Re: Reducing quinolone toxicity?

[Guest guest]

Wow, Matt, this is really good work. Could really explain a lot.

I'm definitely very deficient in mag (as most of us pwc are) and

probably Glutathione as well.

Cipro, a flouroquinolone, was a life saver for me. Really brought me

out of a huge downward spiral, but here I am sitting with severe

tendinosis of both shoulders and pain in my elbows as well, and I am

highly suspicious that it has to do with the Cipro.

It's okay, I'd still trade the tendinosis for the fatigue and brain

fog lift, but if I'd known, perhaps I could have countered the

damage a bit with some supplementation of mag and glutathione.

Actually, I did supplement with i.v. infusions of these substances,

but perhaps it wasn't enough, and perhaps i.v. isn't the way to go

with the glutathione, as Rich says.

penny

> The fluoroquinolones have a lot of attractive features (especially

> the newer ones with the C8-methoxyl group) but the damage

> they can cause to tendons is not uncommon. Lots of people on

> LymeNet have testified to the damage they've experienced. And

> there's good data on PubMed showing just how toxic these

> antibiotics are to chondrocytes, tenocytes, etc.

>

> If you do use them, here are some things to consider.

>

> The basis of the toxicity is still being worked out, but some of

it

> appears to relate to magnesium deficiency:

>

>

> http://tinyurl.com/82hgt

>

> PMID: 12019086

>

>

>

>

> http://tinyurl.com/dpcyl

>

> PMID: 11280370

>

>

>

> http://tinyurl.com/bm26v

>

> PMID: 10639347

>

>

>

>

> But this article:

>

> http://tinyurl.com/8dfjh

>

> PMID: 15546943

>

> suggests that magnesium (and other minerals) should not be

> taken at the exact same time as the fluoroquinolone dose, but

> the two should instead be staggered.

>

>

> But magnesium is not the whole story. It turns out that

> fluoroquinolones may damage tendons in part due to the

> generation of ROS, reduction of glutathione, etc.:

>

> This paper:

>

> http://tinyurl.com/9azzh

>

> PMID: 15478945

>

> notes glutathione problems and that vitamin E and allopurinol

> seem to provide some protection against fluoroquinolone

> toxicity.

>

>

> This paper:

>

> http://tinyurl.com/9sqbu

>

> PMID: 14569066

>

> also discusses the role that these inflammatory signaling

> molecules play, saying, " A likely hypothesis is that the

> glutathione content falls rapidly so that the intracellular

> antioxidant enzymes lose their ability to modulate the

> overproduction of ROS. "

>

>

> Perhaps, then, glutathione and/or other anti-inflammatory

> agents, along with staggered magnesium supplementation,

> may, to some extent, protect against tendinopathy in patients

> using fluoroquinolones. However, if memory serves

> fluoroquinolones can cause seizures and NSAIDs significantly

> enhance this risk. Something about their respective influence on

> GABA receptors, I think. Verify this if it matters to you.

>

> I should say that I've taken only a cursory look into glutathione

> and am not informed enough to comment on it more than I did

> above. I am also not endorsing a model that traces chronic

> illness back to anything that might be called, by the commonly

> held meaning of the word, " stress " . That may be relevant for

> some people, but it has nothing to do with my disease. My

> interest here is related strictly to the possibility of reducing

> fluoroquinolone toxicity.

>

> Matt

[Guest guest]

Thanks, Matt. I wonder if the mg issue would explain my severe reaction

to Samento as well. And I wonder whether I should conclude that it's

likely I have a bad mg deficiency.

- Kate D.

On Saturday, May 14, 2005, at 02:29 PM, phagelod wrote:

> The fluoroquinolones

> The basis of the toxicity is still being worked out, but some of it

> appears to relate to magnesium deficiency:

[Guest guest]

<pennyhoule@y...> wrote:

> but if I'd known, perhaps I could have countered the

> damage a bit with some supplementation of mag and glutathione.

> Actually, I did supplement with i.v. infusions of these substances,

> but perhaps it wasn't enough, and perhaps i.v. isn't the way to go

> with the glutathione, as Rich says.

Alas. Do you know if you were IVing magnesium the whole time?

My experience is that 400 mg of magnesium per day with food including

lipids did not change my muscle twitching. I never tried slow-release

(which might be a problem for those using abx). I get IVs that are

largely magnesium (plus other supplements) and one of these abolishes

my muscle twitching for a month.

Ive never used quinolones yet.

