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Fluoroquinolones & Tendons: Cipro Tendonitis, Rupture and What to Do

Fluoroquinolones — ciprofloxacin (Cipro), levofloxacin, moxifloxacin, ofloxacin and delafloxacin — are powerful, broad-spectrum antibiotics. They are also the drug class with the best-documented link to tendon damage: tendinitis and, less often, a complete tendon rupture, most famously of the Achilles. US and European regulators have tightened their warnings several times since 2008. This page explains which drugs are involved, what the warnings say, who is most at risk, what the proposed mechanisms are, which symptoms to act on, and what to do — with honest evidence grading, and without losing sight of the fact that these drugs can be the right, even life-saving, choice.

Important: This page is general educational information, not medical advice. If you are taking a fluoroquinolone and notice tendon pain, swelling or weakness, contact your prescriber or pharmacist promptly. Never stop or change an antibiotic — or any prescribed medication, including corticosteroids — without talking to the prescriber first: an untreated infection can be dangerous, and they can switch you to a safer alternative.

Key takeaways

  • Fluoroquinolones raise the risk of tendinitis and tendon rupture, most often of the Achilles, and carry an FDA boxed warning (since 2008). Strong
  • The absolute risk is low for most people — a few extra ruptures per 10,000 courses — but rises sharply with age over 60, corticosteroids, kidney disease and organ transplants. Strong
  • Problems can start within hours of the first dose or months after the course ends; risk is concentrated in the first one to two months. Strong
  • Since 2016 (FDA) and 2018–2019 (EMA), regulators say these drugs should not be first choice for mild infections such as uncomplicated bladder infections, sinusitis or bronchitis when alternatives exist. Strong
  • Mechanisms — collagen-degrading enzymes, direct tenocyte toxicity, mitochondrial and oxidative stress, magnesium chelation — come mostly from cell and animal studies. Emerging
  • Long-lasting, multi-system "fluoroquinolone-associated disability" is acknowledged in labeling, but its frequency, cause and treatment are uncertain. Contested

Which antibiotics are fluoroquinolones? Strong

Fluoroquinolones kill bacteria by blocking the enzymes they use to copy DNA. They are prescribed for urinary, respiratory, gut, bone and skin infections, among others. All systemic fluoroquinolones sold in the US — taken by mouth or given by injection — carry the same class boxed warning for tendinitis, tendon rupture, peripheral neuropathy and central nervous system effects.1 The European review covered quinolones given by mouth, injection or inhalation.2

Common fluoroquinolones
Generic nameExample brandNotes
CiprofloxacinCiproThe most widely prescribed; the source of the search term "Cipro tendonitis"
LevofloxacinGenericCommon for pneumonia and sinus, urinary and prostate infections
MoxifloxacinAveloxRespiratory and some abdominal and skin infections
OfloxacinGenericLinked to the highest tendon risk in several older studies89
DelafloxacinBaxdelaNewer (approved in the US in 2017); carries the same boxed warning1

Other quinolones (norfloxacin, pefloxacin, prulifloxacin and others) are marketed in some countries; the EU suspended several older non-fluorinated quinolones altogether in 2018.2 Ear and eye drops containing ciprofloxacin or ofloxacin deliver far smaller amounts into the bloodstream and were not the focus of these systemic warnings; ask your pharmacist if you are unsure which kind you have.

FDA and EMA warnings: a timeline Strong

Regulators have strengthened fluoroquinolone safety language step by step. The dates below are taken from current US prescribing information, the European Medicines Agency's referral page, and peer-reviewed papers that analyze each warning.

