After Taking Levofloxacin, Reader Experiences Painful Side Effects

DEAR DR ROACH: I'm writing in to warn readers of a possible side effect of an antibiotic known as levofloxacin. I was recently treated with this medication for a sinus infection that would not clear up with amoxicillin. After five days of taking the medication, my joints became very inflamed, especially my ankles, and it was painful. I discontinued the medication, but almost three weeks later, I still have pain in my joints.

My doctor never told me of this horrible possible side effect. Levofloxacin is the generic form of Levaquin, which was removed from the market years ago due to these issues. Why wasn't the generic form taken off the market as well? Articles state that the symptoms can be permanent. I'm hoping they eventually lessen because it's miserable. -- K.S.

ANSWER: Levofloxacin is a powerful medication that should not be used lightly. Janssen Pharmaceuticals did indeed stop making brand-name Levoquin in 2017; although the company did not specify why, a spokesperson said "[t]he decision to discontinue Levaquin was made due to the wide availability of alternative treatment options and our focus on developing innovative medicines designed to address unmet medical patient needs."

Levofloxacin, like all drugs in the fluoroquinolone class, has the potential for serious harm. I believe you have tendinopathy (inflammation in the tendons), which is among the more serious side effects, partly because it can lead to rupture of the tendon. Although this is reported to be rare (3 per 100,000 cases), I have personally seen more cases than I would expect to with those numbers. Most people recover in two months, but some cases were reported to last between one to two years.

The Food and Drug Administration put a "black box" warning (the highest possible warning) on levofloxacin to remind physicians of the danger of this side effect and the danger of another symptom called neurological toxicity, which can cause delirium and memory impairment. There are more side effects that occur less commonly.

I hardly ever prescribe this medicine, but I don't think it should be banned entirely. There are a few times when this class of medications alone can be lifesaving. But physicians shouldn't be prescribing it lightly. I'm afraid too many physicians prescribe antibiotics for viral diseases too often.

Patients want them and sometimes demand them, but we still shouldn't prescribe them when we know they won't help. Doctors who refuse antibiotics are at risk for bad reviews from patients, and these can have a significant impact on a physician's practice. All antibiotics have the potential for adverse effects, and overuse contributes to resistance. But fluoroquinolones, in particular, should be used extremely sparingly.

DEAR DR. ROACH: I have tinnitus, which is very loud and makes it difficult to hear people, especially a group of them in a room. Is there anything that can be done for tinnitus? Do hearing aids help? I mind it the most when I'm trying to get to sleep, but I'm not sure if I could wear hearing aids to bed anyway. -- M.B.

ANSWER: Tinnitus almost always happens with hearing loss, but it's important to test this. For people with hearing loss confirmed by an audiologist, a hearing aid can help with understanding speech, and it can also mask tinnitus, which improves symptoms.

For people who have bothersome symptoms at night, increasing ambient noise can be helpful. My patients have recommended using fans, tuning the radio in between stations to provide static at a low volume, and buying specialized sound machines. These can be helpful for many people, but unfortunately, they are not effective for everyone. They occasionally make things worse. The American Tinnitus Association (ATA.org) has many suggestions and references.

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Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803.