Tag Archives: levofloxacin

MedShadow’s Top 10 Stories of 2018

What were the most popular stories we published in 2018? Our Top 10 includes two stories on drugs that have become popular among opioid abusers, as well as articles dealing with drug interactions, a controversial class of antibiotics and a first-person story on an herbal supplement that has come under attack from the FDA, among others. Here are excerpts of the stories with the highest readership.

1. Gabapentin’s Secret: The Drug Opioid Abuser’s Crave

By Ronni Gordon

For many people who take gabapentin – a drug prescribed to treat seizures and pain caused by shingles – side effects such as sedation can be a challenge, as those who take it off-label for neuropathic pain told MedShadow in the past.

But an increasing number of opioid abusers crave that side effect, reporting a calm feeling when combining gabapentin – developed by Pfizer under the brand name Neurontin – with opioids, muscle relaxants and anxiety medications. Some also get a marijuana-like high and an enhanced euphoria. But when overused or abused, it can cause significant organ or brain damage. Read more →

2. Managing Eczema: Are New Treatments Like Eucrisa Worth It?

By Madeline Vann

Eczema (atopic dermatitis) can feel like a moving target for people who live with it. They get control over one flare, only to have eczema redden and irritate another patch of skin. For some patients, changing their bathing and beauty habits along with a thick moisturizer and topical corticosteroid ointments are enough.

“Steroids are the mainstay of treating atopic dermatitis. They’ve been around for decades. They are generally inexpensive, and for the vast majority of patients, that’s how we start treatment,” explains dermatologist Amy Paller, MD, director of the Northwestern University Skin Disease Research Center in Chicago. American Academy of Dermatology (AAD) guidelines recommend using emollient moisturizers, lifestyle changes to avoid triggers, and corticosteroids at first. Read more →

3. How Imodium Became Appealing to Opioid Addicts

By Padma Nagappan

A sports injury from playing squash in high school lead to a herniated disc for Bob Johnson (name changed to protect his privacy), who was initially given codeine for his pain, and then bumped up to hydrocodone, which is more powerful and used to treat severe pain.

He stopped taking the drugs once he began recovering. All was well until he left for college in Philadelphia and started playing on the squash team — and his back began hurting again. He found it was easy to get access to drugs and began buying OxyContin (oxycodone) from a dealer. Read more → 

4. What is the Best Way to Treat Heat Rash?

By Dave Walker, RPh

Question: It’s summer and I’m going to be spending a lot of times outdoors. I’m susceptible to heat rash. What is the best treatment for it?

I remember anticipating summer vacation as a kid. We were always busy planning and participating in neighborhood sporting activities, biking, hiking, fishing and camping trips. The neighborhood moms always had a ready supply of Band-Aids, Bactine and antiseptic cream to take care of those expected and inevitable scratches, scrapes, cuts and insect bites along the way. Read more →

5. 4 Drugs That Interact with Anxiety Meds

By Christy Huff, MD

If you suffer from anxiety, panic disorder or insomnia, your doctor may have prescribed you a tranquilizer belonging to a class of drugs known as benzodiazepines.

Drugs such as Xanax (alprazolam), Valium (diazepam), Ativan (lorazepam), and Klonopin (clonazepam) are some of the most-prescribed medicines – more than 133.4 million such prescriptions were filled in the US in 2014. As with any medication, drug interactions can occur if you take a benzo with another medication, and in certain cases, may be life-threatening. Read more → 

6. Why Aren’t Seniors Getting the Shingles Vaccine?

By Rita Colorito

Nearly 12 years after the FDA approved Zostavax, the first vaccine to prevent shingles in adults 60 and older, the vast majority of seniors still haven’t received it. Only 30.6% of adults age 60 and older reported getting the shingles vaccine, according to the latest CDC (Centers for Disease Control and Prevention) assessment of vaccine coverage.

Since it became available, Zostavax has faced numerous barriers in terms of getting seniors vaccinated, the assessment found. In October, the FDA approved a new shingles vaccine, Shingrix, for people age 50 and older. Less than a week later, the CDC’s Advisory Committee on Immunization Practices (ACIP) recommended Shingrix as the CDC’s preferred shingles vaccine for adults age 50 plus due to Shingrix’s better efficacy and fewer side effects compared to Zostavax. Read more → 

7. Floxed! The Painful, Life-Lasting Effects of Some Antibiotics

By Suzanne B. Robotti

Last week, we ran a news story on antibiotics causing “rare” damages to people. We had a very passionate response from more than 75 people who all claimed to be harmed by a particular type of antibiotics. More than 60,000 people have complained to the FDA about them. It begs the question, how unusual are these “rare” harms.

The side effects and adverse events associated with Cipro, Levaquin and other fluoroquinolones (FQs) can be significant and life altering. Yet many people who have been damaged by fluoroquinolones complain that there are too few warnings. Many claim that doctors don’t believe that their new illnesses have come from the FQs. Worse, sometimes FQs are prescribed when other, less risky — and just as effective — antibiotics are available. Read more →

8. The FDA Has It Wrong on Kratom: How the Herb is Helping People Like Me

By Andrew Turner

Some may ask who are the consumers of kratom, an herb used to treat pain, depression and anxiety that has been the subject of controversy lately in the news. It’s complicated.

We can be anyone. We are your neighbor, the veteran in the supermarket, your college professor and even your best friend. There’s a lot of misconceptions about kratom, how it’s used to treat certain ailments and its potential for addiction. Read more →

9. Can An Opioid Addiction Drug Treat Autoimmune Disorders

By Deborah Lynn Blumberg

A slew of drugs, both new and old, are used to treat autoimmune disorders like multiple sclerosis (MS), lupus and Crohn’s disease. Most of them come with side effects, some of them serious. But research and experience from patients and doctors are mounting that a drug used to treat substance abuse, when used in lower doses, can effectively treat autoimmune conditions with few side effects.