Key regulatory milestones
WhenRegulatorWhat changed
July 2008US FDABoxed ("black box") warning added for tendinitis and tendon rupture3
2013US FDALabel strengthened for peripheral neuropathy, which may be long-lasting56
May 2016US FDABoxed warning expanded to disabling and potentially irreversible reactions that can occur together (tendons, nerves, central nervous system); use for uncomplicated urinary tract infection, acute sinusitis and acute bronchitis reserved for people with no other options14
2018US FDAWarnings added on serious low blood sugar and mental health side effects16
December 2018US FDAWarning on increased risk of aortic aneurysm and dissection, especially in older adults and people with aneurysm risk factors7
November 2018EMA (EU)Review of disabling, potentially permanent side effects finalized: several older quinolones suspended; remaining fluoroquinolones restricted2
February–March 2019European CommissionLegally binding EU decision (14 February 2019 for inhaled levofloxacin; 11 March 2019 for oral and injectable products)2

Two points are often confused. First, the 2018 FDA changes on blood sugar, mental health and the aorta were added to the Warnings and Precautions section of the label; the boxed warning itself still centers on tendons, nerves, the central nervous system and myasthenia gravis.1 Second, the EU restrictions say fluoroquinolones should not be used for infections that may get better on their own or are not severe (such as throat infections), for non-bacterial infections, to prevent traveller's diarrhoea or recurring bladder infections, or for mild-to-moderate infections unless other recommended antibiotics cannot be used. The EMA also advises special caution in older people, people with kidney disease and transplant recipients, and avoiding combined use with corticosteroids.2

Warnings alone have had a modest effect on prescribing: one Medicare analysis found a small decline after the 2016 warning, while single-center and claims studies found no significant change after the 2016 or 2018 warnings.457 That is one reason it is worth asking, when a fluoroquinolone is offered for a minor infection, whether an alternative would work.

How common is fluoroquinolone tendon damage? Strong

The association is consistent across case-control studies, cohort studies and meta-analyses. What matters for an individual is the absolute risk, which is low for most people and much higher for a few.

~2.5×pooled odds of Achilles rupture with fluoroquinolones (meta-analysis)
2.1extra Achilles ruptures per 10,000 patients exposed (UK study)
~19×relative risk of Achilles rupture with a fluoroquinolone plus oral steroids
2–6%of Achilles ruptures over age 60 attributable to quinolones (older UK estimate)
  • A 2019 meta-analysis of 15 studies found fluoroquinolones were associated with Achilles tendon rupture (OR 2.52), Achilles tendinitis (OR 3.95) and tendon disorders generally (OR 1.98).10
  • A UK population study found current use was linked to Achilles rupture (adjusted incidence rate ratio 3.14) for up to 60 days, rising with cumulative dose. The absolute excess was about 2.1 Achilles ruptures per 10,000 patients — but rose to 6.6 per 10,000 (and 19.6 per 10,000 for any tendon rupture) in people aged 60 or over who were also taking oral corticosteroids.11
  • In 1.7 million Ontario adults aged 65 and over, current fluoroquinolone use roughly doubled the hazard of tendon rupture (adjusted HR 2.40), an effect much larger than seen with amoxicillin.13
  • An earlier UK study found an odds ratio of 4.3 for current exposure, rising to 20.4 in people aged 80 and older.9

Whether some fluoroquinolones are worse than others is less settled Contested. Ofloxacin stood out in several older studies, and in the meta-analysis's subgroup analysis ofloxacin and norfloxacin — but not ciprofloxacin or levofloxacin — were significantly linked to rupture; numbers per drug were small, and labeling treats the risk as a class effect.1810

Who is most at risk Strong

US labeling states that the risk is increased in people over 60, those taking corticosteroids, and those with kidney, heart or lung transplants, and that strenuous physical activity, kidney failure and previous tendon disorders such as rheumatoid arthritis may independently add risk. It also stresses that tendon injuries happen in people with none of these factors.1