Hope your tendon pain eventually resolves Penny. Matt, thanks for your

research.

[Guest guest]

Penny

The fluoroquinolones penetrate the CNS fairly well, concentrate

in at least some cells, and are, to my recollection, the drug of

choice (for reasons of penetration) in bacterial prostatitis (with

Bactrim apparently being the only other generally accepted

antibiotic for this). I've had what I believe to be prostatic pain and

am concerned that this could be a reservoir seeding relapse if I

ever achieve remission. The newer fluoroquinolones (with the

C8-methoxyl group) are broad-based, so you don't have to guess

about what bacteria are making you sick and they are

dramatically less likely to permit the development of drug

resistance. Of these newer ones, I like gatifloxacin because it's

cleared almost entirely through the kidneys--apparently it has

much fewer drug interactions.

So I was thinking I'd use the usual antibiotics for, say, six weeks

at a stretch and then switch to a week or so of gatifloxacin. This

would give my liver a periodic break. And I had hoped that the

relatively long intervals between gatifloxacin would give my

tendons time to recover. But I'm reading the literature on

tendonopathy and what the quinolones do to cells in culture,

even after a couple of days, is not pretty. And I'm not sure how

quickly these cells, and the structural integrity of the tendons,

recovers. I used moxifloxacin for about a week last fall and then

some time later (not sure about the timing) I foolishly tried to

open a heavy door to the cold room with just my pinkey (had a

flask in the same hand). Something came loose. It's clearly

visible in my palm even today but the doc isn't sure exactly what it

is. It's not a full-blown rupture. Whatever it is, I appear to be

stuck with it. Could be coincidence, but if it's not, then

fluoroquinolones are not in my future.

Can you say in some detail what your experience with Cipro

was? I'd like to print it out.

First, how much Cipro did you take, and how long did you take it

before you developed the shoulder problems?

Second, how long has it been since you stopped Cipro, and has

your shoulders improved at all spontaneously (i.e., can you

assess the relative role that spontaneous healing may have

played independent of Benicar-mediated pain relief?)?

Third, what specific symptoms were improved with Cipro?

Fourth, did you ever herx? I'm talking mainly here about herx in

the classical sense--bed-ridden for a couple of days.

Fifth, are you saying that you took IV magnesium and glutathione

while on Cipro? Perhaps the mag and glut did delay tendon

damage relative to what would've happened to you, or perhaps

this is evidence that mag and anti-inflammatories are not that

protective. This is why I'm interested to know how much you took

and for how long.

Thanks,

Matt

> Wow, Matt, this is really good work. Could really explain a lot.

>

> I'm definitely very deficient in mag (as most of us pwc are) and

> probably Glutathione as well.

>

> Cipro, a flouroquinolone, was a life saver for me. Really

brought me

> out of a huge downward spiral, but here I am sitting with

severe

> tendinosis of both shoulders and pain in my elbows as well,

and I am

> highly suspicious that it has to do with the Cipro.

>

> It's okay, I'd still trade the tendinosis for the fatigue and brain

> fog lift, but if I'd known, perhaps I could have countered the

> damage a bit with some supplementation of mag and

glutathione.

> Actually, I did supplement with i.v. infusions of these

substances,

> but perhaps it wasn't enough, and perhaps i.v. isn't the way to

go

> with the glutathione, as Rich says.

>

> penny

>

>

>

[Guest guest]

No, I'm pretty sure it wasn't the whole time. I've been on so many

i.v. protocols and abx, that I can't keep it straight. I was too

sick and brainfogged most of the time to keep a journal, even though

I wanted to. Before I got the picc line, I did several months of

infusions at my doc's office. I remember liking how I felt after the

mag. combo infusions. The C combos made me feel really loopy for

about an hour after the infusion and extremely thirsty, but then I'd

feel a little boost of something close to " clarity " afterwards. The

glutathione pushes, --I just don't recall feeling much of anything

at all. I also did H202 and colloidal Silver, which both had a

tendency to make me feel woozy. I remember initially that i.v.

Rocephin gave me a major boost even during the infusion. Right

before I got my picc line, I felt that the Rocephin i.v.s my doc

gave me saved me. I was developing something looking and feeling

like pneumonia, and going down the tubes fast. Really, really weak.

I got a big boost from the rocephin. That occured for a few days,

but then it became entirely ineffective. Like taking nothing. They

gave it to me when I first got my picc line and it had no effect

whatsoever (but at least I warded off whatever was taking me down).

