CIPRO antibiotics can blow out your tendons?

[Misciagno]

Sorry coach if this was already addressed somewhere, but I did a search and couldn't find anything...

I'm posted overseas (Africa) and caught a bug from something I ate or drank. The embassy doc gave me cipro for three days and it seems to be working. Unfortunately, I was just about to start my intermediate TM program this weekend after wearing out my novice progression, and I read that cipro can damage your tendons and that exercise should be curtailed. I asked the doc about this and he said definitely no lifting for at least a week after finishing the pills. Have you heard about this issue before? Is it possible that my achilles tendons will rip apart if I try to squat just because I took cipro for three days? I'm definitely bummed - I was really looking forward to an awesome workout tomorrow...

[Mark Rippetoe]

Nothing can change your tendon composition in 3 days. Chronic use definitely has an effect, but your doctor is just covering his ass as usual.

[vkp78]

Hi Misciagno,
Tendinitis/rupture usually of the Achilles tendon can occur as an adverse effect of cipro during therapy or even months after treatment. Usually in elderly patients who have other co-morbid conditions. If it happens, it happens and you have to get surgery for it. You can die, from a lot of commonly consumed meds(if you get an anaphylatic reaction or other serious adverse reaction).My poorly researched opinion:continue training but go to your doc if you have any unexplained tendon pain(ignore this post if you can't make out the difference between the normal aches and pains of hard training and the I'm screwed kind of pain).

[Misciagno]

Okay, thanks coach -- I feel better about working out today. I had heard Cipro has other nasty side effects, but the tendon thing was new to me. The whole SS program has been working so well, I hated to think some antibiotics would sidetrack me. And thank you much for the programs - at 40 y.o., I'm stronger than ever in the 20-plus years I've been "exercising."

[fanboi]

A quote from Corrao et al, who conducted a fairly large population study with 22194 cases treated with fluoroquinolones (eg ciprofloxacin which is one the fluoroquinolones most commonly associated with tendinopathy): "We can estimate that a single case of rupture of the Achilles' tendon would occur for every 5958 persons treated with fluoroquinolones (95% CI 2148, 23 085). The corresponding number needed to harm is 979 (95% CI 122, 9172) for patients who concomitantly use corticosteroids and 1638 (95% CI 351, 8843) for those aged >60 years."

"Current use of fluoroquinolones significantly increased the risk of tendon disorders as a whole (odds ratio [OR] = 1.7; 95% CI 1.4, 2.0), tendon rupture (OR = 1.3; 95% CI 1.0, 1.8) and rupture of the Achilles' tendon (OR = 4.1; 95% CI 1.8, 9.6)."

Yeah so I would go ahead and train.

[Misciagno]

Thanks -- I appreciate the posts. I went ahead and trained yesterday for an hour and a half on a volume day of TM and had absolutely no problems. Not even sore today. I'm guessing that the tendon warnings are like most of the dire side effects listed for all drugs -- there to cover the drug companies and prescribers in the unlikely case something does go wrong. In 20 years of being a runner and random lifter, followed by two years of Crossfitting, before taking up SS, my ankles and knees never even ached, so I'm pretty confident my achilles tendons are good to go. (A simplistic assessment, I know.) Everyone's feedback is nice reinforcement though.

[hamster]

A quote from Corrao et al, who conducted a fairly large population study with 22194 cases treated with fluoroquinolones (eg ciprofloxacin which is one the fluoroquinolones most commonly associated with tendinopathy): "We can estimate that a single case of rupture of the Achilles' tendon would occur for every 5958 persons treated with fluoroquinolones (95% CI 2148, 23 085). The corresponding number needed to harm is 979 (95% CI 122, 9172) for patients who concomitantly use corticosteroids and 1638 (95% CI 351, 8843) for those aged >60 years."

"Current use of fluoroquinolones significantly increased the risk of tendon disorders as a whole (odds ratio [OR] = 1.7; 95% CI 1.4, 2.0), tendon rupture (OR = 1.3; 95% CI 1.0, 1.8) and rupture of the Achilles' tendon (OR = 4.1; 95% CI 1.8, 9.6)."

Yeah so I would go ahead and train.

An OR of 4.1 for achiles tendon rupture, and you would go ahead and train?

[Mark Rippetoe]

"Current use of fluoroquinolones significantly increased the risk of tendon disorders as a whole (odds ratio [OR] = 1.7; 95% CI 1.4, 2.0), tendon rupture (OR = 1.3; 95% CI 1.0, 1.8) and rupture of the Achilles' tendon (OR = 4.1; 95% CI 1.8, 9.6)."

Do you know what this means, hamster?

[hamster]

Do you know what this means, hamster?

Sure, Rip. The Odds Ratio (OR), otherwise known as the relative odds, is simply the odds of an event given x divided by the odds of an event given y. In the example of achilies tendon rupture, it would be the odds of rupturing the tendon when using fluoroquinolones divided by the odds of rupturing the tending when NOT using fluorquinolones. The abstract says the OR = 4.1, which, roughly speaking, means it is 4.1 times more likely to rupture the achilies tendon if you're currently using fluoroquinolones. The 95% Confidence Interval is 1.8 to 9.6, which, since it doesn't cross 1 (the null value), is statistically significant.

Along the same vein, the abstract is also saying that the risk of any tendon disorder (not just rupture, and not just Achiles) is 1.7 times higher when using this class of drugs, and is the risk of any tendon rupture is 1.3 times higher.

It seems to be solid evidence against heavy lifting while on a fluoroquinolone drug, and perhaps for taking some time off afterwards too, but this is just going by the abstract. I have no idea of the quality of the research itself, which can only be judged by reading the full article. I'll do that tomorrow, and get back to you.

[Mark Rippetoe]

Sure, Rip. The Odds Ratio (OR), otherwise known as the relative odds, is simply the odds of an event given x divided by the odds of an event given y. In the example of achilies tendon rupture, it would be the odds of rupturing the tendon when using fluoroquinolones divided by the odds of rupturing the tending when NOT using fluorquinolones. The abstract says the OR = 4.1, which, roughly speaking, means it is 4.1 times more likely to rupture the achilies tendon if you're currently using fluoroquinolones. The 95% Confidence Interval is 1.8 to 9.6, which, since it doesn't cross 1 (the null value), is statistically significant.

Along the same vein, the abstract is also saying that the risk of any tendon disorder (not just rupture, and not just Achiles) is 1.7 times higher when using this class of drugs, and is the risk of any tendon rupture is 1.3 times higher.

And how high is the likelihood of a tendon rupture to begin with? Does 4.1 times as likely rise to a statistically significant probability itself? In which population? Young male athletes that don't run and don't take other drugs that predispose to the condition? 4.1 times a low number is still a low number. And what human being do you know of that ever ruptured an Achilles tendon while squatting or deadlifting?