Risk factors for fluoroquinolone tendon injury
Risk factorWhat the evidence showsEvidence
Age over 60Odds of Achilles rupture 6.4 at ages 60–79 and 20.4 at 80+ in one UK study; tendinitis association stronger over 60 (OR 8.3 vs 1.6)912Strong
Oral corticosteroids (e.g. prednisone)The biggest multiplier; five studies in a systematic review found higher risk with the combination, and lab work shows the two drugs act synergistically on tendon cells (one meta-analysis did not find its pooled estimate changed significantly by steroid use)8101117Strong
Kidney disease or dialysisNamed by FDA and EMA; one US study found a non-significantly stronger association (OR 20.0 vs 3.9)1212Strong
Kidney, heart or lung transplantNamed in US labeling and by the EMA12Strong
Previous tendon disorders, including rheumatoid arthritisNamed in US labeling as an independent risk factor1Strong
Strenuous physical activityNamed in labeling; mechanistically plausible (loading a weakened tendon)115Emerging
Women, non-obese people, diabetesStronger associations in one US study; findings not consistent across studies12Contested
If you live with arthritis: people with rheumatoid arthritis or other inflammatory conditions are often both on corticosteroids and living with tendon involvement — two of the strongest risk factors. If you are offered a fluoroquinolone, it is reasonable to remind the prescriber about both and ask whether another antibiotic would suit. See long-term corticosteroids and rheumatoid arthritis.

Why the Achilles — and which other tendons Strong

The Achilles is the tendon involved most frequently, but labeling also lists the rotator cuff (shoulder), hand, biceps and thumb, among other sites, and notes that both sides can be affected at once.1 A review of 175 papers, including 89 case reports, describes the same pattern.14 Why the Achilles is singled out is not fully known; it carries very high loads during walking and has a relatively poor blood supply in its mid-portion, which plausibly leaves less margin when its cells and collagen are under chemical stress Emerging.

Timing: hours to months Strong

According to US prescribing information, tendinitis or rupture "can occur within hours or days" of starting a fluoroquinolone "or as long as several months after completion" of therapy.1 The EMA's patient information says tendon swelling and injury may occur within 2 days of starting treatment, or even several months after stopping.2 Epidemiological studies place most of the excess risk during treatment and in the following month or two: a systematic review found the risk of Achilles rupture was greatest in the first month after exposure, and the UK study found the excess persisted for about 60 days.811

In practice, if you develop new tendon pain during a course or in the months afterwards, mention the antibiotic to whoever assesses you — it changes how cautiously the tendon should be loaded.

How fluoroquinolones may harm tendons Emerging

The clinical link is strong; the explanation for it is still being pieced together, mostly from cultured tendon cells and animal studies. Several mechanisms probably act together.15

Proposed mechanisms

  • Collagen-degrading enzymes (MMPs). In human tendon-derived cells, ciprofloxacin and norfloxacin increased expression of the collagenase MMP-1 (while reducing MMP-13), and both ciprofloxacin and levofloxacin raised MMP-1 and MMP-13 protein at drug concentrations similar to those reached in the body.1617 Emerging
  • Direct tenocyte toxicity. Ciprofloxacin reduced type I collagen and the β1-integrin receptor that anchors cells to their matrix, and both drugs activated caspase-3, a marker of programmed cell death; adding dexamethasone made the effects worse — a lab parallel to the clinical steroid interaction.17 Emerging
  • Oxidative and mitochondrial stress. In tendon cell lines, fluoroquinolones caused early oxidative stress, with toxicity varying between drugs.18 Clinically relevant doses of bactericidal antibiotics, including quinolones, caused mitochondrial dysfunction and reactive oxygen species in mammalian cells and mice.19 Emerging
  • Magnesium chelation. Fluoroquinolones bind magnesium and other metal ions. In rats, ofloxacin caused degenerative changes in Achilles tenocytes that were considerably worse on a magnesium-deficient diet, with detachment of cells from the surrounding matrix.20 Whether everyday magnesium status matters in humans is unknown. Emerging

These findings make the clinical association biologically plausible and help explain the corticosteroid interaction, but most experiments used animal cells, high concentrations or juvenile animals. They do not yet tell us how to predict or prevent tendon injury in a given person.

