Risk of aortic dissection, rupture, or aneurysm is leading FDA to require added warnings on oral and injectable quinolone labels.
These aortic complications are rare...occurring in about one in every 11,000 patients in the general population each year.
But that number can jump to one in about 300 high-risk patients. This includes the elderly...patients with a history of aneurysm, hypertension, vascular disease, or smoking...or those with genetic disorders such as Marfan syndrome or Ehlers-Danlos syndrome.
And using a quinolone is linked to a doubling of these risks.
One theory suggests that quinolones may disrupt collagen in the aorta...possibly leading to vessel wall damage and aortic rupture.
Risk is seen with quinolone courses as short as 3 days, but it's higher with courses lasting more than 2 weeks...and may persist for up to 2 months after taking a quinolone. It's too soon to say if one quinolone is riskier than another...or if higher doses increase risk.
This new warning adds to previous quinolone concerns about CNS effects, tendon rupture, peripheral neuropathy, QT prolongation, etc.
But there are still about 30 million quinolone Rxs prescribed each year in the U.S.
Assess your patient's risk of dissection, rupture, or aneurysm BEFORE prescribing a quinolone...and use alternatives when possible.
For example, choose nitrofurantoin or TMP/SMX for most uncomplicated UTIs. Or for community-acquired pneumonia, use high-dose amoxicillin PLUS azithromycin in patients at risk for resistance (age over 65, COPD, etc).
Save quinolones as a last resort for complicated infections or when other antibiotics can't be used...such as patients needing oral treatment for Pseudomonas or those with SEVERE allergies to alternative agents.
Educate patients on a quinolone to report dissection, rupture, or aneurysm symptoms...sudden, severe pain in the stomach, chest, or back.
Find out more about quinolone risks with our chart, Adverse Reactions With Systemic Quinolones.
- Int J Cardiol 2019;274:299-302
- J Am Coll Cardiol 2018;72(12):1369-78
- BMJ 2018;360:k678