Then I moved on to Imipenim, Minocycline, doxycycline, and others I

can't recall at the moment, along with numerous orals including

zyvox and cipro, and nebulized tobramycin, cipro and others.

Unfortunately, we weren't working from current microbiology to back

any of those choices up, so it was primarily guess work based on my

known abx resistances and nothing more. After months of this

treatment, I went into something close to remission for 6 months. I

still had all of my inflammatory symptoms (which I'd become

accustomed to, migraines, pain, poor sleep, etc), but I had more

energy and a fairly clear brain. After 6 months, I collapsed again.

Obviously, didn't get all the bugs, even with the nuclear attack

(based on good intentions and guesswork).

Sorry for the side track. BAck to Magnesium.

I do find that oral mag helps a lot, but I have to take a minimum of

1200 mg per day to stop eye twitching (usually starting with more

like 1600 mg). I had an eye twitch for well over a year. It was

driving me crazy. I started magnesium and it was gone in days.

I've been experiencing the eye twitch again lately. Obviously, I

need to up my Mag.

penny

>

> > but if I'd known, perhaps I could have countered the

> > damage a bit with some supplementation of mag and glutathione.

> > Actually, I did supplement with i.v. infusions of these

substances,

> > but perhaps it wasn't enough, and perhaps i.v. isn't the way to

go

> > with the glutathione, as Rich says.

>

> Alas. Do you know if you were IVing magnesium the whole time?

>

> My experience is that 400 mg of magnesium per day with food

including

> lipids did not change my muscle twitching. I never tried slow-

release

> (which might be a problem for those using abx). I get IVs that are

> largely magnesium (plus other supplements) and one of these

abolishes

> my muscle twitching for a month.

>

> Ive never used quinolones yet.

>

> Hope your tendon pain eventually resolves Penny. Matt, thanks for

your

> research.

[Guest guest]

Probably.

Take a look at how much Mg you ingest in a day.

There really isn't very much in food.

For years I've taken pharmaceutical grade (powdered)

Mg and Ca. It's probably why my bones are still ok, even though

I went thru premature menopause (for reasons no one undertands) at

38.

That was almost 20 years ago, so I've been supplementing a long time

with these minerals, and eating yogurt, eating greens, and drinking

milk.

And I know Ive said it before- but mineral absorption of any one

mineral depends on the ratio and status in the body of many other

minerals- so you can't just (usually) take the one you think is

missing.

Barb

>

> > The fluoroquinolones

>

> > The basis of the toxicity is still being worked out, but some of it

> > appears to relate to magnesium deficiency:

[Guest guest]

-

Your next assignment is to learn about the synergy between

minerals - and which are antagonistic- which ones will be used in the

body when on is missing-

If oral magnesium isn't absorbed- you'll get loose stools- and some

people

take it for just that reason- or the over dose on it to correct

constipation.

I wouldnt IV magnesium alone unless the mineral status

(and overall health of the body) is known..

A (bio)chemistry course would benefit anyone, as we are after all a

big bag of chemicals, and chemical reactions and interactions.

Barb

Here

s a few good sites:

http://ods.od.nih.gov/factsheets/magnesium.asp

>

> > but if I'd known, perhaps I could have countered the

> > damage a bit with some supplementation of mag and glutathione.

> > Actually, I did supplement with i.v. infusions of these

substances,

> > but perhaps it wasn't enough, and perhaps i.v. isn't the way to

go

> > with the glutathione, as Rich says.

>

> Alas. Do you know if you were IVing magnesium the whole time?

>

> My experience is that 400 mg of magnesium per day with food

including

> lipids did not change my muscle twitching. I never tried slow-

release

> (which might be a problem for those using abx). I get IVs that are

> largely magnesium (plus other supplements) and one of these

abolishes

> my muscle twitching for a month.

>

> Ive never used quinolones yet.

>

> Hope your tendon pain eventually resolves Penny. Matt, thanks for

your

> research.

[Guest guest]

Wow Matt, the details are so foggy. The first time I took Cipro, was

in India about 5 years ago, when I caught a stomach bug, and the

boost I got from it was huge. But back then I was pretty anti-abx.

Then, I got it again from my myofascial pain specialist, because the

oral surgeon who removed my wisdom teeth wouldn't give me any abdx,

and I felt like I'd fallen into the black hole of death after that

surgery. I took it for 6 weeks or so, and I truly thought I'd found

the cure! My life started coming back. I had energy. I could think

clearly. It was miraculous. I recall no " herxing " whatsoever,

although the way this illness waxes and wanes, who can tell

one " wane " from the next?