The drug is naltrexone, which was first approved in the 1980s to treat heroin addiction. In recent years, it has been prescribed more and more at a low dose for patients with autoimmune disorders. But is this off-label use (yet to be approved by the FDA) safe and effective? Read more →

10. Pros and Cons: Prednisone

By Tori Rodriguez

If you visit the doctor from time to time for anything other than a routine checkup, it’s likely that at some point you’ve received a prescription for a type of drug called corticosteroids. These are among the most commonly prescribed medications in the US, and they are used in almost every medical specialty.

In a study published last year, researchers at the University of Michigan found that 1 in 5 American adults with commercial health insurance had been prescribed a corticosteroid at least once over a 3-year period. Read more →

Quick Hits: More Fluoroquinolone Risks, Safety of HPV Vaccine & More

Taking fluoroquinolone antibiotics can increase one’s risk of developing an enlargement of and potential tears in the aorta, the heart’s main artery. New research has found that taking drugs such as Cipro (ciprofloxacin) or Levaquin (levofloxacin) is associated with an increased risk for aortic aneurysm and dissection, and that risk increases the longer a person takes the medication. The two conditions are normally slow to develop, but researchers noted fluoroquinolones may speed up that process. Researchers analyzed records of around 1,200 patients that were hospitalized for aortic aneurysm and dissection and compared them to 1,200 control subjects. An editorial accompanying the study said that doctors should be careful in prescribing fluoroquinolones in those that have risk factors for aortic aneurysm, such as older age, smoking and hypertension. Posted September 12, 2018. Via American College of Cardiology.

The HPV (human papillomavirus) vaccine is safe and effective with hardly any risk of serious adverse events, according to a new analysis. Some people have expressed concerns that the vaccine, which is used to prevent cervical cancer, can cause paralysis, chronic pain, neurological disorders and anaphylaxis. Researchers examined reports of adverse events associated with the vaccine made to the FDA between 2009 and 2017. Over that time, around 720,000 doses of the vaccine were distributed. The FDA received only 241 adverse event reports and 95.8% were classified as not serious. Posted September 19, 2018. Via British Journal of Clinical Pharmacology.

Drug companies that manufacture immediate-release opioids will need to offer training to healthcare providers about the risks associated with the drugs and appropriate pain management. Immediate-release opioids are the most commonly prescribed opioids. The FDA has required what is known as an Opioid Analgesic Risk Evaluation and Mitigation Strategy (REMS) for long-acting and extended-release opioids since 2012. The new REMS must also be made available to other people involved in a patient’s pain management, such as nurses and pharmacists. In addition, the education must cover alternatives to opioids. The agency is also updating the labeling of immediate-release opioids to reflect the education available through the REMS. Posted September 18, 2018. Via FDA.

Levaquin Turned Me Into ‘Frankenwoman’

By Rachel Brummert
Drugwatch

I nicknamed myself Frankenwoman. Stitches, staples, plates and screws weave together the old me with who I am now. Scars cover me — some a shiny, ghostly pink and some bumpy, jagged and angry. This is my new normal.

My scars draw attention when I’m in public because there are so many of them. When people ask what happened, I respond, “An antibiotic happened.”

The scars open a conversation about medication safety. Because of this, they no longer embarrass me. I now think of them as battle lines drawn between survivorship and victimization.

The drug that injured me is Levaquin. It’s a powerful antibiotic in the fluoroquinolone family. My doctor prescribed it to me for a suspected sinus infection.

Because fluoroquinolones are so powerful, the FDA says they should be restricted to treat life-threatening infections or when there are no other options. They are associated with serious, often permanent adverse reactions.

Only no one told me that, and I learned the hard way.

The First of Dozens of Tendon Ruptures

A month after I took Levaquin, I was running errands (ironically enough, my last stop was the same pharmacy I had the Levaquin filled). I was a few yards from my car when I simultaneously heard and felt a loud pop.

I could have sworn someone kicked the back of my ankle from behind. I fell to the ground, scraping my hands as I tried to break the fall. My foot was limp, and I couldn’t move it.

My Achilles tendon spontaneously ruptured in my right ankle and balled up in my calf. At age 36, that was the first of dozens of tendon ruptures.

As I was recovering from surgery of my right foot, the Achilles tendon in my left foot spontaneously ruptured. This meant more surgery and more rehabilitation.

A year after that, the Achilles tendon in my left foot ruptured yet again — this time above the site of the last rupture.

It required extensive reconstructive surgery, which meant opening the original scar, extending it a few inches up my leg and implanting hardware.

Doctor: Tendon Ruptures ‘Not Normal’

I had been with the same surgeon for two and a half years. He did all three ankle surgeries.

At my follow-up appointment two weeks after the last surgery in January 2009, I sat on the exam table, happy to be getting my staples out. We exchanged pleasantries before his demeanor changed to serious.

“Listen, 1 rupture…it happens. Two ruptures…it’s bad luck. Three ruptures in someone your age is not normal. I want to see if we can get to the bottom of it. Briefly tell me about your medical history,” he said.

I blinked at him for a moment, not knowing what to make of it. I told him that except for arthroscopic surgery on my knees from a sports injury in my teens and a car accident in my twenties, I’d been healthy and had no history of other orthopedic problems.

He nodded and asked, “What about your overall health?”

As an afterthought, I told him I had a suspected sinus infection about a month before my first surgery and had taken Levaquin for it.

He leaned against the exam table and put his pen down. He told me Levaquin is associated with tendon ruptures and that the FDA issued a black box warning in 2008. That was 2 years after my first rupture.

Confused, Misled, Angry and Betrayed

At first, I thought my doctor was crazy. I could not fathom an antibiotic — meant to help someone feel better — being the cause of all this.

When I went home, I researched it to the point of near obsession. There I found information and other patients who suffered severe adverse reactions from the same class of antibiotics that I took.

I felt confused, misled, angry and betrayed.

I went on to have over 24 more ruptures over the course of 12 years. That averages out to about 2 ruptures a year.

Each rupture required invasive surgeries, lengthy rehabilitations and endless follow-up appointments that led to mounting medical bills.

Adding insult to injury, Levaquin also caused central and autonomic nervous system damage, tinnitus, brain fog, anxiety, insomnia, neuropathy in my hands and feet, and a host of other adverse reactions.

