Nerve Damage and Fluoroquinolone Antibiotics

The US Food and Drug Administration (FDA) is requiring updated labeling on fluoroquinolone antibiotics that includes a stronger warning of the drugs’ potential to cause rapid, and potentially permanent, development of peripheral neuropathy.

Peripheral neuropathy, which affects up to 70% of people with diabetes, is a type of nerve damage that can cause symptoms such as pain, numbness, and tingling in the hands, legs, arms, and feet. The condition is a known risk factor of systemic fluoroquinolones, and warnings about the risk were added to the drugs’ labels in 2004. After reviewing the FDA Adverse Event Reporting System (FAERS) database, the FDA determined that the potentially rapid onset and risk of permanent peripheral neuropathy related to these medicines had not been adequately described.


Peripheral neuropathy can develop at any time while a person is being treated with a fluoroquinolone and can last for months or years after the medicine is stopped. The FDA recommends doctors switch their patients to another type of antibiotic if symptoms of peripheral neuropathy develop, unless continued use of the medicine outweighs the risk.

Approved fluoroquinolones include levofloxacin (brand name Levaquin), ciprofloxacin (Cipro), moxifloxacin (Avelox), norfloxacin (Noroxin), ofloxacin (Floxin), and gemifloxacin (Factive). The risk for peripheral neuropathy appears only to occur with medicines that are administered orally or by injection; topical formulations applied to the ears or eyes are not known to carry the risk.

As we reported last week, this class of medicines has also recently been linked with the potential for severe swings in blood glucose.

If you are prescribed a fluoroquinolone and develop symptoms of peripheral neuropathy, be sure to speak to your health-care provider.

For more information, see this article on MedPage Today or read the FDA’s safety announcement.

  • Mary G

    I was prescribed Levaquin capsules as a precaution prior to eye surgery. I read the insert before I took it and found it has been associated with Achilles tendon rupture and after only 1 to 10 days after taking it. I called my doctor and got a different antibiotic!

    There is also a possibility for developing rhabdomyolysis, which could be made worse if also taking statin drugs that are prescribed for most diabetics.

    Antibiotics can be useful, but they are not harmless. The last thing we need is peripheral neuropathy, ruptured Achilles tendons, and destroyed muscles!!!!

  • Linda from Boston

    I took Levaquin 8 years ago. I can barely walk my leg muscles hurt so much. I am allergic not to just about every medication and food. No dairy, sugar, gluten or anything with preservatives in it. I only eat to iive now. Levaquin has ruined my life from just 9 pills. Do not take any FQ.

  • Sharon

    After hip replacement , I had 10 weeks of Vancomycin through a Pic line- I had MRSA! Shortly after, was diagnosed with fibromyalgia.
    Could the Vanco been a factor in that and my Type II diabetes? Just wondering! Thanks.

  • Audrey

    Sharon, your MRSA, not to mention your surgery itself, could very well have “triggered” the fibromyalgia rather than the medications you were on post-op. Fibro symptoms can start after a multitude of events & physical trauma is very much one of them; even severely stressful situations can provoke onset of symptoms–if I’m remembering that right, that is.

  • Barbara Fiedler

    How about gastroparesis as a neuropathy?? I mean it is a neuropathy, but when discussing them everyone goes immediately to the hands and feet. I have taken cipro for bladder infections many times since I can’t take sulfa. I have gastroparesis now, and honestly it seems to have come one suddenly!! I have always had good A1c’s, have taken good care of myself. When I mentioned this to my gastroenterologist, she responded with it is sometimes length of time with diabetes, not control!! So now we’re to believe that taking care of ourselves is NOT helpful after all? I don’t think so!

    My Mom was ill, she had cancer in her stomach. We were all concerned, and I was in Corpus with her at the hospital. My stomach was acting up like crazy. I just put it down to stress. When I returned home I mentioned it to my primary physician. He sent me to gastro who ran an eating test. That’s when I found out about the gastroparesis. Before this time I had no eating problems what so ever.

    Just curious about the cipro??

  • Kathleen

    Thanks for the information. I printed it out and will take it to my next Dr. app. to be put in my records. I find I forget things and this is too important to forget.