What is Floxing?

Strange name with serious implications

“Floxing” is a colloquial term that was coined to describe adverse events that can occur during or after taking an antibiotic from the Fluoroquinolone (FQ) class of pharmaceuticals.  Floxing is also commonly referred to as Fluoroquinolone Toxicity or FQ Toxicity in it’s acute sense, and FQAD for those affected with chronic, long-lasting disability. The antibiotics, which include drugs with the well known brand names such as Avelox, Cipro, Floxin and Levaquin, are capable of setting into motion an idiopathic syndrome that causes numerous symptoms that can literally number into the several hundred. These symptoms are categorized as adverse events. They are not caused by anaphylaxis or allergic reactions, or your basic class of understood side effects that go away when the drug is stopped.

Adverse events are unintended pharmacologic effects that occur when a medication is administered as prescribed, while a side effect is a secondary unwanted effect that occurs due to drug therapy.

It is a common misconception that adverse events and side effects are the same thing.  Even some doctors confuse the difference between the two. 

Fluoroquinolone Toxicity in susceptible individuals, and it is not known who is susceptible until after the fact, can cause a long term, sometimes permanent, sometimes progressive, multi-system syndrome that can be severely disabling. 

Systems Involved

This syndrome usually encompasses two or more of the following broad physiological systems:

  • Connective tissue: Not just tendons but cartilage, ligaments, other collagenous tissue.  All tendons are susceptible, from the Achilles to the delicate chordae tendineae (heart strings).  Collagen includes connective tissues, skin, and collagen of the eyes. 

  • Neuropathy: Peripheral, poly and autonomic neuropathies.  These include neuromuscular weakness (mysthenia gravis- like) and peripheral ganglionopathy pathologies. Autonomic dysfunction (dysautonomia) affecting the functioning of the heart, bladder, intestines, sweat glands, pupils, blood vessels and gastrointestinal tract. For some, these neuropathies can be permanent, progressive, and very debilitating. 

  • Central Nervous System: Neuropsychiatric manifestations including anxiety, depression, paranoia, and suicidal ideation. 

A detailed list of symptoms is listed below.

Delayed Adverse Events

The Fluoroquinolones have the unique capabilities of causing delayed adverse events.   These are adverse events that, unfortunately for many individuals, do not appear right immediately but instead manifest themselves days, weeks, or months after completion of drug therapy.   The mechanisms remain poorly understood but researchers suspect they involve the mitochondria (a).  Because of this unique presentation, the patients and often the doctors do not suspect Fluoroquinolone antibiotic involvement.  The delay in manifestation of symptoms, which can be significant for some individuals, separates cause and effect confounding diagnosis.  Delayed adverse events contributes to the mistaken view that the Fluoroquinolones are benign pharmaceuticals with a good safety profile.  Often, patients and doctors are puzzled by the syndrome of symptoms in regards to their onset and presentation and often do not suspect that an antibiotic could cause such damage.

Chemotherapy

A majority of patients and many doctors are uninformed on the method of action of the Fluoroquinolones.  This also has led to a false sense of security in regards to safety. It is vitally important for patients and doctors to understand that, the Fluoroquinolones are fundamentally different than any other class of antibiotics.  Our culture’s mindset often associates all antibiotics together as benign substances (penicillin and the pink liquid syndrome).  Again, the Fluoroquinolones method of action is different from other, safer antibiotics.  They are Topoisomerase Inhibitors and are considered chemotherapy, as in anti-cancer style medication!  As preposterous as this may sound, a quick google scholar search will provide irrefutable proof.  The only other Topoisomerase inhibitors that exist in the medical realm are chemotherapy (Anti-tumor/anti-cancer) drugs.  Their chemotherapeutic method of action makes them very toxic against eukaryotic mitochondria, which also accounts for their ability to cause delayed adverse events as mentioned above.  For more information on their chemotherapeutic method of action, see the following documentation:

Discussion

In the same historical time frame since the Fluoroquinolones release into modern medicine, the world consequently saw an increase in the so-called ‘mystery’ illnesses such as chronic fatigue syndrome, fibromyalgia, Gulf War Syndrome, etc…. All the while, Fluoroquinolone antibiotic use was broadening and prescribing was exponentially increasing world-wide(7). Although it would be irresponsible to say that the Fluoroquinolones are the sole cause all mysterious illnesses, the sheer heterogeneity of syndrome, coupled with the enormous prescription rate of the Fluoroquinolones in our society, gives credence to the theory that there are, at the very least, distinct subsets in each of these mystery illness categories that were indeed initiated by Fluoroquinolone exposure.

To the average doctor and to many patients, the adverse events of Fluoroquinolones are disparate and by all definitions, outrageous. There really is no good measure for the type and scope of their damage potential.  This style of damage is ‘off the radar scope’ of most doctors who are taught outdated paradigms in medical school. The documented damages range from permanent nerve damage, tendons spontaneously rupturing, organ failure, psychosis, and dozens more. Most doctors find the broad scope of the damages  in the Fluoroquinolone Toxicity syndrome preposterous and they simply can’t wrap their heads around a differential diagnosis to include the Fluoroquinolones.  Despite the symptom being listed in the drug literature, most doctors don’t know what to look for or how to connect the symptoms. 

