Which drug can cause Spontaneous Tedon Rupture?
I have finally found a bit of time to update the blog. I was off to a torrid pace but the duty of work and family must take priority over my blog. However, it has given me a chance to take some notes on some interesting things I have learned over the past month.
Starting with a drug with the common side effect of spontaneous tendon rupture. In more common terms, torn muscle tendons that happen randomly for no particular reason.
The drug is ciprofloxacin, which most people known as Cipro.
The first time I heard about Cipro was as the first line response to anthrax contamination. However, it is not only used for this, as it is a drug designed to fight other bacterial infections.
Recently I had a practice member come into the office who I have known for over 8 years. Her health has been fantastic ever since she began receiving chiropractic adjustments, and had been battling a hamstring issue she attributed to either biking or horseback riding.
Approximately a month later she comes into the office and lets me know that she had detached tendons of her pelvic floor, and they were causing the discomfort.
Not only is this completely bizarre for a young healthy woman, but the doctors had no answers for her. She decided to look into the possibilities of a drug she was taking 4 months prior for a bladder infection, in this case Cipro.
Guess what the most common side effect of Cipro use is. Spontaneous tendon rupture, typically seen in the Achilles tendon. So at least in that case she was luck as this type of injury would have set her back even longer.
From WEBMD.com:
This medication may rarely cause tendon damage (e.g., tendonitis, tendon rupture) during or after treatment.
I question the comment on the rarity of this symptom, since it went undiagnosed for over month with my patient, until she found out the problem herself.
Since the spontaneous tendon rupture happens 2-3 months following the usage of Cipro, there is a very good chance a person might attribute a tendon rupture to a certain activity and not to the drug. This would only lower the reporting incidence, and as we have seen for many years, drug companies do their best to downplay any potential side effects.
This story also reminded me of an incident where a friend of mine had a very rare tendon rupture of his quadriceps muscle. The reason he came to mind is I remember him talking about stocking up on Cipro as many people were 10 years ago.
I remember that no professional had an answer to why it happened, as they had never seen a 30 year old healthy male with a spontaneous tendon rupture. I am thinking about giving him a call to ask if he had taken Cipro that year.
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I believe tendon ruptures can occur long after 2-3 months after taking Cipro. My husband was a former Marine who was in very good physical condition before taking Cipro. He was in his 40′s in 1998 when he first took Cipro. After taking Cipro, he felt like he was developing RA. His arms and legs started jerking involuntarily. Around 11 months after taking Cipro he had his first rupture involving a soleus muscle..tendon or whatever it’s called in his left leg. It tore completely loose from where it was attached at his ankle. His left calf looked like someone who suffered from polio. It bunched up at the back of his calf leaving his calf looking deformed. That was in 1999. In 2000, he had a ligament rupture at his right knee. In 2001, he had a muscle rupture midway up his right thigh. None of the doctors he saw knew what had caused this. This left him with a permanent limp and extreme weakness in his legs. He did have the second rupture operated on, but shortly afterwards the muscle tore in the same leg. This is just a few of the things that happened to him after taking Cipro. There are worse things that happened. There were no more ruptures for several years. In 2004, he took Cipro once more. Around 11 months later, the rupturing started again. He had 3 ruptures involving both his arms in 2005. The first one during this time was at his right elbow. It was operated on, but tore worse afterwards. The last 1 tore in his left arm while using the amount of pressure a person would use to squeeze a blood pressure bulb. He has nerve damage in his legs and arms. He has to use a wheelchair if he has to be on his legs for any length of time. His hands and feet stay cold and numb. He had 6 ruptures and none of his doctors knew what had caused this. He’s disabled now and not getting any better as time goes by. He was a very strong man before taking Cipro. I don’t blame the doctors for this happening to him. They didn’t know just how damaging Cipro can be. The words on the warnings about rupturing occuring before or after taking Cipro are rather vague.
Cipro is in a family of drugs called quinolones or fluroquinolones. Levaquin, tequin and avelox are just a few more quinolones. My husband took Cipro in 1998. Around 11 months after taking Cipro he had his first rupture. He had 2 more ruptures over the next few years after that. A muscle was involved in 1 of those ruptures. None of the doctors he saw knew why this happened to him. 1 doctor referred to them as unknown myopathies while the rest called them non-trauma ruptures. The rupturing seemed to have stopped for several years. In 2004, my husband took Cipro again. Around 11 months after that the rupturing started to occur again. This time he had 3 ruptures involving both his arms. The doctors still had no idea what was causing this. I had been searching the Internet for years trying to find the cause of these ruptures. 1 day I ran across information about Cipro and tendon ruptures. I recognized the name as a medicine 1 had informed the doctor that he was allergic to because of a rash my husband had after taking it the second time. I checked my husband’s medical records and saw the connection between not only the ruptures but all the ADR’s my husband had been suffering from since taking Cipro the first time and how they became worse after taking Cipro again. I called the FDA and talked to a man who worked there. I told him what happened to my husband and he told me the doctors should have asked my husband if he taken a quinolone when the ruptures occured the first time. I asked the man if ruptures could occur that long a period of time after taking quinolones and he confirmed it did. I find the warnings a little misleading when it states that ruptures can occur while or “after” taking these medicines. “After” means so much more than a few weeks or months. These medicines were “black boxed” in 2008 because of the tendinitis and tendon ruptures.
Thanks for the heads up. I try to keep up on news like this but I hadn’t seem the report on Cipro. Hopefully, all DCs will learn of this and be in a better position to help their patients.
Terry A. Rondberg, DC