days after starting levofloxacin therapy 4.
- Another study found that the risk of tendon rupture with fluoroquinolone exposure persisted for 60 days, with the highest risk occurring within the first month of exposure 5.
- A systematic review of observational studies found that individuals exposed to fluoroquinolones are at increased risk for Achilles tendon rupture, particularly within the first month following exposure to the drug 6.
- A pharmacovigilance analysis of the FAERS database found that the majority of fluoroquinolone-related suspected tendonitis and tendon rupture tended to occur within a few days or one month 7.
Risk Factors for Tendon Rupture with Fluoroquinolone Use
- Concomitant use of oral corticosteroids with fluoroquinolones increases the risk of tendon rupture 5, 6, 8.
- Age is also a risk factor, with individuals over 60 years old being at higher risk of tendon rupture with fluoroquinolone use 5, 6, 8.
- The type of fluoroquinolone used may also affect the risk of tendon rupture, with ofloxacin having the highest risk of tendon injury in some studies 6.
- A study found that ciprofloxacin had the strongest statistical association with tendonitis, while levofloxacin showed the strongest statistical association with tendon rupture 7.