Aortic Aneurysm and Dissection Risk from Fluoroquinolone Drugs (Cipro, Levaquin, etc.)

Aortic Aneurysm and Dissection and Fluoroquinolone Drugs 

Raising Awareness - Why?

There have been some additional questions about recent medical papers and the FDA warning about this group of drugs, which the public recognizes by names such as Cipro and Levaquin. Some may have wondered why the Bicuspid Aortic Foundation is raising awareness about this. They may wonder if it has something to do with their heart. It is not the heart, it is the aorta that is getting attention, along with tendons, muscles, and other areas of the body.

To be clear, these warnings are for the general public, for everyone. 

It is helpful to tell everyone about this.

The reason the Bicuspid Aortic Foundation is putting so much emphasis on this is because we advocate for a special group within the public at large, those who already are prone to developing aneurysms of the aorta in their chest.

Quite simply, there are important questions that we must ask:

Ascending
Aortic
Aneurysm

• If it puts the general population at risk of aneurysm and dissection, what about those who already have enlarged aortas or full blown aneurysms?

• Would this group of drugs make already enlarged, bulging aortas even worse, more dangerous, more quickly? 

Medical Papers in 2015  and the aorta.

In November 2015, two papers were published in medical journals by doctors in Taiwan and Toronto, Canada. Then in May 2016, the FDA issued a new warning.

Here is the abstract of the paper from Taiwan:

Risk of Aortic Dissection and Aortic Aneurysm in Patients Taking Oral Fluoroquinolone

Here is the paper from Toronto:
Fluoroquinolones and collagen associated severe adverse events: a longitudinal cohort study

This paper gives details about what happens to the collagen in the aortic wall:

" In the aortic wall, type I and type III are also the dominant forms of collagen,12 thereby suggesting that a medication contributing to tendon ruptures could also lead to aortic aneurysms. Indeed, pathological sections of aortic aneurysms and aortic dissections demonstrate abnormalities of collagen content, concentrations and ratios.13 Although aortic aneurysms typically develop slowly, our data suggest that fluoroquinolone prescriptions can contribute acutely to aneurysm progression and rupture."

Aneurysms Grow and Rupture More Quickly

Please note that the last sentence, which says that these drugs cause the aneurysm to grow quickly "acute .... progression" and then rupture.  So the general thought that aneurysms do not need to be checked that often, because they grow very slowly, may be dangerous for someone who has taken these drugs.

FDA Warning May 2016

Once again, here is the FDA warning from May, 2016: http://www.fda.gov/Drugs/DrugSafety/ucm500143.htm

 

Here are the first two paragraphs:

"The U.S. Food and Drug Administration is advising that the serious side effects associated with fluoroquinolone antibacterial drugs generally outweigh the benefits for patients with acute sinusitis, acute bronchitis, and uncomplicated urinary tract infections who have other treatment options. For patients with these conditions, fluoroquinolones should be reserved for those who do not have alternative treatment options.

An FDA safety review has shown that fluoroquinolones when used systemically (i.e. tablets, capsules, and injectable) are associated with disabling and potentially permanent serious side effects that can occur together. These side effects can involve the tendons, muscles, joints, nerves, and central nervous system."

While mentioning tendons, which are high in collagen, this statement does not mention the aorta. The papers from Taiwan and Toronto do.

Talking with Doctors

Taken together, these three references help me when talking to doctors about my own family. They help me remember that I should tell them if I or a loved one has ever taken one of these drugs. It also helps me ask for the safest possible drug, if I or my loved one should need an antibiotic. I hope this information helps us all. 

Staying informed together,

Asking our questions,

We are all 

Creating a Climate of Hope.

~ Arlys Velebir

                          Bicuspid Aortic Foundation

Talk to Your Doctor! Fluoroquinolones (Cipro, Levaquin, etc), Collagen Damage Warnings

Classic picture of aortic disease:
 bulging, stretching, curving due to weak connective tissue

There is never a good time to be sick, but why is it that it always seems to happen at the worst time - in this case, a long holiday week end? Yes, this Memorial Day week end my husband's painful left ear sent us to urgent care for help. While there, we had a very important conversation about the right antibiotics for him.

Ear Infection

We don't know why, but this is the second year that my husband has developed ear infection for no apparent reason. He did not suffer with this in childhood, as many children do. Now with an impressive number of birthdays to his credit, what is this all about? He was born with a bicuspid aortic valve, but more than that, there are subtle signs of other "special" things through out his body. No doubt this will move us to investigate further, looking for a reason why this is happening.

Urgent Care

After examining my husband, the doctor explained to us what he saw inside the ear. His stethoscope to my husband's chest had already alerted him to the special sound of the artificial tissue valve in my husband's chest, and he understood the special risk of infection because of that valve. In our experience since the first valve was implanted 26 years ago, this is something that has always been well understood by the doctors he has seen.

"This is in the Cipro family"

As before, both an oral antibiotic and antibiotic drops were suggested. Two choices were mentioned regarding the drops. My husband asked a second time about this. And it was then that the doctor said those words, "This is in the Cipro family"!! I immediately mentioned the recent strengthening of the FDA warning announced on May 12, 2016.  I also said that I had recently discussed this with his aortic disease doctor. We did not want anything from this family of drugs! We settled on the same drops he had received previously, from a "mycin" family, which had not been a problem for him.

Speaking Up

Likely at the pharmacy, but certainly at home, we would have read the labels and caught this. It was so much better to have the discussion directly with the doctor and avoid dealing with it after the fact. It is important to realize that this family of drugs has been available for a long time, and the latest, strongest warning was just issued May 12th. So it is important for us, as the consumers, to be informed and speak up!

My husband is very careful about the medication given to him. Ten years ago, following his last surgery, despite being very unwell in many ways, he asked the name of the medication he was being given in the hospital each time, before taking it. Human beings are fallible, prone to accidentally making mistakes.

Be Informed

Read the May 12th FDA warning.

There is a full paper available to us, published by doctors from Toronto last fall. Those with BAV and other forms of TAD already have issues with the collagen damage/weakness in their aorta and other areas of their bodies. What would taking this drug do to them?

Read it yourself! Print it out! Share it with your doctors!

Fluoroquinolones and collagen associated severe adverse events: a longitudinal cohort study

Sharing information is powerful,

Creating a Climate of Hope.

~ Arlys Velebir

                        Bicuspid Aortic Founation