Neuropathy Warning for Fluoroquinolones

Before getting into this, I will list the approved fluoroquinolones. The list shows the name and the (brand name): levofloxacin – (Levaquin); ciprofloxacin – (Cipro); moxifloxacin – (Avelox); norfloxacin – (Noroxin); ofloxacin – (Floxin); and gemifloxacin – (Factive). Have you memorized them yet? No, I haven't either.


I do have one of them down pretty well and that is Levaquin as that put me back in the emergency room after one pill. Since I already have neuropathy, I suspect that it did not take long to put me in severe pain of all joints and especially my feet and lower legs. Some doctors use Levaquin for pneumonia which is what I had, but I will never knowingly take another pill of Levaquin. The pain is unbearable and I would advise anyone with neuropathy to avoid Levaquin. Probably is wise for the rest of the group if you already have neuropathy.


At least there have been enough adverse events reported with the above drugs that the labels have to be changed to reflect this. However, topical formulations applied to the ears or eyes are presently not known to carry the risk.


As of August 15, 2013, the US Food and Drug Administration (FDA) requires the drug labels and Medication Guides for all fluoroquinolone antibacterial drugs be updated to describe better the serious side effect of peripheral neuropathy. The nerve damage may occur soon after these drugs are taken. The sad part is that for many this condition may become permanent.


If you, as the patient, develop symptoms of peripheral neuropathy, the fluoroquinolone should be stopped. The FDA advises that the patient be switched another non-fluoroquinolone antibacterial drug. Then we see the almost mandatory risk statement of “unless the benefit of continued treatment with a fluoroquinolone outweighs the risk.” If it was me, the pain would prevent me from more of this drug.


“Peripheral neuropathy is a nerve disorder occurring in the arms or legs. Symptoms include pain, burning, tingling, numbness, weakness, or a change in sensation to light touch, pain or temperature, or the sense of body position. It can occur at any time during treatment with fluoroquinolones and can last for months to years after the drug is stopped or be permanent. Patients using fluoroquinolones who develop any symptoms of peripheral neuropathy should tell their health care professionals right away.”

Metformin – Is This First Line Medicine Safe?

This is the substance of an article published in the April issue of Diabetes Care. The title they use is “Diabetes Prevention With Metformin Is Safe, Well-Tolerated.” In essence this is correct, but only when other vital information is added which is absent from the details of this study. A pharmacist friend very kindly pointed this out to me in an email.

She stated, “Metformin can for many (but not all) individuals cause a Vitamin B12 deficiency. Unless they consume foods high in Vitamin B12, most people will end up having this deficiency in long-term Metformin use.” Even my own endocrinologist suggested adding a Vitamin B12 supplement to my regimen while on Metformin. I am thankful I listened to her. I was not Vitamin B12 deficient, but I was at the low point in the recommended range.

Based on my experience, I would suggest anyone taking Metformin (glucophage) talk with their doctor about having the Vitamin B12 test done to establish a baseline and a discussion about adding Vitamin B12 at some point. I repeat, this should include anyone taking or adding metformin to their medication regimen. This is one area that I now feel strongly enough about to repeatedly urge people taking metformin to have the vitamin B12 test done. 

A little background into the symptoms of vitamin B12 deficiency shows they are the classic fatigue and anemia. Most doctors will not do this test, “because the 'Standard of Care' is to ONLY do Vitamin B12 Testing if a patient has a condition called Macrocytic Anemia- where red blood cells become large and shows up as a high number on the MCV Blood Test that is part of a Complete Blood Count. This is somewhat arbitrary and stops many tests that could prevent severe vitamin B12 deficiency.

This article from WebMD dated June 8, 2009 is the article my pharmacist friend suggested that I read. Yes, it is a very convincing argument for being screened for vitamin B12 deficiency. In the study, 40 percent of type 2 diabetes patients using metformin had vitamin B12 deficiency or were in the low-normal range for vitamin B12. Of 77 percent of metformin users with vitamin B12 deficiency also had peripheral neuropathy. This is a common nerve damage complication associated with type 2 diabetes.

Peripheral neuropathy is a major complication of diabetes, as such, the researchers suggest that people using metformin be screened for vitamin B12 deficiency or supplemented with vitamin B12. They further stated that anyone already diagnosed with peripheral neuropathy that uses metformin should be screened for vitamin B12 deficiency.