By David Blyweiss, M.D., Advanced Natural Wellness
In the July 25th issue of Advanced Natural Wellness you learned how antibiotics are contributing to inflammatory bowel disease in older adults.
Today I would like to share more information on a specific class of antibiotics: fluoroquinolones. These drugs come with a long list of disabling side effects. It’s not just a few minor side effects – or even a lot of minor side effects.
No. We are talking about at least five very serious, life-altering side effects. And physicians often don’t make the connection between fluoroquinolones and these side effects, even though the FDA has sent out numerous safety announcements associated with these antibiotics.
Some of the most reported serious side effects are tendonitis, tendon damage and tendon rupture – especially to the Achilles tendon. Tendons are bands of tissue that attach your muscles to your bones. When a rupture occurs, it can cause the tendon to disconnect from the muscle or bone. And the pain is excruciating!
If it’s not treated quickly and properly, it can lead to chronic pain and permanent disability.
It’s estimated that people taking fluoroquinolones have a two to four times increased risk. The problems can start showing up as few as two days after starting the antibiotic, or be delayed several months after stopping them. And, unfortunately, older adults have the highest incidence of this particular side effect.
But that’s not the only debilitating side effect of fluoroquinolones.
The Dark Side of Fluoroquinolones
Fluoroquinolones are extremely powerful antibiotics, but they clearly have their downsides. In addition to tendon damage, they are associated with…
Irreversible peripheral neuropathy. People don’t comprehend the absolute pain of this nerve condition. It begins with tingling in the feet, then moves on to a feeling of “pins and needles” or burning sensations like your feet are on fire.
It interferes with daily activities, because it’s difficult to walk or remain standing for any length of time. And over time it can lead to numbness and a loss of feeling in the feet, which can severely affect your balance.
This side effect may only last a few months after discontinuing the drug. It could last for years. Or it could be permanent.
Both low and high blood sugar levels even in people without diabetes. But the effect can be worse in diabetics. Especially in older patients and people who are taking medications to reduce blood sugar.
When blood sugar levels are too low it can result in serious problems, including a coma. When they are high, it can damage your nerves, blood vessels, tissues and organs.
Aortic aneurysm. This is one of the deadliest side effects of fluoroquinolones. These are rare but serious ruptures or tears in the main artery of the body that can lead to dangerous bleeding. Even death.
Older folks are at the most risk, along with people who have a history of blockages or high blood pressure. It’s estimated that patients are twice as like to experience an aortic aneurysm when prescribed a fluoroquinolone.
Psychiatric issues. The symptoms may be as minor as disorientation, agitation nervousness or attention disturbances. Or they could be as severe as memory impairment and delirium.
It’s All About the Mitochondria
The side effects of fluoroquinolones are mysterious. And they can be hard to pin down, because they can be delayed for weeks, months or even years after taking the drug.
The reason for this delay may have everything to do with the fact that fluoroquinolones cause oxidative stress and damage the mitochondria. Mitochondria are the energy factories inside human cells. They produce about 90% of the energy needed by body.
But fluoroquinolone antibiotics are known to cause mitochondrial dysfunction and impair the replication of mitochondrial DNA. The damage can escalate over time. Then, as the mitochondria continue to run down, the dysfunction contributes to all of the health issues I’ve mentioned, along with many others.
So you can see why physicians are advised to never use fluoroquinolones as a first line of treatment for things like bacterial sinus infections, bronchitis that’s aggravated by a bacterial infection or simple urinary tract infections. They should only be used for severe bacterial infections when no alternative treatment is available.
If you are prescribed one of these antibiotics, be sure to question your doctor aggressively. You’ll recognize them, because their names end in “floxacin.”
Also, make sure he or she knows if you have kidney problems, are taking a corticosteroid or have ever had a serious side effect from a previous quinolone medicine. All of these factors may make you more susceptible to side effects.
In the meantime, it’s always a good idea to shore up your mitochondria and reduce oxidative stress by increasing your antioxidant status.
I like CoQ10 because it helps your surviving mitochondria make more energy. In fact, I recommend that everyone take CoQ10 in the ubiquinol form each day.
Resveratrol and its close cousin, pterostilbene, are great too. They help your body make more mitochondria. This is called “mitochondrial biogenesis”. They work by turning on your SIRT1 gene, which flips on the master regulator (PGC-1a) of mitochondrial replication.
