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  • Writer's pictureJoan Rothchild Hardin

Cipro & Levaquin can cause tendinitis & tendon ruptures

Source: MedPage Today

On top of all the other side effects caused by heavy duty, broad spectrum antibiotics like Cipro & Levaquin, I recently learned they can also cause tendinitis and ruptured tendons.

Source: Regenexx


“Federal regulators are ordering new warnings on Cipro and similar antibiotics because of increased risk of tendinitis and tendon rupture. The new warnings apply to fluoroquinolones, a class of antibiotics that includes the popular drug Cipro….

“The warning applies to drugs of the fluoroquinolone class, including Cipro, Cipro XR, Proquin XR, Levaquin, Floxin, Noroxin, Avelox, Factive, and marketed generics….

“Most of the tendinitis and tendon ruptures affect the Achilles tendon, behind the ankle. But the agency has also received report of tendinitis and ruptures in the shoulder and hand. Tendons connect muscle to bone.

“Officials also say they are adding new warnings cautioning that patients over 60, those taking corticosteroids, and those who’ve undergone heart, lung, or kidney transplants are also at increased risk of tendon rupture or tendinitis if they take fluoroquinolones.

“Researchers don’t know exactly what fluoroquinolones do that promotes tendon rupturing. Theories suggest the drug may impede collagen formation or interrupt blood supply in joints …

“… Patients taking the drugs should tell their doctors immediately if they experience soreness or inflammation in muscles or tendons and that they should not exercise affected joints….”

 – (Zwillich, WebMD, 2008)

Source: ( Dr. William E. Morgan, 2013)


Source: Consumer Reports

  • Abdominal pain

  • Abnormal liver function tests

  • Agitation

  • Anxiety

  • Bleeding easily

  • Blurred vision

  • Bruising easily

  • Burning in the eyes

  • Confusion

  • Dark colored urine

  • Diarrhea, watery or bloody diarrhea

  • Dizziness

  • Drowsiness

  • Fainting

  • Fast or pounding heartbeat

  • Fever

  • Hallucinations

  • Headache

  • Insomnia

  • Nausea/vomiting

  • Nervousness

  • Nightmares

  • Numbness

  • Pain behind the eyes

  • Pale or yellow skin

  • Rash

  • Ringing in the ears

  • Seizures or convulsions

  • Skin pain, followed by a red or purple skin rash that spreads (especially in the face or upper body) and causes blistering and peeling

  • Sleep problems (insomnia or nightmares)

  • Sore throat

  • Stiffness

  • Stomach upset

  • Sudden pain

  • Swelling of the face or tongue

  • Tenderness

  • Tingling

  • Unusual pain anywhere in the body

  • Unusual thoughts or behaviors

  • Urinating less than usual or not at all

  • Vaginal itching or discharge

  • Weakness

“This is not a complete list of side effects and others may occur. “

 – Cunha, RxList, 5/14/2018


Source: Drug Lawsuit Source

These are listed as  “serious and otherwise important adverse drug reactions” of Cipro, some “disabling and potentially irreversible”:

  • Tendinitis and Tendon Rupture

  • Peripheral Neuropathy

  • Central Nervous System Effects

  • Exacerbation of Myasthenia Gravis

  • Other Serious and Sometimes Fatal Adverse Reactions

  • Hypersensitivity Reactions

  • Hepatotoxicity

  • Serious Adverse Reactions with Concomitant Theophylline

  • Clostridium difficile-Associated Diarrhea

  • Prolongation of the QT Interval

  • Musculoskeletal Disorders in Pediatric Patients

  • Photosensitivity/Phototoxicity

  • Development of Drug Resistant Bacteria

– (Cunha, RxList, 5/14/2018)


Source: SFGate

You can see from the following WebMD list of conditions treated with Cipro that this broad spectrum antibiotic is commonly used to combat a wide variety of established bacterial infections and is sometimes even given prophylactically :

