Fluoroquinolone Antibiotics & Benzodiazepines, Again

[adder]

Roughly a year ago I took up the problem of using fluoroquinolones with the past long-term dependence on benzodiazepines (Fluoroquinolone antibiotics after quitting Benzodiazepines) when I suffered some symptoms which might be related to GABA inhibition after I had been prescribed ofloxacin for prostate inflammation. At that point I was benzodiazepine-free for 3 years, but had been on benzodiazepines for 9 years before that. The doctor I went to was sceptical about any connection between my long-term benzodiazepine use and side effects that I experienced and just acknowledged a small fraction of people don't tolerate fluoroquinolones that well and switched me to sulfamethoxazole/trimethoprim (actually we had sort of an argument, I brought in some scientific papers with myself just in case and eventually had to use them to back up my worries because the doctor was reluctant to consider that years of messing with GABA and glutamate systems might have changed them and leave oversensitive but since I was not an MD...). Either way my problem resolved more or less as I later checked myself with another urologist, the pain, swelling, and stinging sensation during urination disappeared, although I never regained the normal flow of urine. I've been on buprenorphine for over 5 years now though, took opioids for years before, so some trouble with urination I consider normal.

Unfortunately, a few weeks ago I've started having symptoms of prostate inflammation again. It was mild at first, so I didn't decide to go to a urologist right away knowing the usual course of treatment and feeling kind of stupid to bring up the problem of my benzodiazepine use, especially because for the past 3 months I've been taking alprazolam for anxiety and panic attacks, started at 0.5-1mg a day, now I'm at 1.5-2mg a day, I can't stop and even if I could, it changes nothing with respect to my potential bad reaction to fluoroquinolones. Eventually I went to a urologist, I had the prostate exam, there was some pain, the doctor felt some swelling and decided to prescribe an antibiotic for 2 weeks, after that I will have a follow-up visit and an ultrasound as he informed me my problem may be beyond that of my prostate. Upon being asked about any allergies I told him about my case from a year ago, he decided to prescribe levofloxacin saying it's a newer generation one and has less of a chance to cause the side effects I had experienced, but if I do, he will change the antibiotic. However, I decided not to mention anything about benzodiazepines which a day later I consider was a huge mistake. Neither prostatitis nor benzodiazepine withdrawal is fun and of course I want to get rid of the former, but the latter happens to be lethal at times, taking a GABA antagonist may be unpleasant for anyone, taking a GABA antagonist having been dependent on benzdiazepines for many years may be even more unpleasant, but taking a GABA antagonist while dependent on benzodiazepines is risky I eventually concluded in my head. I'm well aware these 4 months on alprazolam basically made me dependent on it again and I can feel the tolerance built up, initially I thought it might actually be a good thing to be on it if I have to take a fluoroquinolone and I considered it a positive coincidence, but that's an oversimplification of the interaction I may experience to say the least.

I haven't taken my first dose yet as the local pharmacy did not have levofloxacin in store, I am to collect it today. I read this this morning and the question is if I should take it at all. The information I found in papers puts me at great risk IMO, hell, the 9 years I took benzodiazepine for ruined me and I know this, even though I recovered, even though I work at a job which involves manual precision and multitasking and I do well, I might be cognitively/socially dysfunctional in some way and changed for life, I suppose with that in mind I shouldn't risk further damage and the risk seems high relative to benefits. But before I go back to that doctor a few days later and start explaining why I'm more concerned than I disclosed in the first place and why I did not mention benzodiazepines during the first visit, I need a second opinion, preferably from someone who knows more about GABA/glutamate system than I do and how fluoroquinolones interact with it. I am suffering from anxiety these days, I am exaggerating small things every day.

 

[sekio]

Fluoroquinolones do have some strange side effects, but at the end of the day not everyone experiences them and they are not universal to every possible fluoroquinolone. However it is important to note that levofloxacin is actually just the L-isomer of ofloxacin so you may well end up having the same side effects manifest.

I'd take your ABX as prescribed and be caugtious about how it effects you for the first few days and report any strange effects to the doctor or local medical authority, presumably you can always discontinue it and get moved to penicillin or cephalosporine or the like.

Presumably taking ABX with benzos still in your system will be OK, certainly a different situation than having no benzos in you, as I'd expect the benzos to have higher affinity to GABA_A PAM site than any abx ever would.

 

[Dresden]

You've Been FLOX'ed. I've Taken Them A Time Or Three. No Harm Received, But I Guess I Was Lucky Those Days.

 

[Limpet_Chicken]

They do seem rather prone to causing a host of nasty side effects, such as peripheral nerve damage, tendinitis, spontaneous tendon rupture along with GABAa antagonism and other potential neurological side effects.

Some doctors can do some stupid things alright. I've had doctors try to prescribe me fluoroquinolones, despite the fact that I already have problems that stem from a penetrating joint injury (followed by getting my knee and head stamped on, fucking pikey chav trash) that involved falling on glass, and having it go through my patellar tendon and into the joint, plus plantar fasciitis. As well as being scripted chlormethiazole for seizure control, and scripted 10mg nitrazepam daily (which I don't take anything like so frequently, just use the lot in a couple of days or the occasional tablet, for when either are truly needed, but as far as they (GPs) are concerned I have been dutifully taking 5mg twice a day, every day for a couple of years, while the chlormethiazole I do take at least 3x daily, although in me at least, it causes no physical dependency when used at therapeutic dosages including 'rescue packs' for as needed termination of seizures, even despite a good many years taking it.

