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What is Going on in The Nervous System:

The fluoroquinolone class of antibiotics* has been associated with nerve damage. The FDA has specifically provided warnings that these drugs cause peripheral neuropathy**. Multiple systemic adverse effects may stem from nervous system dysfunction, and the following is just a simplified outline that aims to provide some insight into what you might be experiencing:

Peripheral Nervous System (PNS)

The PNS consists of all the nerves outside the brain and spinal cord. It has two main components: the somatic nervous system and the autonomic nervous system.

1. Somatic Nervous System:

Voluntary Control: Controls voluntary movements by innervating skeletal muscles. For example, moving your arms or legs.
Sensory Input: Transmits sensory information from the body to the central nervous system (CNS), such as touch, pain, temperature, and proprioception (sense of body position).

2. Autonomic Nervous System (ANS):

The ANS controls involuntary body functions and is further divided into three branches: the sympathetic, parasympathetic, and enteric nervous systems:

a. Sympathetic Nervous System:

"Fight or Flight" Response: Prepares the body for stressful or emergency situations. This includes increasing heart rate, dilating pupils, dilating airways, and inhibiting digestion.

Energy Mobilization: Mobilizes energy stores to provide quick energy.

b. Parasympathetic Nervous System:

"Rest and Digest" Response: Promotes relaxation and recovery. It slows the heart rate, constricts pupils, stimulates digestion, and conserves energy.

Homeostasis: Maintains regular bodily functions and conserves energy.

c. Enteric Nervous System:

Gastrointestinal Control: Regulates the functions of the gastrointestinal tract, including peristalsis (movement of food), secretion of digestive enzymes, and blood flow to the gut.

Autonomous Functioning: Often referred to as the "second brain," it can operate independently of the CNS but also communicates with it.

Functions Controlled by PNS and ANS

PNS:

Voluntary movements (walking, typing, etc.)
Sensory perception (touch, temperature, pain)
Reflexes (knee-jerk reaction)

ANS:

Heart rate and blood pressure regulation
Respiratory rate and airway constriction/dilation
Digestion
Gastrointestinal motility
Pupillary response and eye accommodation
Sweating and thermo-regulation
Urination and sexual function

The PNS and ANS work together to ensure that the body can respond to both voluntary actions and involuntary needs, maintaining overall balance and homeostasis.

Fluoroquinolones have been shown in studies to cause mitochondrial dysfunction, impacting the energy production essential for cellular function. Given the high energy demands of neurons within the ANS, mitochondrial dysfunction can have several effects detailed below:

1. Cardiovascular Issues: Mitochondrial dysfunction can possibly impair the autonomic regulation of heart rate and blood pressure, potentially leading to conditions like orthostatic hypotension (a drop in blood pressure upon standing) and arrhythmias.

2. Gastrointestinal Problems: The ANS controls various functions of the digestive system, including motility, secretion, and blood flow. Mitochondrial dysfunction can lead to gastrointestinal issues such as gastroparesis (delayed stomach emptying) and constipation.

3. Respiratory Difficulties: The autonomic regulation of breathing can be affected, potentially causing issues like sleep apnea or other respiratory irregularities.

4. Thermoregulation: The ANS helps maintain body temperature. Mitochondrial dysfunction can impair this regulation, leading to problems with maintaining an appropriate body temperature.

5. Sweating Abnormalities: Mitochondrial dysfunction can possibly affect sweat gland function, leading to excessive sweating (hyperhidrosis) or reduced sweating (anhidrosis), which can impact thermoregulation and skin health.

Overall, the proper functioning of the nervous system is crucial for maintaining homeostasis in the body, and mitochondrial dysfunction can significantly disrupt these vital processes. For more information about nerve damage in those affected by fluoroquinolones, please view Part 2 of our series with Dr. Stefan Pieper, who treats “floxed” patients in his practice in Germany: https://www.youtube.com/watch?v=slxWylnNzQ8

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* For a list of drugs in the fluoroquinolone class

**2013 FDA Warnings: Due to concerns about nerve damage, the U.S. Food and Drug Administration (FDA) issued a Black Box warning about fluoroquinolones and the risk of peripheral neuropathy.

Disclaimer: Fluoroquinolone Toxicity Study does not provide medical advice, and all articles and written content are intended for informational purposes only. We do our best to provide accurate information. Such information is not a substitute for professional medical advice, diagnosis or treatment. Supplements, treatments, and pharmaceutical effects can vary significantly among individuals, particularly in those affected by fluoroquinolone drugs, due to differences in individual responses to these medications.

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References:

Autonomic Nervous System

https://my.clevelandclinic.org/health/body/23273-autonomic-nervous-system

Peripheral Neuropathy Associated with Fluoroquinolones

https://www.academia.edu/11210092/Peripheral_neuropathy_associated_with_fluoroquinolones

Fluoroquinolone-induced serious, persistent, multisymptom adverse effects

https://escholarship.org/uc/item/44d5r44g

Ciprofloxacin impairs mitochondrial DNA replication initiation through inhibition of Topoisomerase 2

https://pdfs.semanticscholar.org/6d82/ae7622517a5731eab55ff3fa63ad73085078.pdf

Fluoroquinolone Antibiotics and Ear Issues:

Fluoroquinolone** antibiotics are a class of broad-spectrum antibiotics associated with many adverse effects. One such issue seen in the FQ community is damage to the inner ear.