Symptoms to act on Strong

Possible tendinitis — call your prescriber the same day

  • New pain, tenderness or aching at the back of the heel or ankle, or another tendon
  • Swelling, warmth or a thickened, tender cord above the heel
  • Stiffness, especially first thing in the morning
  • Pain when walking, climbing stairs or rising onto your toes

Possible rupture — seek urgent care

  • A sudden snap or pop, or a feeling of being kicked in the back of the leg
  • Sudden inability to push off, walk normally or stand on tiptoe
  • A gap or dent felt in the tendon above the heel
  • Sudden shoulder or arm weakness after a pop (rotator cuff or biceps)

The EMA also lists symptoms beyond tendons that should prompt an immediate call: pain, pins and needles, numbness, burning or weakness in the arms or legs; muscle pain or joint swelling; unusual fatigue or depression; and problems with memory, sleep, vision, hearing, taste or smell.2

What to do if a tendon hurts Strong

  1. Contact your prescriber or pharmacist the same day. US labeling instructs clinicians to discontinue the fluoroquinolone at the first sign of a serious adverse reaction, and EU patient information tells patients to contact their doctor at once at the first sign of tendon pain or swelling.12 Your prescriber can then switch you to a different antibiotic so the infection is still treated.
  2. Do not simply abandon the antibiotic on your own. Stopping without a replacement can leave a serious infection untreated. Make the call — out-of-hours services and pharmacists can help — rather than quietly skipping doses.
  3. Rest the painful tendon. Stop running, jumping, hill walking, heavy lifting and other exercise that loads it until you have been assessed; both EU patient information and sports-medicine reviews advise resting the affected area.215 Gentle everyday walking is usually fine unless it is painful or a rupture is suspected.
  4. Mention any corticosteroid you take — tablets, injections or inhalers — but do not stop a steroid on your own; some cannot be stopped suddenly.
  5. Get the reaction recorded. FDA labeling and the EMA both advise avoiding fluoroquinolones in people who have had a serious reaction to one, so make sure it is noted in your medical and pharmacy records.12
Suspected tendon rupture is urgent. A sudden pop with loss of push-off strength needs same-day assessment (urgent care or an emergency department). Early diagnosis keeps both surgical and non-surgical treatment options open. Avoid walking on the leg more than necessary until you have been seen.

Recovery and rehab basics Emerging

There are no controlled trials of rehabilitation specifically for fluoroquinolone tendinopathy, so advice is extrapolated from general tendon care and expert reviews.

  • Protect first, then reload gradually. Clinical practice guidelines for Achilles tendinopathy emphasize progressive, graded loading exercise under the guidance of a physical therapist.25 Sports-medicine authors suggest a more cautious, staged approach after fluoroquinolone exposure, as the tendon may be weakened even before pain is severe.1415
  • Be wary of going straight to heavy eccentric drills. One systematic review suggested fluoroquinolone tendinopathy "may not respond well" to popular eccentric training regimens and may need an alternative, staged approach — a reasonable caution, but based on case reports rather than trials.14 Contested
  • Use pain as a guide. Mild discomfort that settles within a couple of hours is usually acceptable; pain that is worse the next morning means the load was too much. Our 2-hour pain rule explains the idea.
  • Return to sport slowly. Expert guidance for athletes recommends caution with high-load and explosive training around and after fluoroquinolone courses.15
  • Ruptures are managed with surgery or a functional boot program, followed by months of rehabilitation; the choice belongs with an orthopedic team.

A physical therapist can tailor loading to your tendon and your arthritis. See when to see a physical therapist and exercise red flags.