And I'm on tizanidine also, which is specifically a contraindicated drug for prescription of fluoroquinolones, and yet they've still tried to put me on the things, to treat this, that or the other infection (I keep being hit by one after another after another)

 

[adder]

I want to thank for the input and give an update as I'd decided to start levofloxacin, in case anyone found themselves in a similar situation and wondered what to do. I took levofloxacin for 7 days straight, dosing 500mg once a day in the evening as prescribed. For the first few days I didn't notice any improvement or worsening in my symptoms, I also can't say I experienced much adverse effects from the drug, however, starting from day 5 I started experiencing random pains in different parts of my body, mainly forearms and my legs down from my knees, this pain is not something unique and new that I started feeling after levofloxacin, it's pain that is neuropathic as I understand it (I visited two orthopaedists and both associated this pain with some defects in my spine and median nerve neuropathy) and I've been experiencing it regularly for a few years now and it gets better or worse at times. It's hard to say if it was related to levofloxacin, but I started feeling weaker and weaker after day 5 and eventually stopped it after 7th dose because there was also no relief in my symptoms, actually they've started getting worse. I keep a journal on my daily alprazolam use to see the trend in my dosing over time, I analyse my use week to week, there has been an overall increasing trend, in the week I started taking levofloxacin there was also an increase but it's far from being statistically significant.

Apart from levofloxacin I was prescribed 0.4mg of tamsulosin ER and 100mg diclofenac suppositories. I didn't take diclofenac because the pain was bearable and NSAIDs apparently make neurotoxic effects of fluoroquinolones worse, but I wanted to share my experience with tamsulosin. I wanted it to give a try as I found a study which found it to help levofloxacin reach higher levels in prostate (link1, link2), but I feared it might give me a drop in BP, so I didn't take it during the week, I took it yesterday at night and unfortunately I was right, I had some things to do today and it ruined my whole day, I've been experiencing pounding heart upon standing up, brain fog, fatigue, weakness, slight tremors, inexplicable fear, constipation and congested nose (no airflow at all) which I had serious problems clearing with xylometazoline to be able to take buprenorphine sublingually, eventually after 9 doses for each nostril they cleared up enough for me to be able to breathe through my nose. I ended up sleeping for a few hours during the day after taking my morning dose of bupe (which seemed to stabilize my heart rate for some reason) and 0.5mg of alprazolam, it's been 17 hours since I dosed it and still I can feel some side effects like the anxiety and heart beating weirdly although the rest did wear off to a large extent. As for desired effects, only once in the morning ~7 hours after taking the dose I felt my urine flow was improved compared to what I've experienced every day since prostatitis had come back this year. I noticed how buprenorphine negatively impacts my urine flow though. I've never had an alpha-1 antagonist before, it was an unpleasant experience, but most of all it basically made me non-functional, I can't imagine going to work after taking this drug. I'm wondering what's next, but at this point living with this problem with prostate I got seems like a better option than taking fluoroquinolones and alpha blockers for months.

 

[clubcard]

Trovafloxacin - a lesson that ALL medicinal chemists should have drilled into them, especially with HTS telling them what to do. a labile moiety on a highly-strained ring. WHO didn't think that was an obvious and likely problem? A lead lacking sufficient affinity problem-solved by an idiot.

 

[vecktor]

Trovafloxacin - a lesson that ALL medicinal chemists should have drilled into them, especially with HTS telling them what to do. a labile moiety on a highly-strained ring. WHO didn't think that was an obvious and likely problem? A lead lacking sufficient affinity problem-solved by an idiot.

Trovan hepatotoxicity is immune mediated hypersensitivity and this is a general quinolone class effect, unrelated to the cyclopropanamine moiety which is unmetabolized in humans. Other quinolones with electron deficient aryl substitution (nitrophenyl and fluorophenyl and diflorophenyl) on the 1 position have caused pronounced problems with type 2 indirect hepatoxicity and hypersensitivity, it is called idiosyncratic hepatotoxicity for a reason.
Proverbs 17:28
perhaps worth remembering

Adder:
Is your doc sure that it is an infection? if it isn't then the benefits from fluoroquinolones are zero and the risks non zero. Prostatitis if that is what it is can be caused by a bunch of things other than infection.
V

 

[Limpet_Chicken]

Damn, Vecktor, its been a hell of a long time since I've seen you post here, thought you had disappeared like nuke has (she is a truly sad loss to us all having gone )

 

[vecktor]

Damn, Vecktor, its been a hell of a long time since I've seen you post here, thought you had disappeared like nuke has (she is a truly sad loss to us all having gone )

Still drive through the old hood occasionally, I'm sure nuke does too.

good to see you are still around despite the attempts of the NHS's finest to kill you, good to see you don't seem to have mellowed with age too.

 

[Limpet_Chicken]

Oh, they are still at it, and are you serious? as if THAT is ever likely to happen.

And NHS's finest? bunch of fucking butchers is more like it. Hell I've just had one of my GPs send me to an addiction specialist because the doses of morphine I take (rx'd orally, with no account taken as to BA) are apparently huge. Saw the guy, just to get the doctors off my back more than anything and he looked PISSED that I'd been even been sent that far to get there, much less had to go there, and said as much to the doctors responsible, that I should be in pain management, not seeing him [I can just about get to my own docs surgery on a bike or on foot, the journey in a car takes maybe 2 minutes to put it into perspective]