Steroid Usage, the subject is controversial in individuals who have had adverse events from Fluoroquinolones. While it is true that administering steroids with fluoroquinolones can be problematic (1), administering them afterwards is subject to much hearsay. I have often heard “you can’t take steroids after you have been floxed” or “floxed individuals should avoid steroids for the rest of their lives” but these rumors don’t necessarily ring true. I have talked to many floxies who, out of medical necessity, have taken steroids since their adverse events and the results are were very mixed. Keeping in mind that there are always exceptions to the rules, the general overall responses to steroids based on the information I receives is:
Inhaled steroids (including nasal steroids): Overall, individuals who took short acting steroids such as those used for breathing, etc… seemed to tolerate them pretty well. Sometimes the type of medication needs to be adjusted based on personal toleration such as brief pain exacerbation, etc… I have had no reports of adverse reactions to nasal steroids.
Oral Steroids: Overall, individuals who took synthetic corticosteroids such as prednisone seem to tolerate them pretty well in low doses. For some who take a blister pack that is then titrated down, they report feeling worse when taking a higher dose. The resolution of symptoms caused by the higher dose seems to vary in time based on personal physiology. Oral hydro-cortisone was tolerated better than prednisone.
Topical Steroids: Overall, the use of over the counter and prescription topical steroids have a pretty good reported track record especially if used over small areas. I have had a couple reports of severe reactions to topical steroids used over a very large area of skin, such as the entire back, and one report of a severe relapse after a small amount of topical steroid used, although the mechanism for the latter is unexplainable and could be related to something else. In 2 of the three cases the individuals were able to return to baseline functioning after discontinuation and a period of adjustment. Bio-identical hydro-cortisone has a better track record of toleration than Triamcinolone, which is a long-acting synthetic corticosteroid.
Injectable Steroids: This fall into two subcategories: Systemic IM injections/IV vs local injections.
IM/IV: I have talked to several individuals who have used dexamethasone (10 mg) via IM injections and they have reported no symptom relapse. Another individual receive dexamethasone via IV (20 mg)and had no relapse.
Local Injections: Injectable steroids, such as corticosteroids, used for direct administration into joints etc… have the worse track record, with some folks reporting very long lasting pain, including nerve pain, in the joint after administration and some reporting relapses that lasted several years. I have never been able to understand the mechanism for this. It is my guess that dosing a high level of steroid locally in tissue overwhelms the fragile nerves in the area. One male floxie reported severe long lasting pain and reduction in mobility after an injection into a shoulder joint. To my knowledge this situation did not resolve.
It is not uncommon for steroids injected into areas of high nerve density to cause severe problems. Epidural corticosteroids have quite serious and permanent adverse events associated with them, and are not approved by the FDA for such use. In many cases the FDA reports that patients did not recover from epidural steroid reported adverse events. (1)
In some cases, Fluoroquinolones may cause pain in the absence of inflammation. Some doctors, because of their discipline, may assume that inflammation is the culprit and administering steroids as palliative care, which, in some, can make matters worse. It is my opinion, that people seem to fair better in this scenario if there is provable inflammation occurring, such as seen in significantly elevated inflammatory markers or scans. Again, I have spoken to a few individuals where doctors used injections into joints and the floxed folks reported long lasting injuries. In these cases, these folks told me that the had no quantifiable inflammation and were given the steroid injection as palliative care in an attempt to reduce existing paint and limited mobility that was originally cause by the Fluoroquinolones.
Bottom line; make sure that you are well informed before any steroid usage. I have spoken with individuals who have had severe symptoms from just one pill and others who have tolerated large doses of steroids just fine. In a nutshell it seems smaller doses are tolerated better than larger doses but many factors play a role in toleration after having an adverse event to FQ’s. Concomitant medications and supplements, length of time since the FQ reaction, and your overall physical state, all factor into toleration of medications. Discuss all concerns you have with the physician who is prescribing this type of medication.
Steroids in higher dose can increase MMP9, especially in people with weak immun systems. And there are many more possibilites. If you are interested, i would be pleased in writing you.
I was previously on testosterone therapy (testosterone enanthate) before getting fixed and have been afraid of taking more incase it could make my symptoms worse. Could this be possibl? In the meantime I’m suffering from low testosterone which also affects me greatly
And what about hormone replacement therapy are there any risks involved? I was taking testosterone Enanthate before being poisoned by Ciprofloxacin but have been afraid to continue it. It contains castor oil and benzyl benzoate as well.