Turning Pain into Purpose

The confusion and anger catapulted me into accidental advocacy. What happened to me was happening globally. I funneled all the emotions I had about it into advocating for others and began turning pain into purpose.

In the process I learned that there is a bigger picture: The current health care and regulatory system needs to change. My advocacy grew into helping shape policy that protects patients from medical harm.

As odd as it sounds, despite all the pain, I can’t see myself doing anything else. My scars are roadmaps that tell a story about my journey from harmed patient to empowered advocate. They show where I’ve been. They don’t dictate where I’m going.

Rachel Brummert is founder and president of Patient Safety Impact in Charlotte, NC, and is a contributor for Drugwatch. She collaborates with the FDA and the CDC advocating for safer health care, and has been featured in Consumer Reports and The Washington Post.

This article was originally published by Drugwatch. Reprinted by permission of the author.

4 Drugs That Interact with Anxiety Meds

If you suffer from anxiety, panic disorder or insomnia, your doctor may have prescribed you a tranquilizer belonging to a class of drugs known as benzodiazepines.

Drugs such as Xanax (alprazolam), Valium (diazepam), Ativan (lorazepam), and Klonopin (clonazepam) are some of the most-prescribed medicines – more than 133.4 million such prescriptions were filled in the US in 2014. As with any medication, drug interactions can occur if you take a benzo with another medication, and in certain cases, may be life-threatening.

With benzos, there are 2 areas of concern. The first is that interactions might increase the effects of the drug, which can result in oversedation, accidents and/or overdose. The second is that interactions could decrease the amount of a benzo in the bloodstream of a patient who has been on the drug for a long time, which can result in withdrawal symptoms, the most severe being seizures and death. Here are 4 drug classes that can have dangerous interactions with benzodiazepines.

1. Opioids

Opioids such as OxyContin (oxycodone), morphine, and Vicodin (hydrocodone) are painkillers. Katy LaLone, MD, a consulting psychiatrist with A Resilient Space Psychiatry Consultants in Cleveland, says combining benzos with “other sedative medications, especially opioids, can cause cardiorespiratory depression,” putting patients at risk of overdose and death. In fact, 75% of benzodiazepine-related deaths also involve an opioid. This combination is so dangerous that the FDA issued a black box warning in 2016 about prescribing the 2 drug classes together.

Dr. LaLone has even seen overdoses in patients who are on stable doses of the two drugs after developing a “compromised cardiorespiratory status, such as the flu or undiagnosed sleep apnea.” She adds, “overdose is almost always accidental.”

2. Insomnia drugs

Prescription drugs that treat insomnia, known as “Z-drugs” have a mechanism of action similar to benzos. These drugs include Ambien (zolpidem), Lunesta (eszopiclone), and Sonata (zaleplon). Dr. LaLone sees the combination of benzos and Ambien quite frequently in her clinical practice, usually in patients receiving prescriptions from more than one doctor. Patients are often prescribed benzodiazepines for anxiety and a “Z-drug” for insomnia, not realizing the drugs are similar in action.

She notes this “dangerous combination can cause amnestic episodes (blackout spells),” and she almost never prescribes the 2 drug classes together except in special cases. A 2017 study looking at emergency room visits for adverse events from benzos and/or “Z-drugs” found that the combination of the 2 drug classes led to a 4-fold risk for serious outcomes.

3. Proton Pump Inhibitors (PPIs)

These drugs, such as Prilosec (omeprazole), Nexium (esomeprazole), Prevacid (lansoprazole), and Protonix (pantoprazole), are used to treat acid reflux. They can increase blood levels of benzodiazepines by interacting with the same liver enzymes that clear them from the body. This can result in worsening side effects of benzodiazepines including confusion, sedation, dizziness, falls and impaired driving.

The most common offenders are Prilosec and Nexium. Mary Hall, a retiree living in North Carolina, was prescribed Prilosec by her doctor while taking clonazepam. She said, “The clonazepam started to build up, and I started feeling stoned like I was taking more doses of a benzo. I actually had to skip my night dose of the clonazepam and stop taking the Prilosec after three days.” She also developed a “horrible headache” that lasted for several days. She notified her doctor, and he was unaware of the potential interaction.

‘After the first dose of cipro, my heart started beating super fast, I felt really dizzy and had to hold onto the walls for balance. The world was spinning, and I was very shaky’

4. Fluoroquinolone Antibiotics

Fluoroquinolones include Cipro (ciprofloxacin), Levaquin (levofloxacin), and Avelox (moxifloxacin). They compete for the same binding site as benzodiazepines, which means 1 drug blocks the effect of the other. In this case, the fluoroquinolones block the benzodiazepine leading to acute withdrawal in those who are dependent on the benzo. There have been reports in medical literature and online communities of long-term benzodiazepine patients experiencing withdrawal symptoms after taking these antibiotics.

Kristie Walker, a former medical office biller who now lives in Florida, learned about the interaction firsthand after being prescribed ciprofloxacin for a urinary tract infection. She had been taking Xanax for around 15 years. “After the first dose of cipro, my heart started beating super fast, I felt really dizzy and had to hold onto the walls for balance. The world was spinning, and I was very shaky” she says. She informed her doctor of her symptoms and stopped taking the ciprofloxacin after 2 days.

At that point she was profoundly ill. Her heart rate went up to 200 beats per minute just walking from room to room, she was unable to eat due to severe nausea, and she was ultimately hospitalized. Her symptoms were so severe she contemplated suicide. “I thought I was going to die”, she says. After Walker began to research her symptoms online, she found an article on the interaction between benzos and fluoroquinolones and realized the antibiotic had caused her to have acute benzodiazepine withdrawal.

How to Avoid Dangerous Interactions?

There are numerous ways you can protect yourself from dangerous drug interactions involving benzos. Dr. LaLone recommends that you only take medications that are prescribed to you, and take them only as prescribed. Second, obtain your prescriptions from 1 physician and pharmacy, and have regular doctor visits to assess your medication regimen. Third, exercise caution with use of other sedating medications, especially opioids. And finally, inform your doctor of all medications you are taking, including over-the-counter medications and supplements.

