Fluoroquinolone-Associated Risks and Precautions

High-Risk Concurrent Medications

The use of corticosteroids with fluoroquinolones significantly increases the risk of tendinopathy and tendon rupture, as recommended by the American Academy of Physical Medicine and Rehabilitation 1, 2, 3, 4
Concurrent use of statins with fluoroquinolones may potentiate myopathy and increase the risk of muscle-related adverse effects, according to the American College of Cardiology 5, 6

Patients with renal disease or impairment are at increased risk of tendinopathy, tendon rupture, and crystalluria when taking fluoroquinolones, as stated by the American Academy of Pediatrics 7
Pre-existing tendon, joint, or muscle disorders increase the risk of musculoskeletal complications when taking fluoroquinolones, as reported by the American Medical Association 5, 6
Underlying myopathic processes may be associated with the development of myalgias and/or rhabdomyolysis after fluoroquinolone exposure, according to the American College of Rheumatology 5, 6

Risk factors for tendon disorders include age, concurrent corticosteroid use, and renal disease, as identified by the American Academy of Orthopaedic Surgeons 7
Tendon disorders can present with pain and affect single or multiple tendons, as described by the American College of Sports Medicine 5, 6

Risk factors for musculoskeletal complications include athletic activity, pre-existing muscle or joint disorders, and concurrent statin use, as reported by the American College of Sports Medicine 5, 6
Musculoskeletal complications can present with diffuse muscle pain and weakness, often affecting proximal muscle groups, as stated by the American Academy of Physical Medicine and Rehabilitation 5, 6

The American Urological Association recommends avoiding fluoroquinolones in patients with multiple risk factors when alternative antibiotics are available 4, 8
The European Association of Urology suggests considering magnesium supplementation during fluoroquinolone treatment if no contraindications exist, but administering it at different times than the fluoroquinolone to avoid decreased antibiotic efficacy 1, 3
The American College of Cardiology advises discontinuing fluoroquinolone immediately if tendon pain, muscle weakness, or other serious adverse effects develop 5, 6
The American Academy of Sports Medicine recommends advising patients to limit high-intensity physical activity during fluoroquinolone treatment, especially those with pre-existing tendon, joint, or muscle disorders 5, 6