FQAD &
Fluoroquinolone Toxicity
“Fluoroquinolone toxicity syndrome is a pervasive condition that negatively impacts nearly every part of the body.”
-Jay S. Cohen MD
“Doctors must understand that a patient with Fluoroquinolone Toxicity syndrome is not having a simple adverse reaction. The patient's original genetic profile has been altered, mutated, and their symptoms and health complaints are real, not psychosomatic."
- DR. JOE KING
As stated on the black box warning for fluoroquinolones:
“Flouroquinolones have been associated with disabling and potentially irreversible serious adverse reactions that have occurred together including: tendinopathy and tendon rupture, peripheral neuropathy, and central nervous system effects.”
Fluoroquinolone-Associated-Disability (FQAD) is the term addressed by the FDA in 2015 when discussing this multi-system illness that can be caused after fluoroquinolone antibiotic use. However, it is more commonly referred to as Fluoroquinolone Toxicity (Syndrome) within the community of those affected, Physicians who work with patients that have the condition, as well as drug regulator authorities.
As the boxed warning states; “adverse reactions that have occurred together” of the “tendons, central nervous system effects, and neuropathy” as well as reports of neurotoxicity (+) and mitochondrial toxicity. (+) It is important to understand people suffering with this condition are typically experiencing symptoms in multiple body systems at the same time resulting in a “constellation of symptoms” as described by the FDA. Common complaints including but not limited to the sudden onset of: depression, insomnia, neuropathies and nerve related damage, tendon pain, muscular weakness sometimes accompanied with atrophy, anxiety, cognitive impairments, and more can be onsetting and occurring all at the same time resulting in disability; Fluoroquinolone-Associated-Disability.
As the PubMD article published on FQAD states, “Fluoroquinolone antibiotic therapy appears in recent years as a significant medical and social problem, because patients suffer for many years after being prescribed antimicrobial FQ treatments from tiredness, concentration problems, neuropathies, tendinopathies, and other symptoms”. It is important to note the degree to which these symptoms are occurring is debilitating to normal day life functions resulting in the conditions name of Fluoroquinolone-Associated-Disability.
As stated by the FDA when providing diagnostic criteria for this condition that is also mentioned by Stefan Piper, MD in his book, Fluoroquinolone associated Disability- Pathogenesis, Diagnostics, Therapy and Diagnostic Criteria:
“A substantial disruption of a person’s ability to conduct normal life functions with two or more of the following body systems effected:
Peripheral Nervous System
Neuropsychiatric
Musculoskeletal
Sensory/senses
Cardiovascular
Skin
These symptoms are long standing for 30 days or more after the discontinuation of the medication.”
As we can see FQAD is not an adverse effect that resolves after the medication is discontinued. People with this disability can suffer for years or the condition can remain permanent as the boxed warning states.
**In studies done the FDA has reported these symptoms lasting 14 months to 9 years on average ( + )
Stefan Pieper MD states FQAD affects the following body systems:
Mitochondria dysfunction, oxidative stress, mtDNA and genetic mutation.
Collagen damage and up regulation of various enzymes like MMP-2 leading to collagen and connective tissue degration, affecting tendons, joints, and the muscle skeletal system.
Damage of the peripheral nervous system resulting in neuropathies that in some cases can lead to permanent physical disability.
Neuropsychiatric symptoms due to the inhibition of the neurotransmitter GABA receptors by FQs (+) (+)
Potential symptoms that can occur together as a result can look like (Including but not limited to):
+Chronic Fatigue Syndrome
+Insomnia, nightmares, night terrors
+Peripheral neuropathy
+Depersonalization
+Suicide tendencys
+Tendinopathy, tendon weakness and pain
+Muscle weakness, fatigue, and/or muscle atrophy
+Neuropathy, weakness in extremities, pins and needle sensations, skin sensory impairment, numbness
+Cardiac arythmias
+Small fiber neuropathy
+Gastrointestinal complaints and complications
+Dysautonomia (Central Nervous System Effects)
+Hallucinations and auditory hallucinations
+Psychosis
Some other symptoms of FQAD have also been reported via Jay Cohen MD:
+Cardiac arythmias
+Arotic anyurims
+Liver disorders
+Kidney failure
FACTS ABOUT FQAD
+As reported on the BBW symptoms have been reported as both beginning during the course of FQs or 6 months+ after the discontinuation of it, and sometimes longer. (+)
+We have research suggesting FQs accumulate within the cells. The onset of this condition can be accumulative over several courses of the abx or with one single dose. (+)
+Exercising during or after the use of FQs can increase the risks of disability. Sports Medicine Specialists have advised against FQ treatment in athletes. (This is not just due to the potential of tendon ruptures but, cellular nutritional deficiencies and mitochondrial dysfunction) (+)
+Some medications that contain fluoride/flourine or that can induce mitochondrial toxicity (ex: NSAIDS & Steroids) may increase risks. It may also exaggerate the already existing condition.