I had RF (radio-frequency pain relieving treatment/procedure that’s meant to burn through the nerves, thus interrupting the pain pathways, and provide for longer-lasting, albeit temporary, pain relief) in a few of the facet joints in my neck for chronic pain of head, neck, shoulder, upper arm, upper back and upper chest), and following the RF, had a lot of steroid injected in the same spots to soothe the irritation from the burning of the nerves…when the horrendous pain didn’t stop after the expected “few-days-to-a-week-or-so” (thank goodness I only let her do the one side, even though she wanted to do both sides that session). My doctor presumed this longer-lasting and super-severe pain was from nerve inflammation (most likely she was/is correct, but she didn’t know the true *cause* of it), so she did a steroid injection into the same facet joints as the RF…which didn’t soothe it at all, but brought-on bodywide and mental symptoms from all the steroids (I assumed)…and I still suffered nightmare-from-hell levels of pain for *several months* before it began to calm even just a little…my skin and underlying tissues/muscles/etc. felt as though I’d perhaps been thrown through a stack of glass windows leading with my shoulder/neck/upper arm/upper chest/upper back (on my left side), and had been sliced, and stabbed from very deep to superficial ~and~ it also felt like I then landed in lava (or dipped into boiling oil, or been blasted with steam) and been deeply burned on same bodily areas. Currently, after over 18 months, it’s calmed a little to a more tolerable level, but hurts worse than it did pre-procedure; and I have new pains, and have developed very odd and painful nerve patterns in the area too since the nerves began to grow back, stimulated by only light touch. The resulting debilitation and wretched-exhaustion I feel since that happened…and is still happening. I now have central sensitization and all the painful things that go with that…in addition to most of the FQTS symptoms commonly reported (including painful peripheral neuropathies, and pelvic organ prolapses); and, overall I look as though I’ve aged 10-15 or more years in the past two and a half years (my hair has been falling out and it’s changed; my skin is thinner, looser, saggy-er and more and more crepey-looking…like how I remember my great-grandma looking when she was in her late 80s to early 90s (I’m only 64), my teeth and gums look and behave equally aged too, and my eyesight is getting blurry-er; and etc., etc., etc. )…and many cognitive and psychological problems too. Yes, I had chronic pain issues prior to floxxing, but after floxxing I can’t even receive the typical/usual palliative treatments that used to lower my pain and raise my function. And, because my symptoms mostly came-on slowly and increase slowly over time, I didn’t come to realize what was going on until a couple of months ago when I googled info about my foot pain! Fortunately, now my pain management doctor has learned to not use injectable steroid on her floxxed patients, so I’m glad my experience can help others avoid suffering.
How long after you had reaction to quinolones did you receive the steroid injections?
Hi, It was a year after I last received an FQ.
Is there any research done on this topic I can point my doctors to?
I just tried a really low dose of steroids (1/1000th of a 5mg pill, so about 5ug) over a few days. For the first 3-4 days, everything was fine. Now from day 5, I got muscle weakness and burning in arms and legs similar to how flox started originally when I took 3 pills 3 years ago. Time didnt help me to tolerate steroids better. I just can warn and tell that steroids are not safe and even VERY LOW doses are harmful.
Sven, I am sorry that you had a negative response to the small dose of steroids. Everyone is so different, and yes I know many floxies who can’t stand even the slightest amount of steroid in any form.
I am having increased muscle weakness, muscle cramping, and body-wide nerve pain a few days in from taking steroid nose spray for sinus (Avamys). I’m so frustrated. Second floxing was May 2018 for reference.
Hi Sven and Mel,
I’m currently recovering from being floxed 4 months ago.
After you took the steroids and experienced the symptoms again, did they go away or do they stay?
I’m taking a steroid currently and it’s allowing me to do things for myself for the first time in 3 months. I tried not to, but my natural remedies were not kicking in fast enough and I was thinking of death more and more so I just took the Medrol dose pack.
Melanie, I understand. Sometimes we have to just pick our poison. If it means the difference between functioning and not-functioning in life hard decisions have to be made. I hope that you see greater functionality and overall improvement.
11 years out from being severely floxed by Cipro and four months ago now I made the horrific mistake of allowing myself to be pressured into using a topical steroid (clobetasol propionate, which to my HORROR I later learned is the strongest topical steroid on the market). All was fine for about two weeks after application and then the bomb went off. First in my legs, then in my feet. My feet are completely coming apart inside now from doing literally nothing. They tear under their own weight from simply lying in bed (which I do 24/7 now as I’m completely unable to stand up). Every minute of every day is absolute agony. No matter how I position my feet, my ankles and achilles tendons tear. I am likely going to be leaving this planet very soon. I’m getting my affairs in order, albeit slowly as to not jump the gun in case this somehow miraculously reverses itself. So far that’s absolutely not happening. I don’t know how much more I can take of this, it’s breaking me mentally.
When I Google’d the steroid prior to using it, I couldn’t find ANYTHING about it going systemic or potentially causing any sort of muscle/tendon/connective tissue problems. Every single potential side effect I found involved the immediate site of application. So stupid me, I thought it was worth the risk in order to rid myself of a rash I’d had for over a year. I used a tiny amount of the stuff–about the size of a quarter–for three nights in a row. Strangely I applied it to my arm and yet my arms–which were just as severely floxed as the rest of me–seem to have escaped largely unharmed from this massive steroid assault. Somehow the steroid made its way through my arms to my legs and feet where it decided to do all of its damage. I’ve been trying all sorts of things to reverse this damage, but without even knowing what exactly that stuff has done to my legs and feet, I’m just taking stabs in the dark. And none of them are working. Is this a vascular issue? A collagen issue? I haven’t a clue what I’m even dealing with here.
Does anyone know if these severe reactions to topical corticosteroids are capable of reversing themselves in a severely floxed person? And if so, is there anything I can do to speed up the process? This all feels so unbelievably severe that I cannot fathom it will ever fully resolve itself, if at all. And with each passing day my hope fades further and further. I was already housebound prior to application of the steroid so I should’ve known better than to take any risks whatsoever of potentially worsening myself. I couldn’t afford to get any worse. Now I’ve been completely thrown off the cliff.
I am concerned that steroids are the go-to treatment for hospitalized Covid patients. It makes sense that they’d want to treat the severe inflammation this way, but I don’t know what the risk/benefit ratio is for floxies. If I had something to show a doctor about floxies being harmed by steroids maybe we could prepare an alternative, otherwise, I’m sure they’d just make me take them or not treat me at all.
Does anyone have information on the use of Ciprofloxacin and Steroids? I have been told the steroids increase the risks of adverse reactions when taken together. I need information to give to the lawyer representing the Pharmacy that overlooked this contraindication. Thanks in advance.
Thank you so much for posting this! In other groups I follow,, they only talk about never using steroids. Unfortunately, I had an allergic reaction to something and had to use steroids. I’m hoping I don’t have any lasting effects, but Benadryl alone wasn’t cutting it.