Fluoroquinolone-associated disability (FQAD) Contested

"Fluoroquinolone-associated disability", or FQAD, is the name used by patients and some researchers for long-lasting, multi-system symptoms after a fluoroquinolone course — tendon and muscle pain or weakness, neuropathy, fatigue, sleep and cognitive problems and psychiatric symptoms. How much of it is established depends on which part you look at:

  • That serious, sometimes lasting reactions occur together is officially recognized. Since 2016 the US boxed warning describes "disabling and potentially irreversible serious adverse reactions that have occurred together", and the EMA's 2018 review was prompted by long-lasting, disabling and potentially permanent side effects involving tendons, muscles, joints and the nervous system.12 Strong
  • Peripheral neuropathy has epidemiological support. In a large case-control study, current fluoroquinolone users had an 83% higher risk of peripheral neuropathy (RR 1.83), highest in new users.23 Strong
  • How often a persistent multi-system syndrome occurs is unknown. Much of the published description comes from case reports and case series, such as four previously healthy adults whose symptoms progressed after stopping the drug.21 These show it can happen but cannot estimate frequency or prove cause in each case. Contested
  • The mechanism and treatment are speculative. Proposed explanations center on mitochondrial and oxidative injury and mineral chelation, and proposed treatments (antioxidants, mitochondrial support, mineral replacement) are hypotheses drawn from biochemistry rather than tested therapies.22 Contested

The honest summary: patients reporting these symptoms deserve to be taken seriously and assessed properly — and other treatable causes should be looked for — while the science on how common FQAD is and how to treat it remains immature.

Magnesium, antioxidants and the holistic view Contested

Integrative and holistic practitioners often recommend magnesium, antioxidants such as N-acetylcysteine, and other "mitochondrial support" during or after a fluoroquinolone. The rationale is not baseless: magnesium deficiency worsened tendon damage in rats, and N-acetylcysteine reduced antibiotic-induced oxidative damage in cells and mice.1920 But there are no human trials showing that any supplement prevents or treats fluoroquinolone tendon damage.

Timing matters with minerals. Magnesium, calcium, iron and zinc supplements, multivitamins and antacids bind fluoroquinolones in the gut and can stop the antibiotic being absorbed — US labeling for levofloxacin says to take it at least two hours before or after such products.1 Taking magnesium "to protect your tendons" at the same time as the antibiotic could make the infection treatment fail. Ask your pharmacist how to space any supplement, and see our supplements guide.

Other serious warnings to know Strong

  • Aortic aneurysm and dissection. A Swedish cohort found a hazard ratio of 1.66 within 60 days compared with amoxicillin — about 82 extra cases per million courses — driven mainly by aneurysm.24 US labeling advises reserving fluoroquinolones for people with known aneurysm or high risk only when there is no alternative.1 Sudden severe chest, back or abdominal pain is an emergency.
  • Blood sugar swings. Both low and high blood sugar have been reported, mostly in people with diabetes taking insulin or sulfonylureas; severe hypoglycemia leading to coma or death has occurred.16
  • Mental health and nervous system effects — agitation, confusion, insomnia, depression and, rarely, psychosis — can appear after the first dose.1
  • Myasthenia gravis can be worsened; labeling advises avoiding these drugs in people with a history of it.1

When to see a doctor Strong

Seek urgent, same-day care if you have taken a fluoroquinolone and:
  • feel a sudden pop or snap in a tendon, or cannot push off or stand on tiptoe;
  • develop sudden severe chest, back or abdominal pain;
  • have symptoms of low blood sugar (shakiness, sweating, confusion), especially with diabetes;
  • have thoughts of self-harm, severe agitation or confusion;
  • develop new muscle weakness or difficulty breathing.

Contact your prescriber or pharmacist promptly (the same day where possible) if you have:

  • new tendon pain, swelling or stiffness during a course or in the months afterwards;
  • tingling, burning, numbness or weakness in the hands or feet;
  • been offered a fluoroquinolone and are over 60, take corticosteroids, have kidney disease or a transplant, or have had a reaction to one before;
  • persistent symptoms months after a course that have not been explained.

Frequently asked questions

Can Cipro cause tendonitis or a torn Achilles tendon?

Yes. Ciprofloxacin (Cipro) and the other fluoroquinolones — levofloxacin, moxifloxacin, ofloxacin and delafloxacin — carry a US FDA boxed warning for tendinitis and tendon rupture, and the Achilles is affected most often. Large observational studies show the risk is real but uncommon, and much higher in people over 60, people taking corticosteroids, and people with kidney disease or an organ transplant. This is educational information, not medical advice.