+Dietary and lifestyle changes including eliminating steroid and antibiotic meat sources can sometimes be necessary in order for people with FQAD to regain their quality of life or manage symptoms.
+FQAD patients may develop a lifelong sensitivity to all forms of fluoride and quinolones/quinine. (Including forms naturally found in nature and non-natural forms from water, medications, beverages, plants, etc.) (See here)
+FQs chelate essential minerals outside of the cell which can be long standing in those with FQAD and “is thought to produce all the other toxic conditions involved”. Therefore supplementation of these chelated minerals can be seen as a therapy option as reported by Pubmed. (+) (+)
What can Peripheral Neuropathy look like?
Peripheral Neuropathy is one of the more prominent symptoms that go over looked in FQAD (and also neuropsychiatric symptoms) since only tendinopathy is more widely know about it. Lets highlight what PN can look like:
Any of the following (but not limited to):
Numbness in extremities
Pins and needles sensation
Not feeling temperature changes on skin
Loss of nerve connection resulting in muscle weakness or atrophy
Muscle spams, involuntary movement, and muscle twitching
Learn more about peripheral neuropathy here.
Reminder: Symptoms may appear during the abx treatment or months after the discontinuation of it, sometimes longer, and be exacerbated or brought on later by the use of other fluorinated medications or other known medications that contribute to mitochondrial toxicity. Ex: NSAIDS
+People with less noticeable symptoms may not be aware they have fluoroquinolone toxicity until symptoms are severely exacerbated after the use of other fluorided medications or MT medications like NSAIDS.
Listed out is 3 reasons to consider why side-effects to FQs can result into FQAD as a long-term or permanent condition
as reported by PubMed:
“Long-lasting oxidative stress destroys the mitochondrial DNA and the newly synthesized proteins creating cytochrome complexes are so disturbed in their structure leading to permanent electron leakage and oxidative stress.”
“The complexes of FQs with proteins and cations are so stabile that they exist in the cells by many years disturbing energy production and epigenetics.”
“Epigenetic changes in gene regulation become persistent many years after FQ application even in the case of lack of FQ in the cell.”
Who is susceptible to developing FQAD after FQ usage?
Anyone thats why the black boxed warning exists.
PubMDs article written on FQAD states that, “a case-series study showed the potential occurrence of serious, persistent, and delayed multi-symptom serious side effects apparently triggered by FQ use causing severe functional compromise and disability in previously vigorous, healthy individuals.”
A study lead by Joe King MD was conducted where several people with FQAD were selected at random. In this study the FQAD patients were previously healthy people with no health conditions prior to FQ use and were looked at by multiple professionals including a biochemist, microbiologist, pharmacologist, toxicologist, and a biogenetic engineer. After the study was done they discovered, “The conclusion was unequivable: the genetic abnormalities found in the study group were undeniable, and the FQs were the only profitable explanation for these people’s severe, prolonged illnesses.” -JAY S. Cohen, MD in The Hidden Dangers of Antibiotics
With that said, Jay. S Cohen MD suggests these would make patients more susceptible according to our currently (and very limited) proven research:
+Use of corticosteroids
+Sports activities or intense exercise
+Magnesium deficiency
+Previous trauma to tendons or joints
+History of organ transplants
+End stage of Kidney disease
It has also been reported that coprescription of other medications including but not limited to ibprofen can increase FQAD risk.
DID YOU KNOW?
The committee for the European Medicine Agency (EMA) recommended suspending entirely or restricting the use of fluoroquinolone and quinolone antibiotics because of the risk for “disabling and potentially permanent” adverse effects, the agency announced in 2018.
Drug regulator authorities have been petitioning the FDA to accept FQT/FQAD as a condition to be billed to insurance for years.
A news channel reported an estimated of MILLIONS people affected by this condition in 2018.
Oprah Winfrey aired on her television show interviewing 3 women who suffered long term severe adverse effects to fluoroquinolones back in 1993.
