Whether it was for a sinus infection or bronchitis, most people have taken an antibiotic at some point in their lives. Antibiotics can be lifesaving medications but, like all other drugs, they come with risks. In particular, one specific class of antibiotic drugs called the fluoroquinolones carry serious risks that few people are aware of. In light of the growing epidemic of antibiotic resistance, each new generation of antibiotics has bolstered an enhanced degree of potency which can be viewed as both an asset and a liability. The fluoroquinolone class features a robust, broad-spectrum antibiotic effect and includes many popular drugs such as ciprofloxacin (Cipro), ofloxacin (Floxin), norfloxacin (Noroxin), levofloxacin (Levaquin), moxifloxacin (Avelox), and gemifloxacin (Factive).
Chemically speaking, the mechanism of action of the fluoroquinolones closely mirrors that of certain chemotherapy drugs, so it is rather unsettling that these powerful agents are sometimes prescribed for relatively benign infections that would probably resolve on their own or with a milder drug. One notable and unique risk of the fluoroquinolones is that, unlike most other antibiotics, they are neurologically active at commonly prescribed dosages. As an action secondary to their primary antimicrobial effect, they are capable of binding to certain receptors in the brain, spinal cord, and peripheral nervous system. The primary receptor type affected is the GABA-A receptor, which is the exact same receptor that benzodiazepines act on.[1]
When a fluoroquinolone binds to a GABA receptor, the result is the polar opposite of the effect of CNS depressants like benzodiazepines. Fluoroquinolones are antagonists of the GABA-A receptor, meaning that they prevent the binding of GABA and can displace other molecules bound to the receptor, such as benzodiazepines.[1] GABA is an inhibitory neurotransmitter and drugs which enhance its action, like benzodiazepines, cause sedation. The GABA receptor blockade caused by a fluoroquinolone results in a CNS stimulant effect, with neurological manifestations ranging from mild insomnia and agitation to hallucinations and seizures.[2] Anyone can suffer these side effects, but individuals prescribed benzodiazepines are notably much more prone to experiencing these adverse neuropsychiatric reactions.
The culprit is the GABA receptor downregulation imposed by benzodiazepine tolerance. When a benzodiazepine is given chronically (beyond 10 days) there are a series of downward compensatory mechanisms which seek to restore a neurological equilibrium in light of the overstimulation of GABA receptors by the drug. This results in GABA receptors becoming progressively less receptive to GABA over time following prolonged exposure to benzodiazepines.[3] Over time, the brain’s GABA-dependent systems are weakened and there is a heightened vulnerability to external influences which decrease the action of GABA.
A storm neural excitation ensues when a fluoroquinolone “unmasks” the GABA receptor downregulation associated with benzodiazepine tolerance. In addition, since they share the same target, fluoroquinolones are capable of competing with benzodiazepines for GABA receptor binding in a concentration-dependent manner. Studies have shown a complex interaction when a fluoroquinolone and a benzodiazepine are simultaneously bound to a GABA receptor. At high concentrations, fluoroquinolones are capable of displacing a portion of the benzodiazepine molecules bound to GABA receptors.[4] This displacement can precipitate an acute benzodiazepine withdrawal syndrome which is identical to that which would normally happen if an individual were to suddenly reduce their benzodiazepine dosage.
Imagine each GABA receptor as having a gas pedal and a brake pedal. The entire GABA receptor, with its imaginary gas and brake pedals, is anchored into the neuron whose pace it controls. GABA agonists like benzodiazepines act on the brake pedal and GABA antagonists like fluoroquinolones act on the gas pedal. When an agonist acts on the brake pedal, chloride ions flow through the receptor into the neuron. Chloride ions are like an electrostatic glue which slows the neuron down. When an antagonist acts on the gas pedal, the flow of chloride stops and the neuron speeds up.