It is also important to know that if you are considering stopping a benzo after being on it for a long time, it should be tapered to avoid the risk of severe withdrawal, which can result in seizures and even death.

Quick Hits: Drugmaker Stops Making Controversial Antibiotic, Marijuana for Epilepsy & More

Janssen Pharmaceuticals has stopped making Levaquin (levofloxacin), a fluoroquinolone antibiotic associated with many side effects. In December, Janssen, which is part of pharma giant Johnson & Johnson, discontinued both the oral and IV versions. They company claimed the reason for the discontinuation was due to the availability of other treatment options as well as their aim to develop medicines for unmet needs. Levaquin may still be available in pharmacies through 2020, however. Despite Janssen’s move, generic versions of levofloxacin will still be made. Brand-name Levaquin was only 1% of the market share. In 2016, the FDA issued a “boxed warning” on fluoroquinolone antibiotics, the most severe the agency can order for a drug. This highlighted the risk of serious side effects including disturbances in attention, disorientation, agitation, nervousness, memory impairment, serious disturbances in mental abilities, and delirium. Last month, the agency also mandated another labeling change for fluoroquinolones. Posted July 17, 2018. Via The Indy Channel.

While cannabinoids, active ingredients in marijuana, are useful in controlling seizures, they also have the potential for causing adverse events. An analysis, conducted by the UK’s National Institute for Health Research, of 6 randomized controlled trials and 30 observational trials examined the use of cannabidiol, a medical-quality cannabinoid, to placebo in patients, most of whom had severe epilepsy. Patients on cannabidiol saw seizure-free chances increase by 7.8% compared to only 0.7% of those on placebo. Reducing seizure frequency by at least 50% was observed at 43.5% in the cannabidiol group compared to 25% in the placebo group. However, adverse events did increase in those taking cannabidiol compared to placebo (88.4% to 69.7%). In late June, the FDA approved the first cannabidiol-based drug, Epidiolex, for severe seizures. Posted July 30, 2018. Via Nursing Times.

The FDA is warning of dangers and false claims associated with so-called “vaginal rejuvenation” devices. The procedure uses lasers and other energy-based devices to destroy and/ or reshape vaginal tissue and is intended to treat menopausal symptoms as well as urinary inconsistencies or sexual function. The FDA has approved these devices to remove precancerous vaginal or cervical tissue along with genital warts, but has not approved its use for “vaginal rejuvenation.” Serious risks based on reports have been found with the procedure and there is no evidence to see if it is effective. After reviewing reports on the procedure, the FDA found that it can leave vaginal burns, scarring, pain during sex, and recurring/chronic pain. Since it has not been thoroughly reviewed, not all of the risks are known. The FDA has given companies offering the procedure 30 days to respond to questions they have. Posted July 30, 2018 Via FDA.

FDA Again Requires Labeling Changes for Controversial Antibiotics

The FDA has again mandated labeling changes for fluoroquinolones, a class of antibiotics, this time to warn of potentially life-threatening low blood sugar levels (hypoglycemia) and mental health side effects with their use.

Fluoroquinolones are used to treat serious bacterial infections. Common ones include Levaquin (levofloxacin), Cipro (ciprofloxacin), Avelox (moxifloxacin), Factive (gemifloxacin) and Ocuflox (ofloxacin).

The labeling changes came after the FDA conducted a comprehensive review of adverse event reports and case reports published in medical literature. It found instances of hypoglycemic coma in cases where patients — particularly older ones — on fluoroquinolones experienced hypoglycemia. As a result, a subsection of fluoroquinolones labeling will now have to indicate the potential risk of coma with hypoglycemia.

Among all fluoroquinolones, a range of mental health side effects are already described in the warnings and precautions section of the drug label, though they differ by individual drug. The new label changes will make these side effects — including disturbances in attention, disorientation, agitation, nervousness, memory impairment and delirium — consistent across the entire class.

Fluoroquinolones have been the subject of additional warnings in the past. In 2008, the FDA updated their labeling to warn of an increased risk of tendinitis and tendon rupture. A few years later, a risk of worsening symptoms for those with myasthenia gravis (a condition characterized by weakening of muscles under voluntary control) was added as a “boxed warning,” the strongest warning the FDA can require on a drug’s label.

In August 2013, another labeling update was required to describe the potential for irreversible peripheral neuropathy (serious nerve damage). And in 2016, the agency updated labeling to warn of the possible association between fluoroquinolones and potentially permanent side effects pertaining to tendons, muscles, joints, nerves and the central nervous system.

Antibiotics for Severe Asthma: Are They Really Necessary?

When someone is hospitalized for asthma, the standard of care is steroids with bronchodilators, yet many patients also end up getting antibiotics. But a growing amount of medical evidence indicates antibiotics are not only unnecessary, but can also cause side effects and increase patients’ hospital stay and expenses.

Nearly half of the patients who were hospitalized for asthma did not have signs of a lung infection, but nonetheless were given antibiotics, according to a comparative effectiveness study that examined patient medical records in 554 hospitals from the beginning of 2015 to the end of 2016.

Researchers from the University of Massachusetts Medical School-Baystate excluded patients who might need an antibiotic, such as those who are also suffering with pneumonia, sinus, emphysema and sepsis. They still found that 46% of the remaining patients — about 10,000 people — were put on antibiotics.

Given that there are established guidelines for treating asthma, and antibiotics are called for only when there is a lung infection, why do so many physicians dole out prescriptions for them?

No Studies Exploring The Issue

“There are no studies exploring this issue,” of why antibiotics are prescribed in these cases, Mihaela S. Stefan, MD, an associate professor of medicine at UMMS Baystate and lead author of the study, an abstract of which was presented at the May meeting of the American Thoracic Society.

“Potential explanations for this high rate of inappropriate treatment include the challenge of differentiating bacterial from non-bacterial infections, distinguishing asthma from COPD [chronic obstructive pulmonary disease] in the acute care setting, and gaps in knowledge about the benefits of antibiotic therapy.”