  • intestine infection due to the Shigella bacteria

  • Intestinal Infection due to Campylobacter

  • Traveler’s Diarrhea

  • Acute Maxillary Sinus M. Catarrhalis Bacteria Infection

  • Pneumonia caused by Proteus Bacteria

  • Urinary Tract Infection caused by Klebsiella Bacteria

  • Infection of the Prostate Gland caused by Proteus

  • Continuous Bacterial Inflammation of the Prostate Gland

  • Skin Infection

  • Bone Infection caused by Enterobacter

  • Lower Respiratory Tract Infection

  • Complicated Peritonitis caused by E. Coli

  • Abscess Within the Abdomen

  • Infection of Urinary Tract due to Pseudomonas Aeruginosa

  • Urinary Tract Infection caused by Serratia

  • Skin Infection due to Klebsiella Bacteria

  • Acute Maxillary Sinus H. Influenzae Bacteria Infection

  • Complicated Peritonitis caused by Proteus Bacteria

  • Bacterial Infection of Kidney due to E. Coli Organism

  • Bladder Infection caused by E. Coli

  • Urinary Tract Infection due to E. Coli Bacteria

  • Infection of the Urinary Tract caused by Proteus Bacteria

  • Skin Infection due to Staphylococcus Aureus Bacteria

  • Skin Infection due to Streptococcus Pyogenes Bacteria

  • Skin Infection due to Enterobacter Bacteria

  • Pneumonia caused by Bacteria

  • Infection Within the Abdomen

  • Urinary Tract Infection due to Staphylococcus Epidermidis

  • Skin Infection due to E. Coli Bacteria

  • Skin Infection due to Citrobacter Bacteria

  • Infection of Bone

  • Prevention of Plague Following Exposure to Plague

  • Bacterial Pneumonia caused by Klebsiella

  • Staphylococcus Saprophyticus Infection of Urinary Tract

  • Infection of the Prostate Gland caused by E. Coli

  • Skin Infection due to Proteus Bacteria

  • Skin Infection due to Pseudomonas Aeruginosa Bacteria

  • Skin Infection due to Providencia Bacteria

  • Infection of a Joint caused by Serratia Bacteria

  • Treatment to Prevent Anthrax following Exposure to Disease

  • Pneumonia due to the Bacteria Haemophilus Parainfluenzae

  • Pneumonia caused by E. Coli Bacteria

  • Infection of Urinary Tract due to Providencia Species

  • Urinary Tract Infection caused by Citrobacter

  • Skin Infection caused by Morganella Morganii

  • Joint Infection caused by Pseudomonas Aeruginosa Bacteria

  • Bone Infection caused by Serratia Bacteria

  • Pneumonia caused by the Bacteria Enterobacter

  • Complicated Peritonitis caused by Pseudomonas Aeruginosa

  • Complicated Peritonitis caused by Klebsiella Bacteria

  • Bladder Infection caused by Staphylococcus

  • Infection of the Urinary Tract caused by Enterococcus

  • Joint Infection caused by Enterobacter Species Bacteria

  • Infection of a Joint

  • Diarrhea caused by E. Coli Bacteria

  • Bacterial Urinary Tract Infection

  • Typhoid Fever

  • Diarrhea caused by a Bacteria

  • Plague

  • Acute Maxillary Sinus S. Pneumoniae Bacteria Infection

  • Pneumonia caused by the Bacteria Pseudomonas Aeruginosa

  • Bacterial Pneumonia caused by Haemophilus Influenzae

  • Pneumonia caused by Gram-Negative Bacteria

  • Bronchitis caused by the Bacteria Moraxella Catarrhalis

  • Complicated Peritonitis caused by Bacteroides Bacteria

  • Infection of Urinary Tract due to Enterobacter Cloacae

  • Urinary Tract Infection caused by Morganella Morganii

  • Skin Infection due to Staphylococcus Epidermidis Bacteria

  • Bone Infection caused by Pseudomonas Aeruginosa

  • Short-Term Infection with Diarrhea

  • Discomfort & Weight Loss

  • Diverticulitis

  • Diabetic Foot Infection

  • chancroid

  • Heart Valve Infection caused by Haemophilus

  • Pneumonia caused by the Bacteria Anthrax

  • Cystic Fibrosis and Infection from Pseudomonas Bacteria

  • Bacterial Stomach or Intestine Infection caused by Anthrax

  • Infection of the Brain or Spinal Cord caused by Anthrax

  • Urinary Tract Infection Prevention

  • Skin Infection caused by Anthrax

  • Treatment to Prevent Traveler’s Diarrhea

  • Treatment to Prevent Meningococcal Meningitis

  • Presumed Infection in Neutropenic Patient With Fever

 – (WebMD, 2018)



The uses, potential side effects and warnings for Levaquin are similar to those for Cipro. See Levaquin (RxList, 2018A) if you want to check it out specifically.

