A Levaquin warning about reported tendon injuries could have implications for the drug’s reported link to aortic tears and aneurysms.

In recent years, Levaquin and other fluoroquinolone antibiotics have become more popularly prescribed for sinus infections, ear infections and other ailments that used to be treated with Zithromax, tetracycline and other older medications. Too many types of bacteria have become resistant to the older antibiotics, which has led doctors to prescribe Levaquin, Cipro, and Avelox more often.

Fluoroquinolones entered the market in the 1980s and were proven to fight both gram-positive and gram-negative strains of bacteria. Many fluoroquinolones have been linked to risks of serious side effects, leading the FDA to add a Levaquin warning to the drug’s label.

Possible Injuries Lead to Levaquin Warning

Levaquin users were reporting a higher than normal incidence of tendon injuries, which led the FDA to order a black box warning to all fluoroquinolone antibiotics in 2008. The label warned of a potential higher risk of tendon injuries, including ruptures of the Achilles tendon.

In 2013, the makers of fluoroquinolones were told to change the drugs’ labels regarding the risk of peripheral neuropathy. The risk of this nerve disorder had existed on the labels since 2004, but the FDA felt the Levaquin warning didn’t convey the speed with which the condition could manifest and that it could become permanent.

Peripheral nerves connect the brain and spinal cord to muscles, skin and internal organs. Damage to the pathways of the peripheral nerves can cause impaired movement, dulled sensation in the arms and legs or pain, the condition known as peripheral neuropathy.

Levaquin Linked to Aortic Aneurysm

Most recently, researchers have noted a link between fluoroquinolones like Levaquin and an increased risk of an aortic aneurysm or aortic dissection. Fluoroquinolones are suspected of having the same action on the walls of the aorta as they have on tendons because all of these tissues contain collagen.

An aortic aneurysm is the weakening and bulging of the walls of the aorta. An aortic dissection is when the lining of the aorta tears, allowing blood to leak between layers where it doesn’t belong.

Research indicates fluoroquinolones break down the body’s collagen, causing the weakened tissue to be susceptible to tearing.

A pair of respected medical journals published studies regarding the potential link in 2015.

The Journal of the American Medical Association (JAMA) published a study showing patients on fluoroquinolones had a two-fold increased risk of an aneurysm within 60 days of taking the antibiotics. Researchers said, “clinicians should continue to be vigilant for the appearance of an aortic aneurysm and dissection in high-risk patients treated with fluoroquinolones.”

Medical journal BMJ published a study that showed patients on fluoroquinolones had nearly a three-fold increased risk of an aortic aneurysm. The study said patients on fluoroquinolones had a 66 percent increased risk of suffering an aortic aneurysm or aortic dissection within 60 days of taking the medication when compared to patients who took the antibiotic amoxicillin.

Though the FDA has yet to order a label change based on this research, a new Levaquin warning may be in order. Patients who suffer an aortic aneurysm or aortic tear after taking Levaquin may not have been adequately warned about the risks associated with this medication.