Floxed

Back in October of 2001, when I was living in NYC, I got a bad sinus infection, and ended up on a 15-day course of Cipro (ciprofloxacin), which is a member of the fluoroquinolone group of antibiotics. By the tenth day, I was feeling very strange. It's hard to describe...it felt a bit as though I were boiling inside, or as though my bones and muscles were exploding in slow motion. I got through to the fifteenth day, but it was one of the hardest things I've ever done, and I'm famously stoical about physical discomfort.

I got another sinus infection last Saturday. I tolerated it until Tuesday, and then dragged myself to the doctor. This time, I got Levanquin (levofloxacin), which is another fluoroquinolone.

I made it to day three of a ten-day course. Yesterday, my legs were all but unable to bear my weight, and my feet throbbed dangerously inside my shoes. I tried to wash the dishes, and had to rest my arms after five plates. The worst of it came last night, when I found that my neck barely had enough strength to keep my head erect. It put me in an mental fog, too. While driving on Wednesday, I made an appointment to pick up a friend for lunch, and immediately forgot both to pick him up, and to eat! When he called, an hour later, it took me a few moments to remember what had happened.

I already knew that fluoroquinolones were notorious for side effects, but I decided to do a bit of research. On the Internets, I found a page of consumer reviews; on a satisfaction scale of 1 to 5, the fluoroquinolones didn't even make it to 2 ("not satisfied"). An amazing number of people said things like "This is poison...no matter what's wrong with you, it's probably preferable to taking this stuff." I found a number of support groups and discussion boards dedicated to adverse reactions, where people described having been "Floxed." Even allowing for the hysteria and hypochondria that such forums engender, it seemed obvious that something very nasty is going on with these drugs.

My initial bout with Cipro came a week or two after the anthrax attacks that contaminated New York's main post office; the word "Cipro" was on everybody's lips. Did we have enough? How many doses would be needed to protect the entire country? There were reports of hoarders, and of people who'd resolved to take Cipro every day just in case. Before long, the price shot up to almost seven dollars a tablet, until Tommy Thompson "negotiated" a reduced - but still quite profitable - price (for government, not for the public). Anyway, what with all this excitement, getting the prescription was a bit like meeting a celebrity, or being accepted by some exclusive club.

Other antibiotics work against anthrax, so how did Cipro the become the official treatment? As Robert Kuttner reported in October of 2001:

Curiously, another antibiotic, doxycycline, is just as effective as Cipro in treating anthrax. But until this crisis, Cipro was the only drug approved by the FDA explicitly to treat anthrax exposure caused by inhalation of spores. This monopoly is also the result of efforts by Bayer.

According to Dr. Sidney Wolfe, director of Public Citizens Health Research Group, the government asked Bayer last year to present research that would lead to FDA approval of a drug for preventive treatment of persons exposed to inhalation anthrax. Bayer relied on government research (done by American bio-warfare scientists using animal subjects) which clearly showed Cipro and doxycycline, a generic antibiotic, to be equally effective. But Bayer requested and got FDA approval for only Cipro. A month's treatment of doxycycline retails for about $20, or one-15th of what Bayer charges for Cipro.

This article estimates that

...for every million people who take Cipro, as many as 10,000 might experience the less common - and often most serious - side effects.

Of course, those figures refer to short courses like the ones I've been prescribed. Anthrax treatment or prophylaxis requires 60 days. (Some of the people who received treatment during the 2001 attacks report lingering problems.) Fortunately, doxycycline has been approved as a treatment for susceptible strains of anthrax, like the one used in 2001.

There's not really any point to this post, other than advise people to be very careful about taking fluoroquinolones. If your muscles or tendons feel strange or uncomfortable, stop taking it, and ask your doctor for something else. It's not your imagination.