Source: HealthHearty



The American Academy of Family Physicians (AAFP) posted this warning on July 27 2016:

“According to a July 26 FDA Drug Safety Communication … these medications have been associated with disabling and potentially permanent side effects involving tendons, muscles and/or joints, as well as peripheral nerves and the central nervous system. Some patients may even experience more than one such adverse effect.

“Therefore, said FDA officials, fluoroquinolones should be used in patients with acute bacterial sinusitis (ABS), acute bacterial exacerbation of chronic bronchitis (ABECB) or uncomplicated urinary tract infections (UTIs) only when no other treatment options are available, “because the risk of these serious side effects generally outweighs the benefits in these patients.”

“‘Fluoroquinolones have risks and benefits that should be considered very carefully,’ said Edward Cox, M.D., director of the Office of Antimicrobial Products in the agency’s Center for Drug Evaluation and Research, in (a news release). ‘It’s important that both health care providers and patients are aware of both the risks and benefits of fluoroquinolones and make an informed decision about their use.’

“The agency has revised the boxed warning for all drugs in this class of antibiotics to reflect these serious safety concerns. Those drugs are:

  • moxifloxacin (Avelox)

  • ciprofloxacin (Cipro)

  • ciprofloxacin extended-release (Cipro extended-release)

  • gemifloxacin (Factive)

  • levofloxacin (Levaquin) and

  • ofloxacin (Ofloxacin generic brand)….

Specific events reported include:

  • tendinitis and tendon rupture,

  • muscle pain or weakness,

  • joint pain and/or joint swelling,

  • peripheral neuropathy, and

  • central nervous system effects (e.g., psychosis, anxiety, depression, suicidal thoughts).

“Effects can begin within hours of starting the medications, but they may not be seen until after weeks of treatment. Patients should be advised to discontinue the drugs immediately if they experience any serious adverse effects.

“The benefits of fluoroquinolones continue to outweigh the risks when used for certain serious bacterial infections (e.g., pneumonia, intra-abdominal infections) and the FDA says it is appropriate for them to remain available as a therapeutic option in such cases.”  – (AAFP, 2016) & (FDA, 2016)



Since antibiotics target the good (probiotic)  bacteria in and on the body right along with their intended target, harmful bacteria, also be sure to take lots of the probiotic yeast, Sacharomyces boulardii, to protect your gut microbiome from being overrun by pathogenic bacteria anytime you’re given a course of antibiotics. This includes antibiotics you receive unbeknownst to you in your IV along with the anesthetic during surgeries. And remember that you can talk with your surgeon about exactly which antibiotic you’ll be given during surgery and why.

Sacharomyces boulardii is a probiotic YEAST, not a bacterium, so is not targeted by antiBIOTICS and can act as a place holder in your gut microbiome to fill up the space created when an antibiotic kills off your good bacteria.

See this earlier post for more information on Sacharomyces boulardii.

Dr Gabrielle Francis, who alerted me to the tendinitis and tendon rupture warnings for Cipro and Levaquin, recommends following this anti-inflammatory regimen during and for at least three months after a course of one of these antibiotics has been finished:

GLUCOSAMINE SULFATE (integrative Therapeutics) – to lubricate and strengthen tendons, build and support joint cartilage: 1 at breakfast/1 at dinner

BIOINFLAMAX (Nutra BioGenesis) – to maintain a healthy inflammatory response in joint and muscles: 2 at breakfast/2 at dinner

MAGNESIUM MALATE (Designs for Health or Integrative Therapeutics) – to protect joints and muscles: 1 at breakfast/1 at dinner

OSTEOFORCE SUPREME (Designs for Health) – to support bone health: 1 at breakfast/1 at dinner For more information on these supplements (benefits, ingredients list, side effects, interactions), see:

Glucosamine Sulfate BioInflamax What Are the Benefits of Magnesium Malate? and Magnesium Malate OsteoForce Supreme

Source: The Herban Alchemist

In addition, Dr Francis recommends having a detoxifying smoothie for breakfast to keep your body strong while taking antibiotics. This is her version, the Detox Smoothie Bundle. Drink the detox smoothie in the AM and take the antibiotic in the PM.