The exact mechanism by which fluoroquinolone antibiotics can cause inner ear damage is not fully understood and has only been analyzed in animal research, but there are several mechanisms that could possibly result in such issues:

- Disruption of Mitochondrial Function: Fluoroquinolones have been shown to interfere with mitochondrial function in cells. Mitochondria are the energy-producing structures within cells, and their dysfunction can lead to cell death. The delicate hair cells of the inner ear, responsible for transmitting sound signals to the brain, are particularly vulnerable to mitochondrial damage.

- Formation of Reactive Oxygen Species (ROS): Fluoroquinolones can increase the production of reactive oxygen species (ROS) within cells. ROS are highly reactive molecules that can cause oxidative stress, inflammation and damage cellular structures, including those in the inner ear (choclea).

- Inhibition of Ion Channels: Fluoroquinolones may interfere with ion channels in the cochlea, disrupting the normal flow of ions required for proper hearing function.

- Tendon and Connective Tissue Effects: These antibiotics are known for their potential to damage connective tissues, including tendons. Similar effects might extend to the delicate structures in the ear, such as the ossicles(small bones in the middle ear) and tympanic membrane (eardrum).

- Neuropathy: Fluoroquinolones can cause peripheral neuropathy, which involves damage to nerves. If the auditory nerve (cranial nerve VIII) or vestibular nerve is affected, it can lead to symptoms like: Hearing changes or loss, Dizziness, Balance problems

Tinnitus:

Tinnitus is a frequently discussed concern within the FQ-affected community. You can explore more about others' experiences and insights in the support group linked below. Per the Mayo Clinic, here are some other conditions that can cause tinnitus:

Meniere's disease. Tinnitus can be an early indicator of Meniere's disease, an inner ear disorder that may be caused by abnormal inner ear fluid pressure.
Eustachian tube dysfunction. In this condition, the tube in your ear connecting the middle ear to your upper throat remains expanded all the time, which can make your ear feel full.
Earbone changes. Stiffening of the bones in your middle ear (otosclerosis) may affect your hearing and cause tinnitus. This condition, caused by abnormal bone growth, tends to run in families.
Muscle spasms in the inner ear. Muscles in the inner ear can tense up (spasm), which can result in tinnitus, hearing loss and a feeling of fullness in the ear. This sometimes happens for no explainable reason, but can also be caused by neurologic diseases, including multiple sclerosis.
Temporomandibular joint (TMJ) disorders. Problems with the TMJ, the joint on each side of your head in front of your ears, where your lower jawbone meets your skull, can cause tinnitus.
Blood vessel disorders. Conditions that affect your blood vessels — such as atherosclerosis, high blood pressure, or kinked or malformed blood vessels — can cause blood to move through your veins and arteries with more force. These blood flow changes can cause tinnitus or make tinnitus more noticeable.
Other chronic conditions. Conditions including diabetes, thyroid problems, migraines, anemia, and autoimmune disorders such as rheumatoid arthritis and lupus have all been associated with tinnitus.

Please see the excellent Mayo Clinic article link below for much more detail on tinnitus and what to try to mitigate the issue. Not everyone who takes fluoroquinolone antibiotics will experience inner ear issues or damage, and the severity and duration of the ototoxic effects seems to vary among individuals.

Good to know: NSAIDs, such as aspirin, ibuprofen, and naproxen, can alter blood flow to the cochlea (part of the inner ear critical for hearing). Reduced blood flow may temporarily affect auditory nerve function, leading to tinnitus.

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Disclaimer: Fluoroquinolone Toxicity Study does not provide medical advice, and all articles and written content are intended for informational purposes only. We do our best to provide accurate information. Such information is not a substitute for professional medical advice, diagnosis or treatment. Supplements, treatments, and pharmaceutical outcomes can vary greatly between individuals, especially with those damaged by FQ drugs.

References:

Tinnitus (Mayo Clinic) Nov. 30, 2022

https://www.mayoclinic.org/diseases-conditions/tinnitus/diagnosis-treatment/drc-20350162

Pharmacological drugs inducing ototoxicity, vestibular symptoms and tinnitus: a reasoned and updated guide

https://www.europeanreview.org/wp/wp-content/uploads/956.pdf

Ophthalmotoxicity and ototoxicity of the new quinolone antibacterial agent levofloxacin in Long Evans rats.

https://europepmc.org/article/med/1622440

Ototoxicity of Topical Moxifloxacin in a Chinchilla Animal Model

https://onlinelibrary.wiley.com/.../MLG.0b013e318148b275

Ciprofloxacin impairs mitochondrial DNA replication initiation through inhibition of Topoisomerase 2.

https://academic.oup.com/nar/article/46/18/9625/5088042

Types of Medication That Can Cause Tinnitus

https://www.healthline.com/health/medications-that-cause-tinnitus?utm_source=chatgpt.com

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** For a list of drugs in the fluoroquinolone class (Cipro/ciprofloxacin, Levaquin (off market)/levofloxacin, Avelox/moxifloxacin etc) in all forms for humans and pets

USA & Int'l Facebook support groups

Oxygen & Flying with Fluoroquinolone-Associated Disability

It’s that time of year when some will travel by plane to another destination for the holidays. Those that had their lives greatly impacted by the adverse effects of this antibiotic class* may experience issues that could make them more susceptible to low oxygen levels and physical side effects not to be ignored, particularly during flying.