The Black Boxed Warning:
These are the symptoms directly taken off the Black Box warning for fluoroquinolones that make up the condition of FQAD and as stated, “can occur together at the same time in the same patient”
Central Nervous System Effects:
BBW list of CNS Effects:
Restlessness
Dizziness
Insomnia
Nightmares
Hallucinations
Paranoia
Psychosis (toxic) Manic Reaction
Irritability
Tremor
Ataxia
Seizures (including Status Epilepticus) Malaise
Anorexia
Phobia
Depersonalization
Depression (potentially culminating in self- injurious behavior
(such as suicidal ideations/thoughts and attempted or completed suicide)
Paresthesia
Abnormal Gait
Migraine
“Fluoroquinolones, including CIPRO, have been associated with an increased risk of central nervous system (CNS) effects, including. convulsions, increased intracranial pressure (including pseudotumor cerebri), and toxic psychosis CIPRO may also cause central nervous system (CNS) events including: nervousness, agitation, insomnia, anxiety, nightmares, paranoia, dizziness, confusion, tremors, hallucinations, depression, and psychotic reactions have progressed to suicidal ideations/thoughts and self-injurious behavior such as attempted or completed suicide. These reactions may occur following the first dose.” “CIPRO, like other fluoroquinolones, is known to trigger seizures or lower the seizure threshold.”
Tendon Effects:
“Fluoroquinolones, including CIPRO, have been associated with an increased risk of tendinitis and tendon rupture in all ages and adverse reactions.” ..“Tendinitis or tendon rupture can occur, within hours or days of starting CIPRO, or as long as several months after completion of fluoroquinolone therapy”
Peripheral Neuropathy:
“Fluoroquinolones, including CIPRO, have been associated with an increased risk of peripheral neuropathy. Cases of sensory or sensorimotor axonal polyneuropathy affecting small and/or large axons resulting in paresthesias, hypoesthesias, dysesthesias and weakness have been reported in patients receiving fluoroquinolones, including CIPRO. Symptoms may occur soon after initiation of CIPRO and may be irreversible in some patients.”
“Fluoroquinolones, including CIPRO, have been associated with disabling and potentially irreversible serious adverse reactions from different body systems that can occur together in the same patient. Commonly seen adverse reactions include tendinitis, tendon rupture, arthralgia, myalgia, peripheral neuropathy, and central nervous system effects (hallucinations, anxiety, depression, insomnia, severe headaches, and confusion).”
Symptoms list as provided by Dr. Ghalil MD DO via his website
+Muscle Wasting
+Tendon Pain
+Tendon Rupture
+Joint Pain
+Psychosis
+Hallucinations
+Anxiety
+Depresssion
+Insomnia
+Hypersensitivity
+Ear Ringing
+Burning Neuropathy
+Brain Fog
+Memory Loss
+Paranoia
+Death
Common Symptoms as provided by Dr. Ron Hanson via his website
+Fatigue
+Leg Pain
+Brain Fog
+Confusion
+Anxiety
+Neuropathy
+Muscle twithcing
+Suicidal Thoughts
+Joint Pain
“Peripheral Neuropathy is damage to the nerves that exist outside of the brain and spinal cord. It typically causes weakness, numbness, burning, or paresthesia in the lower extremities. Your peripheral nerves are vital for sending sensory information to the spinal cord and brain which allows you to know if something is too hot for example. Neuropathy can also affect organs of the body leading to cardiac arrythmias, bladder incontinence, and gut motility issues.”
-Dr. Mark Ghalil, DO
‘FQs act as inhibitors of a chemical group known as topoisomerase enzymes. Topoisomerase enzymes are vital for maintaining the structural health of the DNA and mitochondria of cells in many types of life forms, including animals and humans. Chemicals that alter the activity of topoisomerase enzymes can cause cell injury or death.
FQs are synthetic antibiotics developed with the ability to inhibit topoisomerase enzyme activity in the DNA of bacteria, thereby destroying bacteria’s ability to reproduce and spread.”
_Jay S. Cohen, MD Author of The Hidden Dangers of Antibiotics
“DNA-adducts are altered forms of DNA that occurs from exposure to a toxin or carcinogen. Once a section of healthy DNA becomes adducted, this section of the gene becomes compromised and dysfunctional. The scientific term for this is genotoxicity, or toxicity to the genes. A DNA-adduct subsequently will block the corresponding gene’s expression and ability to replicate correctly. This in turn hinders the gene’s ability to correctly direct the protein synthesis necessary for its repair. The result of the genotoxicity may be aberrant proteins and mutated cells. The body may then attack the abnormal cells via an autoimmune reaction causing severe inflammation, pain, weakness, fatigue, and failure to heal.”
“This study established beyond a doubt that FQs can cause genotoxicity.”
-Jay S. Cohen MD