How soon after taking a fluoroquinolone can tendon problems start?

US prescribing information says tendinitis or rupture can occur within hours or days of starting the drug or as long as several months after finishing it. Observational studies find the risk is highest during treatment and in roughly the first one to two months afterwards.

Should I stop my antibiotic if my tendon hurts?

Contact your prescriber or pharmacist the same day. Official US and EU product information tells patients to report tendon pain or swelling straight away, because the prescriber will usually stop the fluoroquinolone and switch you to a different antibiotic so the infection is still treated. Do not simply abandon treatment without that conversation, and rest the painful tendon in the meantime. A sudden pop or snap with inability to push off the foot needs urgent care.

Is fluoroquinolone tendon damage permanent?

Many cases of tendinitis settle over weeks to months once the drug is stopped and the tendon is protected and gradually reloaded. A complete rupture usually needs surgical or boot-based treatment and a long rehabilitation. Regulators acknowledge that some people develop disabling, potentially irreversible effects involving tendons, muscles, joints and nerves, but how often this happens and how best to treat it are not well established.

Can I take a fluoroquinolone again after a tendon reaction?

FDA labeling and the European Medicines Agency both advise that fluoroquinolones should generally be avoided in people who have had a serious reaction to one before. Make sure the reaction is recorded in your medical and pharmacy records and tell every prescriber about it.