FQAD encompasses a range of long-term side effects from fluoroquinolone antibiotics, including damage to mitochondria, which play a crucial role in energy production and oxygen utilization in cells.

Why FQAD Could Affect Oxygen Levels:

1. Mitochondrial Dysfunction:

* Mitochondria are essential for cellular respiration, the process that generates energy from oxygen. In individuals with FQAD, mitochondrial damage can impair this process, making cells less efficient at using oxygen.
* This may cause a heightened sensitivity to low-oxygen environments, such as during flights, where cabin pressure reduces oxygen availability.

2. Nervous System Effects:

* Fluoroquinolone toxicity can cause autonomic nervous system dysfunction (dysautonomia), leading to poor regulation of breathing, circulation, and oxygen delivery to tissues.
* Symptoms like shortness of breath, palpitations, or poor oxygenation may become more noticeable during flight.

3. Cardiac and Pulmonary Issues:

* Some people with FQAD report heart-related symptoms (e.g., arrhythmias) and respiratory issues, which can further compromise oxygen delivery.
* Reduced physical activity due to chronic pain or tendon damage can weaken the respiratory muscles over time, exacerbating oxygenation problems.

4. Inflammatory or Vascular Effects:

* FQAD is often associated with systemic inflammation or vascular damage, potentially reducing blood flow and oxygen delivery to tissues.

5. Altitude Sensitivity:

* At cruising altitude, the air pressure inside an aircraft cabin is equivalent to 6,000-8,000 feet above sea level, where oxygen levels are lower. Individuals with compromised oxygen utilization or mitochondrial function may feel the effects more acutely.
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Symptoms of Low Oxygen in FQAD Individuals During Flying:
• Shortness of breath or difficulty breathing
• Fatigue and weakness
• Dizziness or lightheadedness
• Increased heart rate (tachycardia)
• Cognitive difficulties ("brain fog")
• Tingling or numbness in extremities
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Precautions for FQAD Individuals When Flying:

Consult a Doctor: Discuss your condition and symptoms with a healthcare provider. They might recommend supplemental oxygen during the flight or specific medications.

Use Supplemental Oxygen: Some airlines allow passengers to bring FAA-approved portable oxygen concentrators or may provide oxygen upon request (@$300?).

Hydration and Movement: Stay hydrated and move around during the flight to promote circulation and oxygenation.

Compression Socks: If circulation is compromised, these can reduce the risk of blood clots and improve blood flow.

Avoid Stressors: Minimize additional stress on the body by avoiding alcohol, caffeine, or other dehydrating substances.

Monitor Symptoms: Carry a pulse oximeter to monitor oxygen saturation levels during the flight, if possible.

If symptoms of low oxygen (e.g., confusion, severe shortness of breath, or chest pain) occur during or after flying, seek immediate medical attention. A personalized approach is needed in treating FQAD patients, with consideration to patient’s unique symptoms, medical history, severity level, and metabolic requirements.
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References:

   Fluoroquinolones-Associated Disability: It Is Not All in Your Head
https://www.mdpi.com/2673-4087/2/3/17?utm_source=chatgpt.com
   Fluoroquinolone-related neuropsychiatric and mitochondrial toxicity: a collaborative investigation by scientists and members of a social network https://www.mdpi.com/2673-4087/2/3/17
     Medical Advice for Commercial Air Travel https://www.aafp.org/pubs/afp/issues/2021/1000/p403.html...

   Evaluation of patients for supplemental oxygen during air travel
https://www.uptodate.com/.../evaluation-of-patients-for...
   Mitochondrial dysfunction is underlying fluoroquinolone toxicity: an update on mechanisms and implications https://link.springer.com/.../10.1007/s13273-022-00263-9...
    How Airplane Travel Affects Your Body https://health.clevelandclinic.org/dehydration-exhaustion...
    Air Travel - Air Travel - Merck Manual Professional Edition
https://www.merckmanuals.com/.../medical.../air-travel...

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Disclaimer: Fluoroquinolone Toxicity Study does not provide medical advice, and all articles and written content are intended for informational purposes only. We do our best to provide accurate information. Such information is not a substitute for professional medical advice, diagnosis or treatment. Supplements, treatments, and pharmaceutical outcomes can vary greatly between individuals, especially with those damaged by FQ drugs.