Fluoroquinolones are a very effective class of antibiotics including levofloxacin (Levaquin), ciprofloxacin (Cipro), moxifloxacin (Avelox), ofloxacin, gemifloxacin (Factive), and delafloxacin (Baxdela). They work well for otherwise antibiotic-resistant organisms, and many doctors prescribe them as a first line treatment for infection, just assuming that the responsible organisms might be resistant to other lines.

However, we’ve known for over a decade that fluoroquinolones carry with them a number of possible serious side effects—some of which are considered irreversible, or can persist for years afterwards. There’s even a new official term: fluoroquinolone-associated disability (FQAD). Unofficially, it’s known as “getting floxed” (because the suffix on the generic form of them is -floxacin, see above). Here’s what this can look like, and what can be done about it.

Fluoroquinolones and the Mitochondria

Many of the serious side effects associated with quinolones most likely go back to their toxicity to the mitochondria. I wrote here on mitochondrial dysfunction in depth, but mitochondria are the body’s source of ATP, its energy currency. Every cell in the body requires ATP to do its job, which likely explains why quinolones can cause such a broad range of problems… and also why they can persist for so long after the drug is no longer in the system.

Box Warnings for Quinolones

The FDA began to add box warnings to quinolones in July 2008 for tendonitis and tendon rupture (and this is usually my first thought when I hear of an unprovoked Achilles tendon rupture.)

In February 2011, the FDA added to the box warning that those already diagnosed with myasthenia gravis might experience exacerbation of symptoms.

In August 2013, they updated the box warning for peripheral neuropathy. This nerve damage can linger long after the quinolone course is complete.

As of 2018, labels also reflect severe hypoglycemia, depression, suicidality, and psychosis.

Other Quinolone Side Effects

And those are just the major box warnings. Quinolones have also been correlated with:

Treatment for Fluoroquinolone Toxicity

So what do we do about it once the damage is done?

Since the problem occurs at the level of the mitochondria, at least in part, this is a big focus of treatment.

Mitochondrial damage goes hand-in-hand with oxidative stress, so antioxidant support is critical. This study shows that a quinolone-damaged patient reported improvements in disability from antioxidant therapy. NAC is just one of them, but I wrote here on it and how antioxidants work in general.

Supporting the existing mitochondria directly should also be part of the protocol. But it’s also important to generate new, undamaged mitochondria if possible.

Fluoroquinolones also tend to chelate out positively charged ions which act as cofactors for a number of enzymatic reactions in the body, such as magnesium, calcium, zinc, copper, manganese, iron, and selenium. All of these minerals are building blocks for health, so testing levels and replacing those that are lacking is indicated.

This also is an area where low dose immunotherapy of the offending drug may be indicated. This is an energetic rather than a biochemical approach to stimulating the body toward reversing the damage it initially caused.

The Upshot

The FDA box warnings were designed to relegate quinolones to “last resort” rather than “first line” treatment of bacterial infections. All pharmaceuticals carry potential side effects, but what makes quinolones so concerning is that these side effects can persist, or even show up long after the initial course of treatment is completed.

But once damage occurs, there is hope. The body is designed to heal itself, as long as we give it the building blocks it needs to do so, and remove obstacles to cure wherever possible.