Why haven’t the Fluoroquinolones been taken off of the market?
“Why haven’t the fluoroquinolones (FQs) been taken off of the market?” Boy I wish I had a dollar for every time I’ve had someone ask me that question or seen someone post in a Facebook group or on-line forum over the last decade. It really is hard for someone that has fallen prey to FQ toxicity to understand why something so utterly toxic is still being used to this day.
Nothing answers this question more clearly that a little known research paper entitled “Nonclassical Biological Activities of Quinolone Derivatives” written in 2012. This paper clearly elucidates why, from a research perspective, the FQ’s are not going away anytime soon.
The paper describes how the quinolone’s chemical synthesis is flexible and can be easily adapted to prepare new compounds and it is considered ideal for effective drug design. From the paper “…which makes quinolones an endless source of hope and enables further development of new clinically useful drugs.”
I believe that most researchers who work in drug development do not believe that the FQ’s are very toxic. On the contrary, like a kid with an erector set, they see endless possibilities in the construction of new antibiotics and other compounds. The researchers do not consider delayed toxicity that chronically disables thousands of individuals over the long term. No, they believe that the current formulary of quinolones has proven themselves in both safety and efficacy. A couple of years ago I wrote the article “Old Quinolones – The Dead My Rise Again” for Halloween. In the article I discuss how researchers at the University of Virginia School of medicine were attempting to re-engineer the failed quinolone Trovan, which was removed because of liver toxicity. One of the research assistants told me that “if we can re-engineer older quinolones to achieve the same level of efficacy and safety that Levaquin and Cipro have shown, the results will be ground breaking.”
Just like today, the researchers do not consider delayed long term toxicity that is associated with this drug platform. This toxicity is hiding in plain sight. In a brutal twist of irony they are using that very mechanism that causes long term disability in floxies, mitochondrial toxicity, as the mechanism to kill cancer cells today(1). But alas, the researchers only see what they want to see. To them the quinolones have already proven themselves and reports of side effects are just the cost of doing business. To them the adverse events fall within accepted norms.
Although the reasons for their viewpoints are numerous, it is mostly based on mountains of flawed research data tacitly influenced by both pharmaceutical biases and other things such as flawed cell lines used in research(6). Try telling a pharmaceutical researcher that FQ’s cause CFS or Fibromyalgia. Or even more extreme try to link FQ’s to ALS and Parkinson’s. I guarantee that from most you will get a look like you just told them the moon was made of green cheese.
Everyone who watches FQ’s from a safety perspective needs to keep their eyes trained on three areas now and into the future.
- First, Antibiotics, no surprise here. At the time of this writing there are several new quinolone antibiotics in the pipeline both oral and a new aerosol version (2).
- Second, Anti-cancer or Chemotherapy, we have seen the emergence of anti-cancer drugs currently on the market and current research into using FQ’s as anti-cancer agents(1)(3)(4).
- Third, Antiviral, although probably several years away, quinolone based antiviral platforms are being researched(5).
If you remember from Greek Mythology, Cerberus, the dreaded monstrous three headed ‘Hell Hound’ that guards the gates of the underworld to prevent the dead from leaving. With a dramatic flair, the quinolones represent our Cerberus or three areas of dread than has the possibility to do untold harm to thousands.
If researchers considered quinolones a failed platform our outcry would have pushed them into retirement or at least into relative obscurity. In my opinion from a development perspective, there is way too much money to be made and way too many avenues for development for the quinolones to go away anytime soon. As it stands, until researchers fully understand and connect the FQ’s to all the damage they cause, from post Ebola syndromes, to CFS and Fibromyalgia, from Gulf War to ALS and Parkinson’s, all three of these avenues of development I mentioned above will carry with them the risk of horrific adverse events for those unlucky enough to fall victim.
So the next time someone asks you ‘Why are these drugs still on the market?” even though you may not agree, you will at least know the answer.