You and Tony both like the Gatifloxacin. He encouraged me to get

that from my doc, but I have been afraid to use it since the tendon

stuff. If I thought glutathione and Mag could prevent tendon damage

from the Gati, I'd be all over that. I LOVED cipro. It was the best

antibiotic I ever took, until it eventually kind of stopped working.

And then I was afraid to try any other quinolones. Tony says the

same thing you do, that it's one of the best penetrating drugs there

is.

There was quite a lapse before I connected the shoulder situation to

the Cipro, which I think made an existing condition worse. I had

actually experienced shoulder problems prior to starting any abx. I

even went to see a plastic surgeon about possible breast reduction

because I thought my bra straps were causing a problem and if losing

my chest would make the pain go away, it was okay with me :-)

(happened to a friend), but that didn't appear to be the problem.

Then, while I was on abx, including Cipro, I noticed that my elbows

felt very weak and slightly painful when carrying things like a bag

of groceries, so I was very careful in how much strain I put on

them. I also noticed that I seemed to be very close to developing

carpal tunnel in my wrists. It was after I'd been off cipro for a

while, that my shoulders got really bad, and I never knew for sure

if it was due to cipro or abx usage in general. I'm sure the blood

flow to my shoulders is reduced due to hypercoagulation. There's a

condition called avascular necrosis that often hits the shoulders

and hips, which one doc said I probably have, which fits in with

everything else, since I've been dx'd with necrosis of the jaw, and

I wouldnt' be surprised that other parts of my skeleton aren't also

necrotic due to infection.

REgarding pain remission. It's odd, because when I first had pain in

my shoulders, my right shoulder was much worse than my left. Then

starngely, before any Benicar or other interventions, my left

shoulder started getting worse and the right got better. I did, at

that point start physical therapy. I had extremely painful deep

tissue massage, where the doc dug his elbow into my back to break up

all the scar tissue which he said was causing the shoulder pain.

This did seem to help some with movement. I went to him for quite

some time, but when I quit, my shoulders got worse than ever. They

popped constantly (rotator cuff popping). I could barely turn on a

light switch without severe pain, or open a car door. The Benicar

relieved that tremendously. I rarely have popping now, and my right

arm is WAY better. My right elbow hurts sometimes, but it's my left

shoulder/arm that's still the worse, although much better as far as

range of motion, but there's something tight that feels like it goes

all the way from my shoulder, down the back of my arm to my elbow,

and if I move wrong, it hurts, and seems to reinjure it. I think

I've been agravating it every day when hooking my bra, so I've taken

to finding another way to hook my bra, and it seems to be doing

better with the rest. I should probably get a sling or something,

just to force myself not to overuse it. I have trouble sleeping on

my left side as well. I've spoken with an orthopedic surgeon, who

says I may need a little " clean up " surgery, so I'll have to see

where that's going to go. But the Benicar has helped it

tremendously, and that's a fact. :-) Before, I was becoming an

armless duopod. :-)

Hope this helps. I've got to get off these boards now. I have stuff

I need to catch up on.

penny

> Penny

>

> The fluoroquinolones penetrate the CNS fairly well, concentrate

> in at least some cells, and are, to my recollection, the drug of

> choice (for reasons of penetration) in bacterial prostatitis (with

> Bactrim apparently being the only other generally accepted

> antibiotic for this). I've had what I believe to be prostatic

pain and

> am concerned that this could be a reservoir seeding relapse if I

> ever achieve remission. The newer fluoroquinolones (with the

> C8-methoxyl group) are broad-based, so you don't have to guess

> about what bacteria are making you sick and they are

> dramatically less likely to permit the development of drug

> resistance. Of these newer ones, I like gatifloxacin because it's

> cleared almost entirely through the kidneys--apparently it has

> much fewer drug interactions.

>

> So I was thinking I'd use the usual antibiotics for, say, six

weeks

> at a stretch and then switch to a week or so of gatifloxacin.

This

> would give my liver a periodic break. And I had hoped that the

> relatively long intervals between gatifloxacin would give my

> tendons time to recover. But I'm reading the literature on

> tendonopathy and what the quinolones do to cells in culture,

> even after a couple of days, is not pretty. And I'm not sure how

> quickly these cells, and the structural integrity of the tendons,

> recovers. I used moxifloxacin for about a week last fall and then

> some time later (not sure about the timing) I foolishly tried to

> open a heavy door to the cold room with just my pinkey (had a

> flask in the same hand). Something came loose. It's clearly

> visible in my palm even today but the doc isn't sure exactly what

it

> is. It's not a full-blown rupture. Whatever it is, I appear to

be

> stuck with it. Could be coincidence, but if it's not, then

> fluoroquinolones are not in my future.

