This whole story starts off with the patient/friend of mine named Gus Shihab, Esq. (a practicing attorney and power lifter from the Columbus, Ohio). Gus had been lifting for several years and at the age of 40 was putting up some pretty impressive totals. One day while warming up with 135#’s in the gym on the bench press, he noticed a pulling pain in his shoulder and bicep. The pain was very slight at first, but as his repetitions progressed the pain became quite sharp and intense. Before he was finished with his first few warm-up sets, his shoulder pain became so intense that he couldn't even elevate his arm. After trying ice, rest, Advil and ultrasound (at home), Gus called me on my cell about 10:30 PM very frustrated and wanting answers. After listening to his description it became obvious that he needed an MRI and the results were rather shocking. A pec tear and bicep tear. I called Dr. Richard Fisher, a local orthopedic surgeon who specializes in shoulder injury. After putting the two of them together, Rick called and said that there was a history of taking Cipro (an antibiotic) and that was the likely cause. I was in shock, low weight causing a muscle tear and the Cipro…. more importantly, I was on Cipro for a finger fracture a few weeks before and was going to the gym to squat 780 in less than four hours. Let me tell you, that was a very careful workout!

As I looked more and more into this, I found that this is more common than you can imagine. Below are several articles pointing to Cipro and other fluoroquinolones causing muscle/tendon problems. This type of problem will become all too frequent in todays drug world since medications are much more complicated than before. Drugs are now working at the genetic level and cause shifts in cell production or absorption. This makes testing very difficult and side effects vary more from individual to individual. You as the consumer must educate yourself to help protect yourself.

The most common side effects associated with Quinolones are sezures and

It is very important to realize that if you are a young male athlete then you are the primary risk. Don’t forget that Gus is 40 (he gave me permission to say that) and he now has a pec and bicep tear. The side effects of the drug are considered temporary, but the effects have been noted up to several months after coming off the drug.

Look over the list below and discuss your alternatives with your family physician. It is important to ask why, when and what-if with your physician and pharmacist.

CIPRO IS A QUINOLONES (fluoroquinolones) [floor-o-qwin-o-loans]

Several Quinolones exist and here is a short list of possible drug names.

ofloxacin(Floxin®), levofloxacin(Levaquin®, Tavanic®), ciprofloxacin(Cipro®, Baycip®, Cetraxal®, Ciflox®, Cifran®, Ciplox®, Cyprobay®, Quintor®), norfloxacin(Noroxin®, Amicrobin®, Anquin®, Baccidal®, Barazan®, Biofloxin®, Floxenor®, Fulgram®, Janacin®, Lexinor®, Norofin®, Norxacin®, Orixacin®, Oroflox®, Urinox®, Zoroxin®), enoxacin(Penetrex®), lomefloxacin(Maxaquin®), grepafloxacin(Raxar®), trovafloxacin(Trovan®), sparfloxacin(Zagam®), temafloxacin(Omniflox®), moxifloxacin(Avelox®), gatifloxacin(Tequin®), gemifloxacin

HOW THE QUINOLONES CAUSE TENDON TEARS

Quinolones work by disrupting the DNA (blue-prints of the cell). The fact that Quinolones work by disrupting bacteria DNA invites the idea that they might cause disruption of the human DNA. Another thing that is known is that the Quinolones attract and link up with several minerals. It is recommended that you do not take this medication with vitamins or minerals or milk for that matter. Some scientists feel that the normal mechanism of sulfur bonds between collagen cells causes the weakness and leads to eventual problems. Now just for the record, the jury is still out on what actually is going wrong and is still anybody’s guess. The most logical situation is that since the cystein (sulfur) bonds are being broken apart in the bacteria, this is spilling over to the human cells and specifically collagen sulfur bonds. I’ll let you know if I find out.

WHAT CAN YOU DO TO HELP PREVENT TENDON AND MUSCLE DAMAGE

The first is obvious; discuss with your physician other drug options. Discuss staying on the medications for short periods of time, however, always finish all prescribed medications. Don’t take the medication with vitamins or minerals or milk or anti-acids. Refer to Table 1

Table 1: Tips on making Ciprofloxacin safer

DISCLAIMER

I don't want to sound like another chiropractic physician bashing on drugs. Most of my young adult life was spent doing drug research for major pharmaceutical companies. Most of my adult life has been spent working with the strongest and biggest and the fastest athletes in the world. I feel a sense of urgency to protect them and you.

Prescription medication has a place and is quite necessary in today's health-care system. The problem begins with new and more advanced medications that are having much more complicated effects on our systems. Even with all the extensive testing, some longer term or undetected problems can occur.

Drugs used to work primarily on the surface and now medications are moving right into the actual mechanics of the cell (DNA) altering several factors and functions of the body. This article is merely trying to identify a major side effect that has been noted by several researchers and is indicating the young weightlifting male athlete as the primary target. Now if you have Anthrax exposure, Cipro is a great drug, just consider the possible side effects. It is possible that you may have taken Cipro, without any effect at all. Side effects are dependent on several factors like, how long you took the drug, how much you take, and your genetic makeup. Talk it over with your physician and pharmacist.

Suggested Reading:

Tendinitis associated with ciprofloxacin.
Carrasco JM, Garcia B, Andujar C, Garrote F, de Juana P, Bermejo T. Ann Pharmacother 1997 Jan;31(1):120

More on fluoroquinolone antibiotics and tendon rupture.

N Engl J Med 1995 Jan 19;332(3):193

What is the risk of Achilles tendon rupture with ciprofloxacin?
Shinohara YT, Tasker SA, Wallace MR, Couch KE, Olson PE. J Rheumatol 1997 Jan;24(1):238-9

Ciprofloxacin in children: is arthropathy a limitation?
Singh UK, et al. Indian J Pediatr 2000 May;67(5):386-7

Toxicity of quinolones.

Stahlmann R, Lode H. Drugs 1999;58 Suppl 2:37-42

Adverse reactions to fluoroquinolones. an overview on mechanistic aspects.
De Sarro A, De Sarro G. Curr Med Chem 2001 Mar;8(4):371-84

Clinical toxicological aspects of fluoroquinolones.
Stahlmann R. Toxicol Lett 2002 Feb 28;127(1-3):269-77

Dr. David T. Ryan, DC is the Medical Director for the Arnold Fitness Expo and is in private practice in Columbus, Ohio. www.GotSportsDoctor.com

Joe Donovan, MD is a internal medical specialist and Chairman of the Arnold Classic

Brian Griffin, MD is the Executive medical director of the Arnold Fitness Weekend and is board certified in Emergency Medicine and Physical Medicine

Phil Price, MD is also on the Arnold Medical Staff and is a Gastrointestinal Surgeon.