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Fluoroquinolone Antibiotics Linked to Aortic Injuries

Recent studies* indicate that users of fluoroquinolone antibiotics, including Cipro®, Levaquin® and Avelox® are twice as likely to suffer from aortic aneurisms and tears of the aorta—the largest blood vessel in the body.

Last year, doctors wrote more than 26 million fluoroquinolone prescriptions to treat common infections. Unfortunately, these antibiotics have been linked to collagen degradation, which can weaken the aorta, causing it to bulge (aortic aneurysm) and split apart (aortic dissection). Damage to the aorta can lead to strokes, heart attacks, internal bleeding and death.

What are fluoroquinolones?

Fluoroquinolones are a group of wide-spectrum antibiotics, used to treat a variety of problems, including sinus infections, bronchitis and urinary tract infections. They include:

  • Avelox ® (moxifloxacin hydrochloride)         
  • Cipro ® (ciprofloxacin)
  • Cipro ® XR (ciprofloxacin)
  • Factive ® (gemifloxacin mesylate)
  • Floxin ® (ofloxacin)
  • Levaquin ® (levofloxacin)
  • Maxaquin ® (lomefloxacin hydrochloride)
  • Noroxin ® (norfloxacin)        
  • Proquin ® XR (ciprofloxacin hydrochloride)
  • Raxar ® (grepafloxacin hydrochloride)         
  • Zagam ® (sparfloxacin)        

How do fluoroquinolones damage the aorta?

Use of fluoroquinolone antibiotics has been associated with several collagen-related disorders, including tendon rupture, tendinopathy, and retinal detachment. In 2008, the USA Food and Drug Administration issued a black box warning for fluoroquinolones, indicating that these medications were associated with tendonitis and tendon rupture.

Collagen is also a major component of the aortic wall. Since fluoroquinolones have been known to degrade collagen, researchers began to question whether fluoroquinolones may cause or aggravate damage to the aorta, including aortic aneurysm and dissection.

A study by researcher Chien-Chang Lee, MD, of National Taiwan University Hospital and colleagues published in JAMA Internal Medicine found, “Use of fluoroquinolones was associated with an approximately 2-fold increase in risk of aortic aneurysm and dissection within 60 days of exposure.”

What is an Aortic Aneurysm?

The aorta is the largest blood vessel in the body. It carries oxygenated blood away from the heart to the rest of the body. Weakness in the aortic wall can cause it to widen and balloon outward, much like a damaged garden hose. In acute cases, the aorta can rupture and cause severe internal bleeding.

Warning Signs of Aortic Aneurysm

Unfortunately, many people with aortic aneurysms don’t know there’s a problem because they do not experience any symptoms. However, if the aneurysm becomes very large, it may cause pain, numbness, blood clots, or other symptoms. Affected areas vary, depending whether the bulge in the aorta is located in the chest (thoracic aneurysm) or abdomen (abdominal aortic aneurysm). A ruptured aneurysm causes a dramatic drop in blood pressure, sending the person into shock and damaging vital organs.

What is an Aortic Dissection?

An aortic dissection happens when the inner layer of the aorta tears, causing the inner and middle layers of the aorta to separate (dissect). This can lead to aortic rupture or decreased blood flow (ischemia) to organs. Aortic dissections most frequently occur in the upper (thoracic) part of the artery, but may also occur in the abdominal aorta. An aortic dissection may also cause aortic aneurysm. Symptoms of aortic dissection usually begin suddenly and include severe chest pain.


Lee C, Lee M, Chen Y, et al. Risk of Aortic Dissection and Aortic Aneurysm in Patients Taking Oral FluoroquinoloneJAMA Intern Med. 2015;175(11):1839-1847. doi:10.1001/jamainternmed.2015.5389.

Daneman N, Lu H, Redelmeier DA. Fluoroquinolones and collagen associated severe adverse events: a longitudinal cohort study. BMJ Open 2015;5:e010077. doi:10.1136/bmjopen-2015- 010077