>

> Can you say in some detail what your experience with Cipro

> was? I'd like to print it out.

>

> First, how much Cipro did you take, and how long did you take it

> before you developed the shoulder problems?

>

> Second, how long has it been since you stopped Cipro, and has

> your shoulders improved at all spontaneously (i.e., can you

> assess the relative role that spontaneous healing may have

> played independent of Benicar-mediated pain relief?)?

>

> Third, what specific symptoms were improved with Cipro?

>

> Fourth, did you ever herx? I'm talking mainly here about herx in

> the classical sense--bed-ridden for a couple of days.

>

> Fifth, are you saying that you took IV magnesium and glutathione

> while on Cipro? Perhaps the mag and glut did delay tendon

> damage relative to what would've happened to you, or perhaps

> this is evidence that mag and anti-inflammatories are not that

> protective. This is why I'm interested to know how much you took

> and for how long.

>

> Thanks,

> Matt

[Guest guest]

Very important point, Barb.

It's good to remember that calcium antagonizes magnesium, and so

much of our food is fortified with calcium. Many pwc could perhaps

be making their mag situation worse by taking calcium.

penny

> >

> > > The fluoroquinolones

> >

> > > The basis of the toxicity is still being worked out, but some

of it

> > > appears to relate to magnesium deficiency:

[Guest guest]

Your right, Barb, the balance is extremely important. My doc gave me

infusions that were a combo of vitamins and minerals. I just

remember always making sure it had a lot of mag in it, because I

know I respond well to mag.

penny

> >

> > > but if I'd known, perhaps I could have countered the

> > > damage a bit with some supplementation of mag and glutathione.

> > > Actually, I did supplement with i.v. infusions of these

> substances,

> > > but perhaps it wasn't enough, and perhaps i.v. isn't the way

to

> go

> > > with the glutathione, as Rich says.

> >

> > Alas. Do you know if you were IVing magnesium the whole time?

> >

> > My experience is that 400 mg of magnesium per day with food

> including

> > lipids did not change my muscle twitching. I never tried slow-

> release

> > (which might be a problem for those using abx). I get IVs that

are

> > largely magnesium (plus other supplements) and one of these

> abolishes

> > my muscle twitching for a month.

> >

> > Ive never used quinolones yet.

> >

> > Hope your tendon pain eventually resolves Penny. Matt, thanks

for

> your

> > research.

[Guest guest]

What was your severe reaction? (sorry if you've described this at

length already). Did it involve tendon or muscle problems?

I've never looked into samento but I thought there were rumors

that it contains a quinolone-type compound. You probably know

better than I do about that.

If so, I, too, wonder if you can reverse the logic. If mag deficiency

increases FQ toxicity, then can we infer that those people who

experience tendonopathy (a fraction of those taking FQs, but not

a negligible fraction) are mag deficient?

Maybe.

Matt

>

> > The fluoroquinolones

>

> > The basis of the toxicity is still being worked out, but some of

it

> > appears to relate to magnesium deficiency:

[Guest guest]

Well, if it's anything like Samento, it took 3 months for my Achilles

tendons to recover after 13 days of Samento. But that's me, not you,

and it's a different drug....

- Kate

On Saturday, May 14, 2005, at 03:27 PM, phagelod wrote:

> But I'm reading the literature on

> tendonopathy and what the quinolones do to cells in culture,

> even after a couple of days, is not pretty.  And I'm not sure how

> quickly these cells, and the structural integrity of the tendons,

> recovers.

[Guest guest]

On Saturday, May 14, 2005, at 04:45 PM, phagelod wrote:

> What was your severe reaction? (sorry if you've described this at

> length already).  Did it involve tendon or muscle problems?

It was very specific to my Achilles tendons, which I had never had any

problem with before. The pain was nearly unbearable, even with pain

killers. Benicar helped with the pain, so I assume it had to do with

inflammation. I wasn't able to obtain the Benicar for quite a while

after the pain started though, so it had already subsided a lot.

> I've never looked into samento but I thought there were rumors

> that it contains a quinolone-type compound.  You probably know

> better than I do about that.

I never found out anything more than that Samento has quinovic acid

glucosides.

- Kate D.