Ofloxacin Risks, Warnings, and Complications

TENDON INFLAMMATION AND TENDON RUPTURE: Ofloxacin and other fluoroquinolones have been linked to serious, disabling, and potentially irreversible tendinitis (inflammation) and tendon rupture. (A tendon is a fibrous band of tissue that connects muscle to bone). This complication frequently involves the Achilles tendon in the ankle but can also involve the rotator cuff in the shoulder or tendons in the hand, thumb, upper arm, or other parts of the body. Tendon problems can occur on both sides concurrently. Tendinitis and tendon rupture may occur within hours to days of starting ofloxacin or several months after finishing treatment. 

The risk of developing fluoroquinolone-associated tendon problems is higher in elderly patients (age 60 plus), in those taking corticosteroid drugs, and in people who have undergone kidney, heart, or lung transplants. Additional risk factors include strenuous physical activity, kidney failure, and tendon disorders such as rheumatoid arthritis. However, tendinitis and tendon rupture have also been reported in people who did not have any of the above risk factors. 

Before starting treatment with oral ofloxacin, tell your doctor if you have a history of a tendon disorder or tendon rupture on fluoroquinolones. Stop taking ofloxacin immediately and tell your doctor right away if you develop sudden pain, swelling, or stiffness in a tendon, difficulty moving a muscle, hear a snapping or popping sound, or are unable to bear weight on the affected area. 

PERIPHERAL NEUROPATHY: Patients treated with fluoroquinolones, including ofloxacin, are at a greater risk of developing peripheral neuropathy (nerve damage). Symptoms may include numbness, tingling, burning, and prickling sensations, decreased sensation to touch or temperature, unusual sensations, and weakness. These side effects can occur soon after starting norfloxacin treatment and may be irreversible in some people. 

Stop ofloxacin immediately if you experience peripheral neuropathy symptoms such as burning pain. Tell your doctor if you have had this adverse effect in the past after taking fluoroquinolones. Your provider may avoid prescribing ofloxacin to you if this is the case. 

CENTRAL NERVOUS SYSTEM EFFECTS: Ofloxacin and other fluoroquinolone antibiotics can increase the risk of central nervous system (CNS) effects such as seizures (convulsions), elevated intracranial pressure (pseudotumor cerebri), and toxic psychoses. Additionally, these medications can cause lightheadedness, tremors, feeling anxious or restless, memory problems, hallucinations, and confusion due to CNS stimulation. Tell your doctor if you have epilepsy, cerebral arteriosclerosis, or other risk factors for seizures. Stop taking ofloxacin and call your doctor right away or seek emergency medical help if you notice any unusual changes in mood or behavior.

WORSENING MYASTHENIA GRAVIS : Fluoroquinolone antibiotics, including ofloxacin, can worsen muscle weakness in people with a condition called myasthenia gravis. This can be severe enough to require ventilatory support for breathing and may even result in death. Tell your doctor if you have myasthenia gravis. Your provider will likely avoid prescribing ofloxacin to you. 

ALLERGIC REACTIONS: Taking ofloxacin can result in serious and potentially fatal allergic reactions, including anaphylaxis (throat closing). These severe reactions frequently occur after the first dose of the medicine. Other signs and symptoms of a severe reaction may include low blood pressure, low blood sugar, seizures, loss of consciousness, swelling of the face, tongue, or throat, difficulty breathing, skin rash, hives, and itching. In addition, allergic reactions to ofloxacin may also cause fever, severe dermatologic reactions (toxic epidermal necrolysis, Stevens-Johnson syndrome), joint pain, muscle pain, inflammation of the blood vessels, lungs, kidneys, or liver, liver failure, anemia, low platelet count, low white blood cell count, and other blood abnormalities.

Stop taking ofloxacin immediately at the first sign of a hypersensitivity reaction. Seek emergency medical care if you notice any unusual or severe signs and symptoms. 

CLOSTRIDIUM DIFFICILE ASSOCIATED DIARRHEA (CDAD): Nearly all antibiotics, including ofloxacin, can cause Clostridium difficile-associated diarrhea (CDAD), ranging in severity from mild to fatal. This occurs due to a disruption of the normal gut microbiome by antibiotics, leading to an overgrowth of a bacteria called Clostridium difficile or C. diff. Call your doctor right away if you develop severe watery, bloody, or foul-smelling diarrhea. It can happen up to 2 months or more after antibiotic treatment. 

MASKING OF SYPHILIS : Ofloxacin is used to treat certain sexually transmitted diseases like gonorrhea and chlamydia. However, it is not effective against syphilis. When this antibiotic is used to treat gonorrhea, it can mask the symptoms of incubating syphilis. Your healthcare provider will test you for syphilis before prescribing ofloxacin for gonorrhea and again after three months. If the test is positive, you will need to take appropriate treatment for syphilis.