In Addition, A Significant Drug-Drug Interaction Between The Concomitant Use Of Fluoroquinolones And Renin–Angiotensin-System Blockers
An article published by the Canadian Medical Association during June 2013 in its medical journal CMAJ, "Risk of acute kidney injury associated with the use of fluoroquinolones", reported on a study that revealed serious renal side effects in some men who used the popular Levaquin, Cipro, or Avelox, i.e., fluoroquinolone class of antibiotics.
From the Abstract for this June 2013 CMAJ article:
Background: Case reports indicate that the use of fluoroquinolones may lead to acute kidney injury. We studied the association between the use of oral fluoroquinolones and acute kidney injury, and we examined interaction with renin–angiotensin-system blockers.
Methods: We formed a nested cohort of men aged 40–85 enrolled in the United States IMS LifeLink Health Plan Claims Database between 2001 and 2011.... to assess the rate ratio (RR) for acute kidney injury with current, recent and past use of fluoroquinolones,... with amoxicillin and azithromycin as controls.
Results: ... Current fluoroquinolone use had a 2.18-fold (95% confidence interval [CI] 1.74–2.73) higher adjusted RR of acute kidney injury compared with no use. There was no association between acute kidney injury and recent (adjusted RR 0.87, 95% CI 0.66–1.16) or past (RR 0.86, 95% CI 0.66–1.12) use.... The dual use of fluoroquinolones and renin– angiotensin-system blockers had an RR of 4.46 (95% CI 2.84–6.99) for acute kidney injury. Our case-time–control analysis confirmed an increased risk of acute kidney injury with fluoroquinolone use (RR 2.16, 95% CI 1.52–3.18). The use of amoxicillin or azithro mycin was not associated with acute kidney injury.
Interpretation: We found a small, but significant, increased risk of acute kidney injury among men with the use of oral fluoroquinolones, as well as a significant interaction between the concomitant use of fluoroquinolones and renin–angiotensin-system blockers.
We will continue to monitor this emerging drug safety issue involving acute kidney injury -- as well as the association between retinal detachment and fluoroquinolones, e.g., Levaquin, Cipro, Avelox -- and report further developments here.