Fluoroquinolone antibiotics after quitting Benzodiazepines

[adder]

I've been placed on ofloxacin a few days ago for prostatis inflammation that I'd been suffering for a few months now. Now, ofloxacin belongs to a fluoroquinolone class of antibiotics which have been found to inhibit the activity of GABA-A receptors, be it via negative allosteric interaction at the benzodiazepine site or directly. This obviously poses a great risk on people who are dependent on benzodiazepines or other drugs working via GABA receptors and take fluoroquinolone antibiotics. Below are a few links on this matter:

http://pubmedcentralcanada.ca/pmcc/articles/PMC1368276/pdf/brjclinpharm00069-0066.pdf
http://www.benzoinfo.com/single-pos...cs-in-the-Benzodiazepine-Dependent-Population
https://www.hindawi.com/journals/crim/2009/705635/
http://www.japer.in/doc/jan-march 2013/93.pdf

I quit benzodiazepines over 3 years ago and I don't experience any adverse effects that I could, without a doubt, attribute to my past benzodiazepine dependence before considering other possible causes. I wasn't immediately aware that the antibiotic I take is a fluoroquinolone though I'd known there was a class of antibiotics interacting with the binding of benzodiazepines. I googled it when I started experiencing increased shaking more noticeable than what I would normally feel when anxious, then came a few weirdly familiar nightmares and unsettling feeling dissociated from the surroundings which increased my anxiety. I would think this might be normal to some extent for someone suffering from anxiety to experience more anxiety after such an antibiotic even without prior benzodiazepine dependence, but still it concerns me as it might be getting worse and worse with each dose, and I'm only on day 4 of my treatment out of 20. It also makes me wondering about the extent of my GABA/glutamate system still not working properly 3 years after quitting benzos.

Has anyone had, first-hand or second-hand, any experience with combining benzodiazepines with fluoroquinolone antibiotics or using these antibiotics after quitting benzodiazepines or other GABAergic drugs? If so, please respond if you had any adverse effects.

 

[Limpet_Chicken]

I got scripted cipro recently for an infection, although I did not take it, the rx was collected and will be used only, after purification, for in-vitro culture work, got put on IIRC erythro and metro after pointing out to my GP that not only do I have a known case of joint injury involving tendonitis, (the fluoroquinolones can cause spontaneous tendon rupture, do as little as possible physical exertion during the course of the fluoroquinolone)

And thankfully, I could also avoid it by pointing out to my GP that I'm also taking tizanidine, which is contraindicated with cipro and the other FQ antibiotics. Can't remember why but I don't want to find out, and that I'm taking chlormethiazole for seizure prophylaxis (its not indicated or licensed for this afaik in the UK, doesn't have an indication for seizures in the BNF, but its extremely rapid acting and it works for me as a monotherapy, and if a seizure is just beginning or about to, it works as fast as the capsules break open, within minutes) so pointed out that taking a GABAa antagonist or inverse agonist would be a bad idea, after explaining what a GABAa antagonist was.

 

[adder]

2 days later I'm almost sure I'm experiencing side effects from ofloxacin. I suffered from horrible dissociation after quitting benzodiazepines and it feels much like it, the physical side effects aren't that pronounced, but it's this uncanny fear out of nowhere that something is wrong or something bad is just about to happen which debilitates me. I'm thinking about going back to the doctor who prescribed it, I took 10 pills and still have 30 of these ahead of me which is 2 weeks.

 

[aced126]

Well I personally would try to get prescribed another class of antibiotics if possible.

 

[adder]

I stopped taking it and I will try to catch the doctor as soon as possible. I'm not really sure why he specifically went for this drug, I guess it's because I had this condition for months, hence also a 20-day treatment, and ofloxacin is supposedly used in resistant bacterial infections of prostate among others. But last night I got such a strong pain of spinal muscles along with restless legs after taking the night dose that reminded me much of the first few weeks of benzodiazepine withdrawal. I got anxious as hell wondering how I am going to fall asleep and get up to work, luckily I still have a bottle of baclofen pills, which I don't use for the very same reason I shouldn't have taken ofloxacin, and I took one (just 10 mg) and it helped in ~30 mins.