I also recommend supplementing with nicotinamide riboside (vitamin B3). It helps your body naturally produce an enzyme called “nicotinamide adenine dinucleotide” (NAD for short). This enzyme is absolutely crucial to both SIRT1 and mitochondria!
And the most important nutrient I tell patients to take, if they’re going on a fluoroquinolone, is N-acetylcysteine (NAC) 1200 mg twice a day to actually help protect mitochondrial integrity.
You should take good care of your mitochondria all of the time. But it’s more important than ever if you’ve taken a fluoroquinolone antibiotic in recent years, or are currently taking one.
SOURCES:
Disabling and potentially permanent side effects lead to suspension or restrictions of quinolone and fluoroquinolone antibiotics. European Medical Agency. Press Release 2018.
Baggio D, Ananda-Rajah MR. Fluoroquinolone antibiotics and adverse events. Aust Prescr. 2021 Oct;44(5):161-164.
FDA Drug Safety Communication: FDA requires label changes to warn of risk for possibly permanent nerve damage from antibacterial fluoroquinolone drugs taken by mouth or by injection. FDA Safety Communication. 2013.
FDA reinforces safety information about serious low blood sugar levels and mental health side effects with fluoroquinolone antibiotics; requires label changes. FDA Safety Communication. 2018.
FDA In Brief: FDA warns that fluoroquinolone antibiotics can cause aortic aneurysm in certain patients. U.S. Food and Drug Administration. Press Release 2018.
Hangas A, Aasumets K, Kekäläinen NJ, Paloheinä M, Pohjoismäki JL, Gerhold JM, Goffart S. Ciprofloxacin impairs mitochondrial DNA replication initiation through inhibition of Topoisomerase 2. Nucleic Acids Res. 2018 Oct 12;46(18):9625-9636.
Kalghatgi S, Spina CS, Costello JC, Liesa M, Morones-Ramirez JR, Slomovic S, Molina A, Shirihai OS, Collins JJ. Bactericidal antibiotics induce mitochondrial dysfunction and oxidative damage in Mammalian cells. Sci Transl Med. 2013 Jul 3;5(192):192ra85.
Michalak K, Sobolewska-Włodarczyk A, Włodarczyk M, Sobolewska J, Woźniak P, Sobolewski B. Treatment of the Fluoroquinolone-Associated Disability: The Pathobiochemical Implications. Oxid Med Cell Longev. 2017;2017:8023935.
Zhang X, Eliasberg CD, Rodeo SA. Mitochondrial dysfunction and potential mitochondrial protectant treatments in tendinopathy. Ann N Y Acad Sci. 2021 Apr;1490(1):29-41.
Pareyson D, Piscosquito G, Moroni I, Salsano E, Zeviani M. Peripheral neuropathy in mitochondrial disorders. Lancet Neurol. 2013 Oct;12(10):1011-24.
Kwak SH, Park KS, Lee KU, Lee HK. Mitochondrial metabolism and diabetes. J Diabetes Investig. 2010 Oct 19;1(5):161-9.
Yu E, Foote K, Bennett M. Mitochondrial function in thoracic aortic aneurysms. Cardiovasc Res. 2018 Nov 1;114(13):1696-1698.
Giménez-Palomo A, Dodd S, Anmella G, Carvalho AF, Scaini G, Quevedo J, Pacchiarotti I, Vieta E, Berk M. The Role of Mitochondria in Mood Disorders: From Physiology to Pathophysiology and to Treatment. Front Psychiatry. 2021 Jul 6;12:546801.
Marappan, G. Coenzyme Q10: Regulators of Mitochondria and beyond. In V. Y. Waisundara, & M. Z. Jovandaric (Eds.), Apolipoproteins, Triglycerides and Cholesterol. 2020. IntechOpen.
Mizuguchi Y, Hatakeyama H, Sueoka K, Tanaka M, Goto YI. Low dose resveratrol ameliorates mitochondrial respiratory dysfunction and enhances cellular reprogramming. Mitochondrion. 2017 May;34:43-48.
Khan NA, Auranen M, Paetau I, Pirinen E, Euro L, Forsström S, Pasila L, Velagapudi V, Carroll CJ, Auwerx J, Suomalainen A. Effective treatment of mitochondrial myopathy by nicotinamide riboside, a vitamin B3. EMBO Mol Med. 2014 Jun;6(6):721-31. Imai SI, Guarente L. It takes two to tango: NAD+ and sirtuins in aging/longevity control. NPJ Aging Mech Dis. 2016 Aug 18;2:16017.