References

  1. US prescribing information (FDA-approved labeling) for levofloxacin, moxifloxacin and delafloxacin (Baxdela): Boxed Warning; Warnings and Precautions 5.1–5.2 (tendinopathy and tendon rupture), aortic aneurysm and dissection, blood glucose disturbances, psychiatric adverse reactions; Drug Interactions (chelation agents). U.S. National Library of Medicine, DailyMed. dailymed.nlm.nih.gov
  2. European Medicines Agency. Quinolone- and fluoroquinolone-containing medicinal products — referral (review finalized 15 November 2018; European Commission decisions 14 February and 11 March 2019). ema.europa.eu
  3. Tanne JH. FDA adds "black box" warning label to fluoroquinolone antibiotics. BMJ. 2008;337:a816. PubMed 18632714
  4. Bratsman A, Mathias K, Laubscher R, Grigoryan L, Rose S. Outpatient fluoroquinolone prescribing patterns before and after US FDA boxed warning. Pharmacoepidemiol Drug Saf. 2020;29(6):701–707. PubMed 32390266
  5. Sankar A, Swanson KM, Zhou J, et al. Association of fluoroquinolone prescribing rates with black box warnings from the US Food and Drug Administration. JAMA Netw Open. 2021;4(12):e2136662. PubMed 34851398
  6. Althaqafi A, Ali M, Alzahrani Y, Ming LC, Hussain Z. How safe are fluoroquinolones for diabetic patients? A systematic review of dysglycemic and neuropathic effects of fluoroquinolones. Ther Clin Risk Manag. 2021;17:1083–1090. PubMed 34675522
  7. Rizk JG, Slejko JF, Heil EL, Seo D, Qato DM. Impact of the US Food and Drug Administration warning regarding increased risk of aortic aneurysms or aortic dissections on fluoroquinolone prescribing trends. BMJ Open Qual. 2024;13(3):e002925. PubMed 39053916
  8. Stephenson AL, Wu W, Cortes D, Rochon PA. Tendon injury and fluoroquinolone use: a systematic review. Drug Saf. 2013;36(9):709–721. PubMed 23888427
  9. van der Linden PD, Sturkenboom MC, Herings RM, Leufkens HM, Rowlands S, Stricker BH. Increased risk of Achilles tendon rupture with quinolone antibacterial use, especially in elderly patients taking oral corticosteroids. Arch Intern Med. 2003;163(15):1801–1807. PubMed 12912715
  10. Alves C, Mendes D, Marques FB. Fluoroquinolones and the risk of tendon injury: a systematic review and meta-analysis. Eur J Clin Pharmacol. 2019;75(10):1431–1443. PubMed 31270563
  11. Morales DR, Slattery J, Pacurariu A, Pinheiro L, McGettigan P, Kurz X. Relative and absolute risk of tendon rupture with fluoroquinolone and concomitant fluoroquinolone/corticosteroid therapy: population-based nested case-control study. Clin Drug Investig. 2019;39(2):205–213. PubMed 30465300
  12. Wise BL, Peloquin C, Choi H, Lane NE, Zhang Y. Impact of age, sex, obesity, and steroid use on quinolone-associated tendon disorders. Am J Med. 2012;125(12):1228.e23–1228.e28. PubMed 23026288
  13. Daneman N, Lu H, Redelmeier DA. Fluoroquinolones and collagen associated severe adverse events: a longitudinal cohort study. BMJ Open. 2015;5(11):e010077. PubMed 26582407
  14. Lewis T, Cook J. Fluoroquinolones and tendinopathy: a guide for athletes and sports clinicians and a systematic review of the literature. J Athl Train. 2014;49(3):422–427. PubMed 24762232
  15. Hall MM, Finnoff JT, Smith J. Musculoskeletal complications of fluoroquinolones: guidelines and precautions for usage in the athletic population. PM R. 2011;3(2):132–142. PubMed 21333952
  16. Corps AN, Harrall RL, Curry VA, Hazleman BL, Riley GP. Contrasting effects of fluoroquinolone antibiotics on the expression of the collagenases, matrix metalloproteinases (MMP)-1 and -13, in human tendon-derived cells. Rheumatology (Oxford). 2005;44(12):1514–1517. PubMed 16148020
  17. Sendzik J, Shakibaei M, Schäfer-Korting M, Lode H, Stahlmann R. Synergistic effects of dexamethasone and quinolones on human-derived tendon cells. Int J Antimicrob Agents. 2010;35(4):366–374. PubMed 20034766
  18. Pouzaud F, Bernard-Beaubois K, Thevenin M, Warnet JM, Hayem G, Rat P. In vitro discrimination of fluoroquinolones toxicity on tendon cells: involvement of oxidative stress. J Pharmacol Exp Ther. 2004;308(1):394–402. PubMed 14569066
  19. Kalghatgi S, Spina CS, Costello JC, et al. Bactericidal antibiotics induce mitochondrial dysfunction and oxidative damage in mammalian cells. Sci Transl Med. 2013;5(192):192ra85. PubMed 23825301
  20. Shakibaei M, Pfister K, Schwabe R, Vormann J, Stahlmann R. Ultrastructure of Achilles tendons of rats treated with ofloxacin and fed a normal or magnesium-deficient diet. Antimicrob Agents Chemother. 2000;44(2):261–266. PubMed 10639347
  21. Golomb BA, Koslik HJ, Redd AJ. Fluoroquinolone-induced serious, persistent, multisymptom adverse effects. BMJ Case Rep. 2015;2015:bcr2015209821. PubMed 26438672
  22. Michalak K, Sobolewska-Włodarczyk A, Włodarczyk M, et al. Treatment of the fluoroquinolone-associated disability: the pathobiochemical implications. Oxid Med Cell Longev. 2017;2017:8023935. PubMed 29147464
  23. Etminan M, Brophy JM, Samii A. Oral fluoroquinolone use and risk of peripheral neuropathy: a pharmacoepidemiologic study. Neurology. 2014;83(14):1261–1263. PubMed 25150290
  24. Pasternak B, Inghammar M, Svanström H. Fluoroquinolone use and risk of aortic aneurysm and dissection: nationwide cohort study. BMJ. 2018;360:k678. PubMed 29519881
  25. Chimenti RL, Neville C, Houck J, Cuddeford T, Carreira D, Martin RL. Achilles pain, stiffness, and muscle power deficits: midportion Achilles tendinopathy revision — 2024. J Orthop Sports Phys Ther. 2024;54(12):CPG1–CPG32. PubMed 39611662