Visit Dr Francis’s website, The Herban Alchemist, if you want to read more about her.


Source: Healthy Market


“The federal government must crackdown on the use of antibiotics such as cephalosporins and fluoroquinolones within the nation’s meat industry because of the threat that antibiotic resistance poses to public health, says one of the government’s leading veterinary drug safety officials.” (Webster, 2008) Regions that produce the most pork and chicken also use the most antibiotics on farms. Hot spots around the world include the Midwest in the U.S., southern Brazil, and China’s Sichuan province. Yellow indicates low levels of drug use in livestock; orange and light red are moderate levels; and dark red is high levels.

Source: PNAS

If you eat meat made from factory-farmed animals, you’re also consuming a variety of antibiotics – possibly including fluoroquinones – in each juicy burger, serving of fried chicken, and side of bacon you enjoy.

Source: winstonclose

Factory farmed animals (cows, pigs, chickens) are given fluoroquinones – among other antibiotics. (Doucleff, 2015) & (FDA, 2009). The 2009 FDA report lists 2 fluoroquinones and 47 other approved antibiotics for use on factory-farmed cows. You can see the report for yourself: Antimicrobials Sold or Distributed for Use in Food-Producing Animals .

Source: The Outdoor Journal

I was also trying to track down which antibiotics are known to be given to farm-raised fish in the US and elsewhere and found only these five that have been detected in aquacultured fish:  oxytetracycline, 4-epioxytetracycline, sulfadimethoxine, ormetoprim, and virginiamycin. But, lest you think wild-caught seafood is antibiotic-free, oxytetracycline has also been detected  in wild-caught shrimp from Mexico, perhaps from coastal pollution, sewage contamination, mislabeling, or cross-contamination during handling and processing. (Lueing, 2015)

Source: MicrobeWiki

And, in case you noted the dates of the articles and the report cited above and figure the FDA has surely fixed the problem by now, here’s a quote from a recently published article on the rise of antibiotic resistant illnesses:

“The overuse and misuse of antibiotics in the meat industry is contributing to the rise of antibiotic-resistance in the U.S. and across the world. This serious public health issue is estimated to kill 10 million people a year worldwide by 2050. In the U.S., antibiotic-resistant infections cause over two million illnesses and 23,000 deaths each year, costing society between $55 billion to $70 billion each year.

“The majority of antibiotics in the U.S. are given to animals that are not sick; they are mixed into animals’ food and water to make them grow bigger or to prevent illness in cramped and unhealthy environments.” (As You Sow, 6/14/2018)

Source: The Hearty Soul

Many thanks to Dr Gabrielle Francis for alerting me to this situation and recommending the protocol of supplements to take during and after a course of Cipro or Levaquin as protection against tendon damage.


Almost immediately after I published this post, Christian John Lillis, Executive Director of The Peggy Lillis Foundation (Lillis, 2018), sent me this article his friend Rachel Brummert just posted on about the dozens of spontaneous tendon fractures she has experienced after taking Levaquin for a suspected sinus infection:  Levaquin Turned Me into ‘Frankenwoman’. (Brummert, 8/24/2018)

Source: Alliance for the Prudent Use of Antibiotics

These ghastly experiences motivated her to become a  trained Patient Advocate through the National Center for Health Research and a trained Special Government Employee (SGE) through the U.S. Food and Drug Administration. She also works with the Centers for Disease Control and Prevention (CDC) on fluoroquinolone awareness communication campaigns.