Side effects from antibiotics varied depending on class. Her team found that macrolides (a class of antibiotics that includes clarithromycin and erythromycin) had a lower risk of diarrhea compared to quinolones — such as Cipro (ciprofloxacin) and Levaquin (levofloxacin) and third-generation cephalosporins, such as Cedax (ceftibuten) and Rocephin (ceftriaxone). Macrolides had only a 1.2% risk of leading to diabetes compared to the other antibiotics at 2.2%.

This recent study is a follow-up to a 2016 JAMA Internal Medicine study Stefan co-authored in which they analyzed records of nearly 52,000 patients in 577 hospitals across the US. They found that nearly 60% of patients received antibiotics for asthma.

Dig Deeper to See What Triggered Asthma

Asthma exacerbations can be caused by a variety of factors, such as pollution, dust, tobacco smoke, outdoor allergens, pets, mold, emotional triggers, physical exercise and weather. Sinus infections, the flu and colds can also trigger asthma attacks.

“I personally rarely prescribe antibiotics for patients with asthma flare that don’t have other symptoms,” Stephen Lee, MD, a pulmonary disease specialist with Sharp Rees-Stealy Health in San Diego, said. “You look at what may have caused asthma to flare. Was there exposure to triggers?

“If someone has known asthma and is supposed to use a maintenance inhaler every single day no matter how they feel, we know that compliance with these daily inhalers is poor, people often forget to take it, or don’t want to take it daily, or wait until they’re ill to take it,” Lee explained as a possible reason for an asthma exacerbation.

Why Physicians Err on the Side of Caution

“It’s very common for patients coming in to the hospital complaining of respiratory symptoms to be given antibiotics. We’re always going to worry that we will miss an infection,” Lee said.

While Lee hardly ever prescribes antibiotics, he said physicians often feel like patients expect it, or they add it on just to be safe, so he was not surprised by the results of the study.

“There is overuse of antibiotics in the outpatient setting which can flow over to inpatient, too. A lot of doctors feel compelled to add it, just to be sure, so they err on the side of precaution,” he said.

When patients come in with respiratory complaints, one easy way to rule out pneumonia is with an X-ray, but when there’s a cough with sputum, it can be a gray area that leads doctors to hedge their bets.

When a patient is hospitalized, they’ve already progressed through the system, possibly from the ER, where attempts would have been made to manage it, so there’s a certain level of urgency related to their clinical status, Lee explained, which differs from that of an outpatient.

Stefan’s recent study also excluded patients with bronchitis — which is usually caused by a virus — who were given antibiotics, which Lee questioned, since there is no reason to prescribe them for bronchitis, which can often overlap with asthma.

“If they’re getting sicker, coughing a lot and bringing up a lot of sputum, that may be when I’m compelled to prescribe them, but it’s uncommon,” he noted. “How do you separate it out from a cough? Even if it was viral or bacterial, there’s no call to use it for bronchitis.”

The Costs of Antibiotic Prescribing for Asthma

Inappropriate use of antibiotics comes at a huge cost, both monetary and health-wise. It contributes to antibiotic resistance, which in some people can make it difficult to fight bacterial infections when they actually do have one.

“Inappropriate use of antibiotics is a public health problem, given the risk of bacterial resistance and adverse events. Antibiotic resistance adds an average of $1,383 to the cost of treating a patient with a bacterial infection, resulting in a national cost of $2.2 billion annually,” Stefan said, quoting a recent study.

“Asthma exacerbations are an important cause for recurrent hospitalizations, and although there are published guidelines, physicians are slow to adopt these guidelines,” she added

Stefan wants to dig deeper to find out why so many doctors are prescribing antibiotics that are unnecessary. Her team plans to do a qualitative study to assess providers’ attitudes and beliefs about antibiotic prescribing practices for asthma.

Floxed! The Painful, Life-Lasting Effects of Some Antibiotics

Last week, we ran a news story on antibiotics causing “rare” damages to people. We had a very passionate response from more than 75 people who all claimed to be harmed by a particular type of antibiotics. More than 60,000 people have complained to the FDA about them. It begs the question, how unusual are these “rare” harms.

The side effects and adverse events associated with Cipro, Levaquin and other fluoroquinolones (FQs) can be significant and life altering. Yet many people who have been damaged by fluoroquinolones complain that there are too few warnings. Many claim that doctors don’t believe that their new illnesses have come from the FQs. Worse, sometimes FQs are prescribed when other, less risky — and just as effective — antibiotics are available.

Antibiotics are one of the great medical advances of the 20th century. But their power — like all medications — comes with a risk of side effects. Penicillins are the oldest of the antibiotics and are generally safe (but they do have side effects like diarrhea, skin rash, fever and more).

FQs are the newest group of antibiotics. They include ciprofloxin, levofloxacin and several other ones that all end in “floxin.” All of these antibiotics carry “black box” warnings — the most serious caution that the FDA has — about possible tendon rupture, permanent nerve damage and risk of worsening myasthenia gravis – a neuromuscular and autoimmune disease. Here is a good article on the various categories of antibiotics and their uses.

Here are some of the comments (lightly edited) that friends of MedShadow posted on Facebook (and please go to our Facebook page to read even more comments):

Please note that these are comments posted on Facebook. MedShadow did not vette them for accuracy. In addition, MedShadow does not endorse the organizations mentioned. As with any information offered in a public forum, please conduct your own research and speak frankly with your doctor. If you have questions about fluoroquinolones or any other medications you are taking, please consult a medical professional.

RT said: appreciate your article! I was seriously harmed by the fluoroquinolone Levaquin, permanently disabled me with just 10 pills creating peripheral neuropathy, and many other serious problems. I’ve learned a great deal since then including much you have said here. There are tens of thousands of us out here suffering, and many more who don’t even know their problems came from these seemingly simple antibiotics!

KD said: I took levofloxacin for a simple sinus infection and ended up with immediate tendon/nerve/joint damage overnight…followed by 5 years of pain that I’m still battling…. Fluoroquinolone antibiotics should only be used as a last resort, not a first line of defense. These are a very dangerous class of antibiotics, and shouldn’t be taken lightly. Thank you MedShadow Foundation for covering this story on fluoroquinolones!

