Fluoroquinolones adverse effects

Fish DN. Fluoroquinolone adverse effects and drug interactions. Pharmacotherapy 2001 21(10 Pt 2) S253-72. 

The more common adverse effects seen with the administration of these dm include nausea, diarrhea, headache, abdominal pain or discomfort, and dizziness. A more serious adverse reaction seen with the administration of the fluoroquinolones, especially lomefloxacin and sparfloxacin, is a photosensitivity reaction. This is manifested by an exaggerated sunburn reaction when the skin is exposed to the ultraviolet rays of sunlight or sunlamps. 

Common adverse effects of calcium salts include constipation, bloating, cramps, and flatulence. Changing to a different salt form may alleviate symptoms for some patients. Calcium salts may reduce the absorption of levothyroxine, iron and some antibiotics, such as tetracycline and fluoroquinolones. 

Fluoroquinolones are well tolerated. The most common adverse effects are nausea, vomiting, diarrhoea, headache, insomnia, skin rash and occasionally abnormal liver function tests (with trovafloxacin). Phototoxicity has been particularly reported with pefloxacin, lomefloxacin, sparfloxacin and ofloxacin. Tendinitis is a serious side effect rarely reported in adults. Because of cartilage damage in children it must be used under close supervision. 

Psychiatric adverse effects in patients taking fluoroquinolones occur at a rate of 2-4%, causing headache (2-4% of patients), dizziness (2-3%), and other symptoms (under 1%), including confusion, agitation, insomnia, depression, somnolence, vertigo, light-headedness, and tremors. Seizures are rare. Isolated cases of depression (273) and psychosis have been described (274). 

Owing to adverse effects (including severe anaphylaxis, OT interval prolongation, and potential cardiotoxicity), several fluoroquinolones have had to be withdrawn (for example temafloxacin and grepafloxacin) or strictly limited in their uses (for example trovafloxacin) after marketing. A serious idiosyncratic reaction profile is possibly related to the immunologically reactive 1-difluorophenyl substituent that characterizes temafloxacin, tosufloxacin, and trovafloxacin (7). 

The main central nervous system adverse effects of the fluoroquinolones include dizziness, convulsions. 

Photosensitivity is a common adverse effect of the fluoroquinolones. It results from an abnormal reaction of the skin to natural or artificial light sources, usually associated with the UVA part of the electromagnetic spectrum (315-400 nm), mediated by the absorption of light energy into fluoroquinolones, followed by degradation of the molecule and formation of cytotoxic photoproducts (64). 

Shimada J, Hori S. Adverse effects of fluoroquinolones. Prog Drug Res 1992 38 133 3. 

The adverse effects rates of levofloxacin are 1.3% for nausea, 0.1% for anxiety, 0.3% for insomnia, and 0.1% for headache. No levofloxacin-related adverse events were reported at a rate higher than 1.3%, and most were less common. High-dose levofloxacin (750 mg) was also well tolerated. Surveillance data reported low adverse event rates nausea 0.8%, rash 0.5%, abdominal pain 0.4%, and diarrhea, dizziness, and vomiting 0.3%. The adverse drug reactions rate for levofloxacin is stiU one of the lowest of any fluoroquinolone, at 2% compared with 2-10% for other fluoroquinolones (6-9). 

In a study based on European and international data from about 130 million prescriptions, the adverse effects profile of levofloxacin was compared with that of other fluoroquinolones there was a low rate of hepatic abnormalities (1/650 000) (6). However, two cases of severe acute liver toxicity were reported in patients who had received intravenous levofloxacin (20,21). 

Abnormalities of liver, renal, and hematological parameters have been reported. As with other antibiotic regimens, pseudomembranous colitis may occur during or after treatment. Fluoroquinolones have the potential to cause adverse effects on developing cartilage and bone thus, ciprofloxacin should be used with caution in pregnant women and young children. 

Adverse effects might be produced when fluoroquinolones are administered with other medications. Here are potential adverse reactions ... 

Therapy should consist of an agent administered for 7 days that has a relatively low adverse-effect potential and is safe for the mother and baby. The administration of a sulfonamide, amoxicillin, amoxicillin-clavulanate, cephalexin, or nitrofurantoin is effective in 70% to 80% of patients. Tetracyclines should be avoided because of teratogenic effects, and sulfonamides should not be administered during the third trimester because of the possible development of kernicterus and hyperbilirubinemia. In addition, the available fluoroquinolones should not be given because of their potential to inhibit cartilage and bone development in the newborn. A follow-up urine culture 1 to 2 weeks after completing therapy and then monthly until gestation is complete is recommended. 

Rash, in areas of the body exposed to UV light, may be indicative of drug phototoxicity. Among the antibacterial agents, the tetracyclines and the sulfonamides are notably phototoxic. More recently, the fluoroquinolones have been implicated in phototoxic responses, and because these antibiotics are widely used, the incidence of this type of adverse effect is increasing. 

The newer fluoroquinolones (ciprofloxacin, norfloxacin, enoxadn, pefloxacin, gatifloxadn and moxi-floxacin) have similar toxicities and incidence of adverse effects. In general, compared to other antibiotics, these are relatively safe agents [190]. Gastrointestinal side-effects are the most common (0.8 to 6.8% of patients), followed by central nervous system manifestations (0.9 to 1.8%), and skin reactions (0.6 to 2.4%). Rare cases of increased serum creatinine levels have been reported [203]. Indeed, in a study of 133 febrile episodes in neutropenic patients comparing the effectiveness and safety of high-dose oral ciprofloxacin versus azlociUin and netilmicin, there were no renal ad-... 

Lee CW, Fialkow RZ, VanWyck D. Adverse effects associated with the newer fluoroquinolones. Am J Kidney Dis 1989 13 510-... 

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