Christian John Lillis and his brother Liam started The Peggy Lillis Foundation to fight Clostridium difficile by building a nationwide Clostridium difficile awareness movement that educates the public, empowers advocates, and shapes policy. Peggy Lillis, Christian and Liam’s mother,  died at age 56  after having a root canal and being prescribed the antibiotic Clindamycin to treat a dental abscess. Seven days later she became septic and went into cardiac arrest from the massive C. diff infection that had taken over her colon. (Peggy Lillis Foundation, 2018)

Source: Alliance for the Prudent Use of Antibiotics

“(Clindamycin) increases the risk of hospital-acquired Clostridium difficile colitis about fourfold.” (Wikipedia, 7/26/2018)



American Academy of Family Physicians (AAFP.) (July 27, 2016). Use Fluoroquinolones Only as Drug of Last Resort for Some Infections. See:

As You Sow. (6/14/2018). Antibiotics & Factory Farms. See:

Brummert, R. (8/24/2018).  Levaquin Turned Me into ‘Frankenwoman’. See:

Cunha, J.P.  (5/14/2018). Cipro: Side Effects Center. RxList. See:

Doucleff, M. (2015). For The Love Of Pork: Antibiotic Use On Farms Skyrockets Worldwide. NPR. See:

FDA. (2009). SUMMARY REPORT on Antimicrobials Sold or Distributed for Use in Food-Producing Animals. Center for Veterinary Medicine. See:

FDA. (7/26/2016). FDA Drug Safety Communication: FDA updates warnings for oral and injectable fluoroquinolone antibiotics due to disabling side effects. See:

Francis, G. (2018). Personal communication.

Francis, G. (2018). Detox Smoothie Bundle. See:

Francis, G. (2018). The Herban Alchemist. See:

Hardin, J.R. (2014). Sacharomyces boulardii. See:

Hutchins, M. (2017). What Are the Benefits of Magnesium Malate?. LiveStrong. See:

Lillis, C.J. (2018). Personal communication. Luening, E. (2015). Study identifies antibiotics in farm raised seafood. Aquaculture North America. See: Morgan, W.E. (2013). Tendon Rupture Related to Antibiotic Use: Fluoroquinolone induced tendon ruptures are a growing concern. See:

Peggy Lillis Foundation. (2016). See:

Pure Formulas. (2018A). BioInflamax. See:

Pure Formulas. (2018 B). Magnesium Malate. See:

Pure Formulas. (2018 C). OsteoForce Supreme. See:

RxList. (2018 A). Levaquin. See:

RxList (2018 B).  Glucosamine Sulfate. See:

WebMD. (2018). What Conditions does Cipro Treat? See:

Webster, P.C. (2008). Crackdown on factory farm drug use urged. Canadian Medical Association Journal, 184:1, E23–E24.

Wikipedia, 7/26/2018). Clindamycin. See:

Zwillich, T. (7/28/2008). FDA Warning: Cipro May Rupture Tendons: Agency Issues ‘Black Box’ Warning for Antibiotics Known as Fluroquinolones. WebMD. See: © Copyright 2018. Joan Rothchild Hardin. All Rights Reserved.

DISCLAIMER:  Nothing on this site or blog is intended to provide medical advice, diagnosis or treatment.

Comments submitted prior to 8/25/2021

Wow! Thanks! This is a really good comprehensive article about FQs and the many ways they can harm people. The thing everyone needs to understand is that these adverse drug reactions (ADRs) are not even close to rare; they are happening all the time to people you know and maybe even to you. The problem is that the ADRs are usually delayed by months so no one makes the connection, not patients or their doctors. Even when we do figure it out, our doctors will tell us those reactions are incredibly rare as if that means that we can’t possibly be having one. Sadly, there are literally millions upon millions upon millions of

us but we are routinely misdiagnosed with lupus, fibro, ALS, Parkinson’s, MS, Gulf War Syndrome and any of hundreds of other WRONG conditions. The worse our problems are, the more it just has to be something else. We have found that it is incredibly difficult to convince a doctor that he or she destroyed your life and yet that is exactly what happened

to every single one of us. I urge everyone who reads this to google “fluoroquinolone toxicity” and “floxed” and follow where it goes. You need to know this info as doctors hand this stuff out like candy and are oblivious to the trail of bodies behind them. Please learn about this