JK said: I lost my life as I knew it because I took ciprofloxacin three and a half years ago for a suspected UTI. With my ears ringing, my heart and mind racing, and my body disintegrating, unable to run; it is like being stuck in my own horror show. I alternately fear the end, and hope for it. Thanks for the coverage, Alanna and Medshadow.

FYM said: Thank you so much for doing this story, we need all the help we can get to spread the news about these dangerous drugs. I was still working cleaning houses at 78 and was in good shape except for some arthritis and due to Avelox, in 2011, I became disabled and could not work anymore. Then was given Cipro in 2015 and levofloxacin in 2016 and now I am mostly crippled, with about 15 of the rare side effects of these drugs and can barely take care of myself. And there are thousands of young and old alike that are in worse shape than me. So please continue spreading the word.

CBG said: Thank you for helping to expose the dangers of this horrific, disabling drug. Cipro has changed my life. Since taking it 2 years ago, I have so much pain in all my joints and muscles, sciatica, neuropathy, blurred vision, brain fog, fatigue, panic attacks, insomnia and anxiety. This is definitely not the way my husband and I planned to spend our retirement.

Suggested Resources From Our Facebook Comments

MAG said: Here is a great video about this by Global TV in Toronto, about 13 minutes, still the best out there, hard hitting, informative, the guy with the beard really tells it like it is… 😉

LS said: Dr. Jay Cohen was a great advocate for the FQ community. He recently passed away. His book, with a slight title change is being re-published, due to the FQ communities efforts. If order from Amazon Smile a small percentage of the proceeded will help the FQ community.

EL said: This is a public group of almost 4000 injured by fluoroquinolone antibiotics.

KD said: If you, or a loved one has been struggling with undiagnosed health issues, and you’ve taken a Fluoroquinolone Antibiotic in the past, you may have been floxed. Consider joining our support group of over 9200+ and growing: https://www.facebook.com/groups/floxies/

MAG said: THANK YOU! Thank you so much for doing a story about fluoroquinolones, or FQs! There are literally millions upon millions who have been harmed…Doctors routinely misdiagnose us with lupus, fibro, ALS, Parkinson’s, MS, and a hundred others. If you have a diagnosis you are not comfortable with or if you or a loved one have mysterious and unexplained health issues, from head to toe, body or mind, please come to this page and learn more about FQs. If you have taken an FQ like Cipro or Levaquin or any of the any others, many of which were banned, then please join one of the support groups it has listed….As a leader in the FQ community and author of an upcoming book about damaged done by doctors, I look forward to getting to know you. Best wishes to all!

Antibiotic Side Effects Mount and Researchers Don’t Know Why

More than 60,000 reports have been sent to the FDA of patients detailing side effects associated with fluoroquinolone antibiotics, according to an article published in the journal Nature. Although more than 6,500 deaths are included in the report, side effects associated with these antibiotics are rarely reviewed or studied.

Such antibiotics include Cipro (ciprofloxacin), Levaquin (levofloxacin), Avelox (moxifloxacin) and Floxin (ofloxacin).

The article discusses research coverage for fluoroquinolone antibiotics and indicates that analysts don’t know why the drugs cause “rare but disabling” side effects. The piece also suggests that drug manufacturers have very little interest in researching medications that have been on the market for decades, which is partly due to the fact that there are no incentives offered for researching profitable drugs.

Also, some researchers have avoided publishing studies that critically evaluate and go against drug companies because they fear that the well-funded pharmaceutical companies may retaliate.

There are 3 black-box warnings on all fluoroquinolones, cautioning that the drugs can cause a tendon rupture, permanent nerve damage and worsen myasthenia gravis – a neuromuscular and autoimmune disease. In the past 5 years alone, the FDA has updated fluoroquinolone labeling 20 times.

What to Do If You Have Allergic Reactions to Antibiotics?

What started out as a few pinprick-sized dots on my forearms on Christmas Day turned into a huge allergic reaction that would go on — in various forms — until the 4th of July.

The culprit was the antibiotic dicloxacillin, a member of the penicillin family.

Though antibiotics can be lifesaving, I was taking this one mostly out of convenience. I am prone to mastitis, which occurs when a lactating woman’s milk duct clogs and becomes infected. The symptoms include fever and body aches.

Lactating women — as I was at the time — are typically busy moms with at least one very young child. My youngest was 11 months old. My other two sons were 3 and 8. I had no time to deal with my own illnesses, so if there was a quick fix, I took it.

I now know that was a big mistake.

This was not my first time taking dicloxacillin. I had developed mastitis 6 times over the previous 3 years, and dicloxacillin had quickly cured it with no ill effects.

My seventh round of this antibiotic was the unlucky one. By the time the rash popped up, I had already finished taking the 10-day antibiotic series. I was having a delayed reaction.

Allergies May Be Immediate or Delayed

Drug allergies are still somewhat of a mystery, says Dr. Min Jung Lee, an assistant professor of pediatrics and internal medicine at the University of Texas Southwestern. However, there are indications that frequent antibiotic use does make patients more susceptible to developing allergies.

“The most common symptoms of the immediate reactions occur a half an hour to an hour after taking the medication,” she says. “Symptoms include swelling, vomiting, coughing and anaphylaxis.”

Then there is the delayed reaction, which can happen after the entire series of antibiotic has been consumed. While still dangerous and often lengthy, delayed reactions move more slowly and any life-threatening symptoms usually can be treated with antihistamines and steroids.

Those pinprick spots on my forearms gave way to huge hives all over my body. The last week of December 2010, I went to the emergency room 3 times. Once in an ambulance, I developed large hives, fainted, had swollen lips, mouth sores, gum swelling, fullness in my throat, body aches and more.

Unlike food and seasonal allergies, drug reactions are difficult to understand and predict, says Dr. Corinna Bowser, an allergist at Narberth Allergy and Asthma clinic in Narberth, Penn.

“The difficulty we are facing is that we just don’t know what gets broken down into our bodies,” she says. “It’s unpredictable. What’s the mechanism? Does it happen right away, will it happen later?”