Despite the fact that the FDA, some academic researchers, and a small amount of doctors acknowledge the ability of the Fluoroquinolones to cause these damages, and despite documentation by Black Box warnings and the manufacturer’s drug literature, a cognitive dissonance exists and Fluoroquinolone Toxicity is usually not suspected nor connected by doctors.  These drugs truly have fallen through the cracks in our pharmacovigilance system.

Doctors remain woefully ignorant to the propensity for the Fluoroquinolones to do such levels of harm, mainly because they do not understand the Fluoroquinolones unique method of action and their ability to separate cause and effect.  The FDA in the recent past, has recognized this syndrome and has coined the phrase Fluoroquinolone Associated Disability or FQAD (8).

Detailed Symptom List:

You will notice that many symptoms have overlaps with symptoms commonly seen in other pathologies.  This leads credence to the idea that many pathologies, not all, in the world today have at their core a common thread of Fluoroquinolone use.  During their heyday, the Fluoroquinolones were one of the most prescribed antibiotics in the world, with hundreds of millions of prescriptions given out yearly worldwide.  Even today, tens of millions of prescriptions are given out annually. 

A listing of Fluoroquinolone Toxicity adverse symptoms, commonly reported by sufferers (not all inclusive):  

Central Nervous System

  • psychosis
  • panic
  • anxiety
  • insomnia
  • seizures
  • tremors
  • dizziness
  • confusion
  • depression
  • suicidal thoughts
  • tinnitus
  • memory loss
  • brain fog (impaired thinking)
  • headaches
  • depersonalization
  • abnormal dreams

Autonomic Nervous System

  • cardiac – tachycardia
  • cardiac – bradycardia
  • cardiac – palpitations
  • abnormal sudomotor (sweat response)
  • lightheadedness
  • low blood pressure
  • high blood pressure
  • pupil dilation dysfunction

Gastrointestinal

  • liver damage
  • kidney damage
  • pancreatic damage
  • impaired swallowing
  • colitis
  • irritable bowel syndrome
  • digestive tract pain (abdominal pain)
  • diarrhea
  • constipation
  • acid reflux
  • gastritis
  • delayed gastric emptying
  • nausea

Miscellaneous

  • DNA damage
  • Dryness (body wide)
  • Rashes
  • Multiple Chemical Sensitivities

Endocrine

  • thyroid abnormailites
  • low testosterone
  • hair loss
  • hypoglycemia
  • hyperglycemia
  • excessive thirst and urination
  • temperature regulation problems
  • fatigue

Vascular

  • Poor peripheral circulation
  • swollen veins
  • Purple or red spots under skin esp. in limbs (purpura, petechiae)
  • Swelling limbs (edema)
  • Easy / excessively large bruising

Peripheral Nervous System

  • fasiculations
  • tremors
  • numbness
  • pain
  • burning
  • tingling
  • itching
  • stinging
  • weakness
  • spasticity
  • gastrointestinal motility issues and pain
  • teeth, mouth and lip pain
  • neuralgia
  • reduced muscle output

Musculoskeletal System

  • joint pain
  • tendon pain
  • tendon rupture
  • muscle pain
  • muscle weakness
  • muscle wasting
  • rhabdomyolysis
  • exercise intolerance

Ocular

  • vitreous floaters
  • focusing Issues
  • eye pain
  • double vision
  • dry eyes
  • light sensitivity (photophobia)
  • retinal tears
  • drooping eyelids
  • black specks

Dermatological

  • dry Skin
  • easy sunburn
  • rashes
  • reopening of scars and wounds

Dental

  • broken teeth
  • gum issue

Reproductive

  • Ovarian Cysts
  • Erectile problems
  • Missing Menstruation 3 months or more(Amenorrhoea)
  • Dry Vagina during Intercourse

Food Sensitivities:

  • Caffeine
  •  Sugar
  •  Soy
  •  Milk
  •  Alcohol
  •  Gluten
  •  Carbonated beverages (non-alcoholic)
  •  Aspartame MSG
  •  Acidic foods
  • Nightshades (tomatoes, white potatoes,  eggplant, peppers)
  • Sulfites

Conclusion

If you are experiencing unexplained health problems please do yourself a favor and check your medical history for Fluoroquinolone usage even if it was many years ago.  A comprehensive guide to the names common names of Fluoroquinolones and their generic equivalents can be found here.  If you are unsure of a drug name ask your doctor or pharmacist for clarification.

Because of the long term nature of these drugs through damage to the mitochondria (8,9) and their ability to mask cause and effect, and in addition to their epigenetic capabilities, it is still uncertain if even mild cases can have symptoms that show up many years after the initial onset and after the patient has, on the surface, appeared to completely recover.  Currently, anecdotal data is reflecting with greater frequency mild cases where the patient has seemingly resolved, only to resurface at a later date after some sort of systemic stressor (illness, surgery, other pharmaceutical usage).   Only time will supply us with the data.

In the mean time, the best course of action is to avoid all Fluoroquinolone use where possible. If antibiotic use is warranted please discuss any concerns and the possibility of a safer alternative with your doctor. 

#Floxing, #Fluoroquinolones, #FQ_Toxicity, #FQAD

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