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Quinolones/Corticosteroids

This information is generalized and not intended as specific medical advice. Consult your healthcare professional before taking or discontinuing any drug or commencing any course of treatment.

Medical warning:

Moderate. These medicines may cause some risk when taken together. Contact your healthcare professional (e.g. doctor or pharmacist) for more information.

How the interaction occurs:

How this interaction occurs is not known.

What might happen:

Taking these medicines together may increase your risk of tendon problems, especially if you are 60 years of age or older; if you already have problems with your joints (such as rheumatoid arthritis); if you have had a kidney, heart, or lung transplant; have kidney problems; or if participate in strenuous physical activity.

What you should do about this interaction:

Let your healthcare professionals (e.g. doctor or pharmacist) know that you are taking these medicines together. If you have joint, muscle, or tendon pain or swelling, contact your doctor right away. Rest and refrain from exercise until you see your doctor.Your healthcare professionals may already be aware of this interaction and may be monitoring you for it. Do not start, stop, or change the dosage of any medicine before checking with them first.

References:

1.Lipsky BA, Baker CA. Fluoroquinolone toxicity profiles: a review focusing on newer agents. Clin Infect Dis 1999 Feb;28(2):352-64.
2.Cipro (ciprofloxacin hydrochloride) US prescribing information. Bayer Corporation August, 2013.
3.Tequin (gatifloxacin) US prescribing information. Bristol-Myers Squibb Company January, 2006.
4.Levaquin (levofloxacin) US prescribing information. Ortho-McNeil Pharmaceutical, Inc. August, 2013.
5.Maxaquin (lomefloxacin hydrochloride) US prescribing information. Pfizer Inc. January, 2005.
6.Avelox (moxifloxacin hydrochloride) US prescribing information. Bayer Pharmaceuticals Corporation August, 2013.
7.NegGram (nalidixic acid) US prescribing information. Sanofi-Synthelabo, Inc. November, 2012.
8.Noroxin (norfloxacin) US prescribing information. Merck & Co., Inc. August, 2013.
9.Floxin (ofloxacin) US prescribing information. Ortho-McNeil Pharmaceutical, Inc. February, 2011.
10.van der Linden PD, Sturkenboom MC, Herings RM, Leufkens HG, Stricker BH. Fluoroquinolones and risk of Achilles tendon disorders: case-control study. BMJ 2002 Jun 1;324(7349):1306-7.
11.Seeger JD, West WA, Fife D, et al. A case-controlled study describing the epidemiology of Achilles tendon rupture with a focus on fluroquinolone antibiotics. Abstract #A-519. 43rd Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC), Chicago, IL September 17, 2003.
12.van der Linden PD, van Puijenbroek EP, Feenstra J, Veld BA, Sturkenboom MC, Herings RM, Leufkens HG, Stricker BH. Tendon disorders attributed to fluoroquinolones: a study on 42 spontaneous reports in the period 1988 to 1998. Arthritis Rheum 2001 Jun;45(3):235-9.
13.Fleisch F, Hartmann K, Kuhn M. Fluoroquinolone-induced tendinopathy: also occurring with levofloxacin. Infection 2000 Jul-Aug;28(4):256-7.
14.Khaliq Y, Zhanel GG. Fluoroquinolone-associated tendinopathy: a critical review of the literature. Clin Infect Dis 2003 Jun 1;36(11):1404-10.
15.Chhajed PN, Plit ML, Hopkins PM, Malouf MA, Glanville AR. Achilles tendon disease in lung transplant recipients: association with ciprofloxacin. Eur Respir J 2002 Mar;19(3):469-71.
16.Filippucci E, Farina A, Bartolucci F, Spallacci C, Busilacchi P, Grassi W. Levofloxacin-induced bilateral rupture of the Achilles tendon: clinical and sonographic findings. Reumatismo 2003 Oct-Dec;55(4):267-9.
17.Mathis AS, Chan V, Gryszkiewicz M, Adamson RT, Friedman GS. Levofloxacin-associated Achilles tendon rupture. Ann Pharmacother 2003 Jul-Aug;37(7-8):1014-7.
18.Butler MW, Griffin JF, Quinlan WR, McDonnell TJ. Quinolone-associated tendonitis: a potential problem in COPD?. Ir J Med Sci 2001 Jul-Sep; 170(3):198-9.
19.Haddow LJ, Chandra Sekhar M, Hajela V, Gopal Rao G. Spontaneous Achilles tendon rupture in patients treated with levofloxacin. J Antimicrob Chemother 2003 Mar;51(3):747-8.
20.Cebrian P, Manjon P, Caba P. Ultrasonography of non-traumatic rupture of the Achilles tendon secondary to levofloxacin. Foot Ankle Int 2003 Feb; 24(2):122-4.
21.Schwald N, Debray-Meignan S. Suspected role of ofloxacin in a case of arthalgia, myalgia, and multiple tendinopathy. Rev Rhum Engl Ed 1999 Jul-Sep;66(7-9):419-21.

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