When an agonist is present for a prolonged period of time, the brake pedal gradually becomes worn out. Additionally, the neuron will recruit chemical messengers to tune up the gas pedal so that the neuron can continue to move along at its desired pace. It might be a pace that provokes anxiety, but it is the precise pace which will allow the neuron to fulfill its purpose within the unique neural circuit it belongs to. After being chronically slowed down by benzodiazepines, neurons want to break free but are held back by the presence of the drug. They will progressively fight back harder and harder to overcome this pharmacological oppression. Fluoroquinolones unleash neurons from their chemical bondage by disengaging the brake and stepping on the gas pedal, causing a sort of neural short-circuit as the freed neurons begin to race out of control.
It has been shown that certain non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen are capable of enhancing the GABA receptor blockade cause by fluoroquinolones, potentiating their neurotoxicity and exacerbating their CNS side effects.[5] NSAIDs are frequently co-prescribed with fluoroquinolone antibiotics for painful infections like sinusitis and urinary tract infections. Adding further insult to injury, some fluoroquinolones including ciprofloxacin (Cipro) are inhibitors of the CYP1A2 liver enzyme which is responsible for metabolizing caffeine and other xanthine alkaloids found in coffee, tea, and chocolate.[6] This commonly results in an increased sensitivity to the stimulating effects of caffeine when ciprofloxacin is taken. Hence, it is hardly a surprise that coffee drinkers who are prescribed a benzodiazepine are at an even higher risk for fluoroquinolone-induced seizures and neuropsychiatric disturbances.
It is an unfortunate truth that many healthcare practitioners outside the realm of neuroscience are unaware of these lesser-known facts about fluoroquinolone antibiotics. The fluoroquinolone-caffeine interaction is well documented but the fluoroquinolone-benzodiazepine interaction is not currently recognized in any of the current web-based drug interaction cross checking systems commonly used by healthcare consumers. Most pharmacists are not aware of the issue either, and will readily dispense fluoroquinolone prescriptions to benzodiazepine-dependent patients. This interaction is not consistently recognized yet it very consistently gets benzodiazepine-tolerant individuals into deep trouble. Studies have found that benzodiazepine-dependent individuals frequently experience depression, anxiety, psychosis, paranoia, severe insomnia, paraesthesia, tinnitus, hypersensitivity to light and sound, tremors, seizures, and suicidal thoughts upon exposure to fluoroquinolone antibiotics.[7]
These symptoms are all consistent with acute benzodiazepine withdrawal syndrome. Furthermore, it may take several weeks or even months after discontinuing the fluoroquinolone for the affected individual to become symptom-free. This may be due to the long-term potentiation that occurs when excitatory glutamate-containing synapses are overstimulated by a deficit of GABA activity. Some individuals never return to their pre-fluoroquinolone state and they are commonly referred to as having been “floxed”. They are left with conditions including peripheral neuropathy, muscle weakness, cognitive dysfunction, new or worsened mental illness, and even paralysis which are all consistent with excitatory neurotoxicity (excitotoxicity) and brain damage.[8][9][10]
Taking all this into account, it is imperative that moving forward more healthcare professionals will become aware of and publicly acknowledge this dangerous interaction which has rendered normal, healthy people disabled. However, this alone is not enough. It is equally important that benzodiazepine-dependent individuals become aware of this interaction so that they can better advocate for themselves. It is well known that chronic benzodiazepine usage often creates chemical sensitivities which require the affected individuals to avoid a variety of foreign substances which most normal people can tolerate, and fluoroquinolones probably fall at the very top of that list.
All doctors should be aware that prescribing a fluoroquinolone to a benzodiazepine-dependent individual carries a serious risk for disability which could potentially be permanent. Fluoroquinolones should be contraindicated with chronic benzodiazepine exposure in nearly every scenario, including nonmedical benzodiazepine abuse. Clinicians should explore all alternatives before fluoroquinolones are considered. In rare cases where it has been determined that failing to administer a fluoroquinolone could result in death, benzodiazepine-dependent individuals should have their benzodiazepine dosages increased for the entire duration of fluoroquinolone therapy and until the drug is completely cleared from their system.
I had been a benzo user on and off for a few years. Was given metronidazole. Took it for 4 days. Was given Ativan at the hospital when I lost it after 3 days. It’s been a month, and I am not doing better at all. I am 33. Was active and top notch healthy before this happened. Was actually prescribed Metronidazole only for a mild case of dermatitis. My life has been ruined in the past month. After this all happened, I was given Ativan again. It helped a bit but temporarily. Then was stopped again. Didn’t know about this whole withdrawal thing. Metronidazole acts the same way as Fluoroquinolones when it comes to benzos. Had the same effect on GABA. I am so scared.. I just want to recover.
