Is it safe to run while taking Levaquin (levofloxacin)?

Safety of Running While Taking Levaquin (Levofloxacin)

It is not safe to run while taking Levaquin (levofloxacin) due to the increased risk of tendon injuries, particularly Achilles tendon rupture, which can occur during and up to 6 months after treatment. 1

Risks of Fluoroquinolones and Physical Activity

• Levofloxacin and other fluoroquinolones are associated with a wide array of musculoskeletal complications involving tendon, cartilage, bone, and muscle that are likely underrecognized and underreported 1
• Levofloxacin specifically has demonstrated a higher propensity to cause tendon damage compared to other fluoroquinolones, with a 120% increased risk of Achilles tendon rupture within 30 days of use 2, 3
• The FDA has included a black box warning on all fluoroquinolones regarding the risk of tendinitis and tendon rupture 4

Specific Recommendations for Athletes Taking Fluoroquinolones

Sports medicine guidelines specifically recommend:

1. Athletes should avoid all use of fluoroquinolone antibiotics unless no alternative is available 1
2. If a fluoroquinolone must be used, training alterations should begin at the first dose, including:
   • Reduction in high-intensity activities 1
   • Reduction in ballistic activities 1
   • Decrease in total training volume 1
3. These reductions should continue throughout the entire course of antibiotic treatment 1
4. All athletic activity should cease immediately at the onset of any musculoskeletal symptoms 1

Risk Factors for Tendon Injury with Levofloxacin

The risk of tendon problems while taking levofloxacin is higher if you:

• Are over 60 years of age 4, 5
• Are taking corticosteroids 4, 5
• Have had a kidney, heart or lung transplant 4
• Have kidney dysfunction 5
• Engage in physical activity or exercise 4
• Have a history of tendon problems 4

Warning Signs to Monitor

• Tendon pain, swelling, or inflammation are early warning signs that require immediate medical attention 4
• The most common site of injury is the Achilles tendon at the back of the ankle 4
• Signs of tendon rupture include:
  • Hearing or feeling a snap or pop in a tendon area 4
  • Bruising right after an injury in a tendon area 4
  • Inability to move the affected area or bear weight 4

Return to Running Protocol

If you must take levofloxacin:

• Avoid running and high-impact activities during the entire treatment course 1
• After completing the antibiotic course, only return to running if you have no symptoms 1
• Return to activity should be gradual and under direct medical supervision 1
• Close monitoring should continue for at least 1 month after completing the antibiotic 1
• Be aware that symptoms can appear as late as 6 months after exposure to fluoroquinolones 1

Alternative Approaches

• Ask your healthcare provider about alternative antibiotics that don't carry the same tendon rupture risk 4
• If levofloxacin is absolutely necessary, consider cross-training with non-weight-bearing activities during and for several weeks after treatment 1
• Consideration may be given to magnesium supplementation during treatment, but remember to separate dosing from levofloxacin by at least 2 hours to avoid decreased antibiotic efficacy 1