Tendon Rupture and Ciprofloxacin

I've been prescribed a course of Ciprofloxacin (and Metronidazole). The "warnings and side effects" will scare you half to death. The two that are particularly concerning for hiking are "stay out of the sun" and "Tendon Rupture".

"Tendon ruptures have happened up to several months after people have stopped taking their fluorquinolone".

So has anyone had any issues hiking after taking Cipro? I expect to be out of commission for a few weeks, but do I really need to put the brakes on for several months? I don't do anything "epic", but I do like to get out a couple times a week. I expect I'll ask my MD at some point, but was wondering if anyone had any experience.... Wouldn't want to be halfway up a trail and have my achilles snap...

TomK

It happened to a runner friend, while he was taking the drug. A few years ago I tripped and fell while trail running, split my knee open and needed stitches. The doctor prescribed cipro prophylactically. Remembering my friend, I requested an alternative antibiotic.

Good luck

Someone close to me was prescribed that drug and asked me for my advice. After doing some research, I advised them stay away from that drug at all cost.

Last month, I had pneumonia and was prescribed "Levaquin," which is in the same class as Cipro. The tendon rupture thing was one of the rare side effects that my doctor mentioned.

When I was there, practically dying of pneumonia, I was in no position to argue against what drug my doctor thought would help me best.

A month later, I worry about every little tweak I feel in my ankles when I'm hiking.

I'd avoid it if I could, but if you already started taking it, you'd probably know if it affected you.

Do NOT take Cipro or any of the other twenty two antibiotics in the fluroquinolones family. They are a last resort antibiotics. I developed very serious reactions the day after I started to take Cipro. My jaws "locked" up and everything in my mouth (gums, tongue etc.) felt they were on fire. Even drinking water through a straw felt like pouring gasoline on a fire. Symptoms lasted about one week. Please do not take this poison.

I personally wouldn`t take ANY prescribed drugs, unless it was a matter of life or death (maybe SEVERE pain). You can strengthen your immune system by fighting off most invasions naturally, I think. Eat right. It makes a BIG difference. Just my 2 cents.

Thanks for the heads up. I think I know someone who may have had this sort of damage who quit hiking.

Unfortunately, the real world is that antibiotic ineffectiveness is long term issue getting worse and the profit motive really isn't there for new drugs to be developed. I heard an observation from a doctor one time that the best thing to do is avoid cities and airports and especially hospitals as they are the breeding grounds for drug resistant antibiotics.

I would suggest that, if you haven't already, communicate with your doctor the importance of hiking to you & your concerns about Cipro causing an increased risk of tendonitis & tendon rupture. Discuss the possibility of using an alternative. Perhaps even get a second opinion from a respected doctor who hikes seriously. At the risk of stating the obvious, sometimes circumstances demand that we take medications with serious potential side-effects, other times suitable, less risky options are available.

Staying out of the sun is a bit of a pain, but you can manage your sun exposure with SPF rated clothing, including hats and gloves. You might also be able to time your hikes so to avoid the middle of the day. To go to the extreme, predawn starts & night-hiking can offer completely different, memorable experiences.

Look it up on the Interwebs...WebMD or something.

TEO said:

I would suggest that, if you haven't already, communicate with your doctor the importance of hiking to you & your concerns about Cipro causing an increased risk of tendonitis & tendon rupture. Discuss the possibility of using an alternative. Perhaps even get a second opinion from a respected doctor who hikes seriously. At the risk of stating the obvious, sometimes circumstances demand that we take medications with serious potential side-effects, other times suitable, less risky options are available.

Staying out of the sun is a bit of a pain, but you can manage your sun exposure with SPF rated clothing, including hats and gloves. You might also be able to time your hikes so to avoid the middle of the day. To go to the extreme, predawn starts & night-hiking can offer completely different, memorable experiences.

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I definitely think your suggestions are very important if a hiker was prescribed a long-term course of these drugs.

In my case, I literally thought I was going to die. I couldn't breathe. I coughed so hard that, many weeks later, my ribs still ache. I couldn't catch my breath if I expended the tiniest bit of energy. Getting out of bed required recovery time so I could catch my breath. Simply taking a few steps would have me winded. There was no way I could consider hiking or being in the sun. My course of Levaquin was only for 5 days. Now I'm freaking out about the potential for ruptured tendons. I must be feeing better! I wonder when up you would know that you were adversely affected? Does anyone know?

My advice: Don't get medical advice from internet BB's. You'll always get disproportionately negative responses. Why? Anytime someone has an adverse effect (which may or may not even be related to the medication), they are likely to tell several people about it. On the other hand, people who have good responses rarely tell anyone about it. They take the antibiotic, are cured, and move on with their lives. Consequently, practically everyone "knows this guy who took Cipro and, like, died that day." In spite of the fact that they probably know a hundred other people who took Cipro without any negative consequences. Slight exageration there, but hopefully you get my point: the internets will make it sound a lot scarier than it needs to be.

The reality is, severe/irreversible side effects are rare.

But why not call your doctor's office and ask for her/his thoughts? S/he has probably prescribed this and related drugs hundreds or thousands of times and can tell you about their experiences and may also be able to tell you about the actual incidence of tendon rupture in clinical trials. This seems to me like a much more reliable source of information than a few scary anecdotes on VFTT.

But if it makes you feel better, I've been on Cipro for the better part of the past month. This time has included a week camping on the Cape (with several beach days) as well as most of a week camping and hiking in the Whites. I took my usual sun-limiting precautions (sunblock, hat, swim shirt during mid-day hours), and I opted out of carying a pack that's heavier than my usual pack to give me better odds against any tendon injury. I've got a few days left, but no issues so far regarding sun sensitivity or tendon issues. I'm in the same camp as most others here, I think, in that I'd really prefer to never take any drug. But I also try to keep probable costs and benefits in perspective.

I took Cipro in college for an infection and remained very active with no side-effects or injuries from playing basketball and volleyball while on my regimen. When it comes to risk though, it's really about percentages. And to those who experience a problem, the percentages don't matter. Anecdotes are not sound arguments, they are singular data points. It can be hard to overcome perception. It's always good to ask questions, just make sure you're asking the right people.

hikerbrian said:

My advice: Don't get medical advice from internet BB's.

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My advice is to listen to Brian.

First, let me thank those who were kind enough to reply with their experiences and opinions.

The first week, I was not in any mood to hike. After that, although I felt better, I thought it prudent to wait until I see the doctor again (in a few days), although I may do something short and flat sometime in the next couple days, just to get out of the house. I've finished the course of both medications, seems to have done what they were supposed to do, and so far, no egregious side effects .

My doctor is aware of my hiking and other activities, my general reluctance regarding prescription medicines, and my specific concerns about this specific course of treatment, and we spoke again about it when I saw him early in the course of treatment.

Some of the replies here were quite helpful to me in formulating questions for my doctor, and I'm grateful for that.

TomK