I continued to develop smaller rashes, experienced joint pain, mouth sores and swelling in my fingers, as well as other strange symptoms, like parosmia, a disorder where your brain can’t identify common odors.

Adding to the confusion, many drug allergy symptoms can be confused for symptoms caused by the bacteria that the drug has been prescribed to treat. Bacterial infections can cause rashes.

In my case, it was clear that my reaction, which was becoming serious, was caused by a drug allergy. I was prescribed a massive dose of the corticosteroid prednisone, which tapered over the next 20 days. The steroid did get the rash under control, but my symptoms would continue for weeks.

I continued to develop smaller rashes, experienced joint pain, mouth sores and swelling in my fingers, as well as other strange symptoms, like parosmia, a disorder where your brain can’t identify common odors.

To make matters worse, while going through this process I developed mastitis an eighth and final time. This time I took clindamycin, a drug that comes from a completely different antibiotic family.

I reacted again. And as a result, I finally had to stop breastfeeding.

Multiple Drug Allergy Syndrome

This time though, I noticed the mild rash after just 1 day. I stopped taking the drug, but the symptoms continued. Rashes popped up on my stomach and feet. I had a fever, mouth sores, back pain and swelling around the eyes.

Later, I discovered natural therapies to treat mastitis through my neuropathologist. Heat and cold compresses, lecithin, garlic, and I actually put cabbage leaves in my bra, which for some reason dries up the milk production. The problem is that there is no magic bullet and it takes longer. So instead of feeling sick for a day, nursing moms will feel sick for a week.

All my reactions and symptoms finally came to a sudden end in mid-July, 7 months after they started. But the fear lingered. I was afraid I’d be allergic to other antibiotics and was terrified to try another.

Seeking answers, I began doing research. I found a name for my condition: Multiple Drug Allergy Syndrome.

I finally made an appointment at the Mayo Clinic in Rochester, Minn., where I met with one of the few doctors who specialize in multiple drug allergies.

He was considerably less concerned than I was, and that gave me hope. He put together a plan so that the next time I needed antibiotics I had some reasonable options.

Photograph Visible Allergy Symptoms

Any visible allergy symptoms should be documented with a photograph, says Dr. Maria Castells, physician at Brigham and Women’s Hospital and professor of medicine at Harvard Medical School.

The antibiotics most likely to cause reactions are penicillins, cephalosporins and sulfonamides, Dr. Castells says.

A Kaiser Permanente study in 2009 found that 7.9% of the population is allergic to penicillin, 4.3% to sulfanimides, and 1.2% to macrolides. Females are more likely to be affected, Dr. Lee says.

The good news is that a lot of research is being done on this topic, she says, “especially on genetic determinants and tests to predict allergies.”

Adding more hope for sufferers, antibiotic allergies are often transient, meaning one can be allergic at one time in their lives and then grow out of it 10 years later, Dr. Lee says.

Also, multiple drug allergies does not mean ALL drug allergies.

“Patients can be allergic to multiple medications, but that is rare,” says Dr. Castells. “Most of the time two or three medications are responsible. There is always an antibiotic that a patient can take.”

Two types of tests are available to determine if you might be allergic to penicillin or cephalosporins: A skin test and graded challenge. The skin test involves inserting a small amount of penicillin under the skin. If a red, itchy bump forms, then the patient is allergic. If not, it doesn’t necessarily mean they are not allergic. The patient could still have a non-immediate, delayed reaction. The graded challenge takes place in a doctor’s office with a low dose of penicillin. The dose is increased. If no reaction, the doctor feels it’s safe to prescribe the antibiotic.

As for me, I’m happy to report that I have since been able to take the antibiotics Levaquin (levofloxacin) and Zyvox (linezolid) with no reaction. However, I do avoid antibiotics whenever possible. If there’s another way to treat a condition, I choose that route.

4 Foods That Can Mess With Your Meds

You probably know that you shouldn’t mix certain medications because of the risk of dangerous drug-drug interactions. And you’ve probably heard the common warnings to avoid taking some types of medication on an empty or full stomach or with alcohol.

But you may not be aware of food-drug interactions, which can occur when a medication interacts with a food or beverage and causes undesirable effects. The medication may not work as well as it should, or the combination can cause a negative side effect or worsen an existing one. Also, it may prevent your body from fully absorbing the nutrients from the food or beverage in question.

“There are different types of interactions, and the magnitude of the interaction depends on many factors,” says Lingtak-Neander Chan, PharmD, a professor of pharmacy at the University of Washington and elected fellow of the American College of Nutrition. For example, your age, sex, medical history, body weight, and number and dosage of medications used can all influence the way drugs and nutrients interact in your body.

“There is also a lot of misleading information out there on the Internet,” he notes.

We highlight 4 of the most common medications that can be affected by specific foods or drinks, along with tips on how to avoid these interactions. However, you should always talk to your doctor if you are concerned about potential interactions with medications you are taking or plan to take.

High blood pressure/heart disease meds and potassium-rich foods like bananas, potatoes and licorice

banana-140More specifically, angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs). ACE inhibitors include drugs like lisinopril, ramipril, enalapril and captopril, while some examples of ARBs are losartan, valsartan, candesartan and telmisartan. These meds, which are used to treat high blood pressure and heart disease, make blood vessels relax and dilate, decrease the heart’s workload and improve circulation.

“These drugs have the tendency to increase potassium retention by the body, and elevated potassium concentration in the blood increases the risk for developing irregular heartbeats,” explains Chan. People taking ACE inhibitors or ARBs should limit their intake of high-potassium foods like bananas, oranges, avocados, tomatoes, white and sweet potatoes and dried fruits — especially apricots.

On the other hand, natural licorice root contains a compound called glycyrrhizin, which can decrease potassium levels and throw off heart rhythms. “Bottom line, too much or too little potassium in the blood can cause dangerous and life-threatening cardiac side effects,” says Cimperman. Black licorice candy, licorice tea, and, of course, licorice root should be avoided while taking these drugs. And stay away from salt substitutes. Many have simply replaced the sodium with potassium.