 

[aced126]

That's weird how the FDA approved such an antibacterial that could precipitate GABAergic withdrawals.

 

[Limpet_Chicken]

They are nasty antibiotics, but sometimes the consequences of NOT treating would be graver.

And GABA antagonism is one of the more pleasant potential side effects of fluoroquinolones. They can cause spontaneous rupture of tendons, even without applied excessive stress, and I've read of people taking them and ending up crippled. Physically or neurologically.

And tendon rupture sounds really fucking painful. Having say, your achilles tendons burst whilst you walk doesn't sound fun in the slightest. That sounds worse even than a penetrating injury to a joint through a tendon (and I should know. That happened to me as a kid, and punched a piece of broken glass through my patellar tendon and into the joint. Had to pull as much of it as I could out and walk back to seek help since it was long before I had a mobile phone) Was not a pleasant experience. Especially with a piece of broken glass snapped off in my patellar tendon after being pulled mostly out. Its left me crippled for 15-20 years and on an indefinite repeat script of morphine and oxy, to the extent I don't even have to ask my doctor for it, its printed out ready for me to pick up in the morning every time it is meant to run out so all I have to do is go in and pick it up from the receptionist [one of whom is rather cute and seems to quite like me. Cute for non-autistic at any rate)

Actually experiencing not a (relatively speaking) clean penetration of the tendon but having it weaken wholesale and simply burst, christ that sounds nasty as hell. One doc tried putting me on ciprofloxacin recently and I refused. They ended up having to use metronidazole and I forget which other, might have been gentamicin, or that might have been another time. Either that or metro and massive doses of erythromycin.

And in the case of antibiotics we keep the nastier/nastiest ones around still often, because of resistant organisms. Gentamicin for example can cause hearing loss, luckily for me it didn't, but the alternative was to try a carbapenem and have a crash cart standing by the ward bedside in case I went into anaphylactic shock (I'm badly allergic to penicillins, and the carbapenems are also beta-lactams, but not all patients allergic to penicillins are to carbapenems, there is a fair chance, presumably greater or lesser according to the specific antibiotic, but still, I wasn't about to trust my life to a flip of a coin, and if it went in my disfavor, then the medical response succeeding.

Sometimes people are allergic to all other alternative antibiotics that an organism is sensitive to, and sometimes the organism itself is resistant to them all bar one or two. Or both. In which case you better hope its your lucky fucking day. I'd probably be wearing a toe-tag and sleeping in a big freezer right now if I had been IgE-response type allergic to gentamycin and metronidazole. Or at least, an amputee at waist level. Certainly there is no doubt about the fact I'd have been well and truly buggered.

 

[adder]

I must say I'm clueless what to do now. I went back to the same doctor and told him about the side effects and that I took benzodiazepines but quit them 3 years ago. He did confirm that such side effects happen rarely, but did not know how and if it could be related to my past benzodiazepine. As he explained, fluoroquinolones are a first-line drugs for prostatitis because they penetrate the blood-prostate barrier well and the spectrum of antibiotics that do so well is fairly narrow. So I got scripted another antibiotic, a combination of sulfamethoxazole and trimetoprim... I took just 2 doses and muscle trembling is way way worse than it was with ofloxacin after a few days, I can feel no psychoactive side effects though, other than some anxiety over the trembling and how it will resolve. It seems like my only option is to stick to amoxicillin and hope it helps, I have a pack of 500/125 pills that I suppose I'm going to take for the next 2 weeks, but I doubt it will help properly, I've been having this for a long time now and during this time I took amoxicillin at least twice for 14 days for sinus infection, it didn't really help with my prostate then.

 

[sekio]

Starting, and not completing, 3 seperate antibiotics is a good way to develop resistant organisms. Amoxicillin does produce appreciable concentrations in prostate tissue though.[ref]

Are you supplementing with folate while taking SMX-TMP ? Those drugs work by knocking out bacterial folate production, I would imagine your gastric microbes don't like that.

 

[Limpet_Chicken]

Could you not get your doc to script you a benzo or phenobarb, temporarily, for the duration of the course of the FQ antibiotic, then taper as soon as its done with? because it definitely sounds like the antibiotic is the cause, and they are known GABAa antagonists?