Avoid using fluoroquinolones (ciprofloxacin and levofloxacin) in patients with hypertension, Marfan syndrome and Ehlers-Danlos syndrome or a history of arterial blockages or aneurysms.

A US Food and Drug Administration (FDA) review found that fluoroquinolones can increase the occurrence of rare but serious events of ruptures or tears in the aorta, which can cause serious, sometimes fatal bleeding. Aortic dissections or ruptures of an aortic aneurysm can occur in people taking these antibiotics orally or by injection.

Because of this risk, the US FDA is advising doctors to try to avoid prescribing fluoroquinolone antibiotics to patients who have an aortic aneurysm or are at risk for an aortic aneurysm, such as patients with hypertension or peripheral atherosclerotic vascular diseases or certain genetic conditions such as Marfan syndrome and Ehlers-Danlos syndrome and elderly patients. Fluoroquinolones should be prescribed to these patients only when no other treatment options are available.

Patients are also advised to seek immediate medical care if they develop sudden, severe, and constant pain in the stomach, chest or back. 

The FDA issued a separate warning in July 2018, alerting people that fluoroquinolones could increase the risk of rapid fall in blood sugar (hypoglycemia) and certain mental health side effects such as disturbances in attention, disorientation, agitation, nervousness, memory impairment and delirium.

In July 2016, the FDA had issued safety information about disabling side effects of the tendons, muscles, joints, nerves and central nervous system associated with fluoroquinolones; peripheral neuropathy in August 2013 and tendinitis and tendon rupture in July 2008.

In May 2016, the FDA restricted the use of fluoroquinolones in patients with acute sinusitis, acute bronchitis and uncomplicated urinary tract infections who have other treatment options.

Dr KK Aggarwal

Padma Shri Awardee

President Elect Confederation of Medical Associations in Asia and Oceania   (CMAAO)

Group Editor-in-Chief IJCP Publications

President Heart Care Foundation of India

Past National President IMA