Antibiotics & dairy products

MilkQuinolone antibiotics like Cipro (ciprofloxacin), levofloxacin and moxifloxacin, and tetracyclines like doxycycline and minocycline, bind to the calcium in dairy-based foods and beverages.

“Dairy products and calcium-rich products decrease the absorption of these antibiotics from the gut, which may lead to treatment failure for infections,” says Chan. In one study, the absorption of ciprofloxacin was reduced by up to 36% when participants took the drug at the same time as milk or yogurt. Other research found that even small amounts of milk that were added to coffee or black tea — containing very little calcium overall — had a major impact on the absorption of tetracycline.

You should take extra care to avoid the risk of minimizing the infection-fighting effects of the drug. Milk, cheese, ice cream, yogurt and butter, as well as calcium-fortified foods such as some juices and cereals, should not be taken while on these particular types of antibiotics. If for some reason these “cannot be avoided, separate the drug and dairy products by at least 2 hours,” Chan advises.

Statins & grapefruit…or maybe not

grapefruit-140“With certain statins that lower ‘bad’ cholesterol levels, such as simvastatin [Zocor] and atorvastatin [Lipitor], it’s important to avoid grapefruit and grapefruit juice consumption because it can raise statin levels in the blood and increase the risk for serious side effects,” according to Kennedy. Grapefruit can increase absorption of the statins and lead to symptoms like dizziness, muscle pain and kidney failure, adds Chan.

However, he notes that the research that reported those effects used double-strength grapefruit juice, made by mixing frozen grapefruit juice concentrate with 1 can of water instead of the usual 2.

“There is no strong evidence showing ready-to-drink grapefruit juice or eating grapefruit results in the same magnitude of drug-nutrient interaction, though from the patient safety perspective, it is often recommended to patients who are taking these medications to avoid drinking grapefruit juice altogether,” he says.

Opt for other fruits like oranges, kiwi fruit, blood oranges and other fresh produce instead, suggests Kennedy.

Warfarin & vitamin K leafy greens.

broccoliThis anticoagulant — or blood-thinner — called Coumadin can help prevent dangerous blood clotting in patients with certain heart conditions. Because “vitamin K is important for numerous reactions that cause blood to clot properly, significant changes in vitamin K intake will affect the time it takes for blood to clot and likely require a change in warfarin dose,” according to Lisa Cimperman, MS, RDN, LD, a clinical dietitian at University Hospitals Case Medical Center in Cleveland and spokesperson for the Academy of Nutrition and Dietetics.

It is not necessary or advisable to avoid vitamin K-rich foods altogether, however — just be consistent. The key is to “maintain a consistent and moderate day-to-day intake of vitamin K-rich foods such as broccoli, cabbage, collard greens, spinach, kale and turnip greens,” says Stacy Kennedy, MPH, RD, a senior clinical nutritionist at the Dana-Farber Cancer Institute at Brigham and Women’s Hospital in Boston, and co-founder of Wellness Guides.

Mango, avocado, cranberry juice or cranberry products can have similar effects, but “rather than avoid these heart-healthy foods completely, speak with your doctor before adding them so they can help you plan ahead and monitor your blood closely as you shift to a healthier diet,” she recommends.

Talk to Your Doc to Balance Your Diet & Your Meds

Consider this a general primer to help alert you to some common potential effects of mixing certain foods and medications, but be sure to learn what’s best for you by talking to your health care providers.

“It is imperative that individuals discuss all their medications and supplements with their physician and pharmacist,” says Cimperman. “In the case where there is a significant food-drug interaction, consult with a registered dietitian to make sure your diet is nutritionally complete while avoiding problematic foods.”

Quick Hits: FDA Limits Use of Antibiotics Class, Misusing Rx Drugs & More

Use of a common class of antibiotics should be limited due to a risk of potentially permanent side effects. The FDA has approved safety labeling changes for fluoroquinolones given that an agency safety review found that both oral and injectable fluoroquinolones are associated with disabling side effects involving tendons, muscles, joints, nerves and the central nervous system. These side effects can happen hours to weeks after the drug is taken. Common fluoroquinolones include Levaquin (levofloxacin), Cipro (ciprofloxacin), Avelox (moxifloxacin), Floxin (ofloxacin) and Factive (gemifloxacin). The new labeling also limits fluoroquinolones to patients who are unable to take other antibiotics for acute bacterial sinusitis, acute bacterial exacerbation of chronic bronchitis and uncomplicated urinary tract infections. Posted July 26, 2016. Via FDA.

Half of Americans may be misusing their prescription medications by taking other drugs that could lead to drug-drug interactions, according to a new report from Quest Diagnostics. The lab test company analyzed more than 3.1 million results from lab specimens collected between 2011 and 2015. Quest found that last year, 54% of the specimens indicated misuse of prescription drugs, mostly as a result of taking other drugs either non-prescribed or illicit. The figure was 53% in 2014 and 63% in 2011. Results also showed that 28.6% of samples that tested positive for heroin also tested positive for benzodiazepines. Most troubling was that benzodiazepines were not prescribed in 90% of these cases. Benzos were found to be the most popular drug that led to “inconsistent” test results among all age groups, followed by opioids. Posted July 27, 2016. Via Quest Diagnostics.

The FDA has approved a new once-daily injection to treat type 2 diabetes. Adlyxin (lixisenatide) is known as a glucagon-like peptide-1 (GLP-1) receptor agonist. Other approved drugs in this class include Byetta (exenatide), Victoza (liraglutide) and Trulicity (dulaglutide). Adlyxin’s safety and effectiveness was demonstrated in 10 clinical trials that enrolled 5,400 patients with type 2 diabetes. In addition, patients at risk for atherosclerotic cardiovascular disease treated with Adlyxin did not have an increased risk of cardiovascular adverse events. The most common side effects seen with Adlyxin were nausea, vomiting, headache, diarrhea and dizziness. Hypoglycemia was also evident in some patients treated with both Adlyxin and other antidiabetic drugs. Posted July 28, 2016. Via FDA.