I should have also mentioned…that I am so happy to report that due to the changes I mentioned in diet and adding in necessary nutrients…I feel very well and almost energetic most days. There were a string of years when I thought I was not going to make it due to the symptoms. I never imagined I could feel this good again. Never lose hope. The body is a miraculous creation with an innate ability to heal. God builds miraculous creations…one quote that helped me so much was from a doctor who said “If I could gather up 1 cubic centimeter of the mitochondria within you and I compared it to 1 cubic centimeter if the sun…your mitochondria would be 10,000 times brighter.” Whether it is true or not…I don’t know…but I began believing that I was in a vehicle that was quite powerful with an innate desire for life and healing. Mankind can do enormous destruction…but it is peanuts to the life force that is in us and all around us. Always believe in the ability to heal.
This brings a tear to my eye. I was floxed in March 2020 and benzo’d by a few sporadic doses of lorazepam weeks ago. I can’t share how anxious, hopeless, and depressed I’ve felt – you already know. However, messages like yours give me the fuel to motor on another day with the belief that I will heal. Thank you for sharing.
I was taking Avalox for a sinus infection & it caused intense overstimulation of the cns. It is now (all quinolones) on my list (to Dr.’s, ER’s, Hospitals etc) as meds I cannot use. This also goes for epinephrine (also epipen, and novacain—which includes epi to prevent bleeding). This is due to (+,+) from both parents to the COMT gene, which means that I methylate epinephrine and dopamine too slowly. All quinolone antibiotics raise dopamine intensely. If someone wants to give me novacain instead of carbocain (has no epi), or thinks I must have a quinolone antibiotic I either leave and go to another doctor or tell them my cousin is a attorney who sues hospitals.
In 2019 I was hospitalized due to Klebsiella pneumonia/sepsis from a port catheter (chemo). I had an andverse reaction to a med they gave me in the hospital (whole body hugely red and humongouse hives. The dr. said he was going to give me epinephrine and benedryl. I refused strongly and had to give a calm scientific medical reason why before the dr. would listen to me. The epi problem is described above–but I am allergic to benedryl –a 1st class antihistamine. I can use zyrertec –3rd class. Each of the 3 classes of antihistamines are actually different chemicals. Some people are allergic to some of the classes of antihistamines. I told the Dr. and his nurses to give me an injection into my IV of Salumedrol (which is generic methylprednisolone)–a very strong corticosteroid that will stop an allergic reaction. Not ideal if you are getting an antibiotic for a bacterial infection but neccesary to remain alive. I told them they should give me these and don’t wait too long because the skin swelling would eventually spread to the trachea and lungs.–and they would not want a dead patient because it would weird them out. You can tell I am still okay if I am telling doctors silly jokes during an emergency. They gave me the correct drugs and the symptoms went away promptly. I also had a infectious disease specialis due to them not knwoing immediately what infection was giving me over 103 fever. There were may bloodtests and blood cultures. They use IV meds to treat, but 2 of them are Avalox, and penecillin—so the dr. had to locate a special, very expensive med, special ordered, that was given IV every 8 hrs for 1 hour and then 10 days a different one, once a day for 3 hrs. IV at an infusion center and at the hospital out patient area on a weekend. Insuranc epaid for everything and I got great care and I am now perfectly healthy–but the allergy and genetic problem with adverse drug issues seems to require that a patient proactively study info for their illness and treatment–which is crazy0but a good idea.—and much of it was not know by me until the timme when I had very severe reaction. The Avalox reaction had my face muscles twitching and my hands trembling for 6 months–which was weird because at the time Iwas teaching in a HS>
BTW–I found from many blogs with floxxed people some of whom weere doctors dealing with this quinolone issue, that Taurine, Gaba, was helpful.
Patients unfortunately have to study, their own genetics, the mechanisms of actions of different drugs, and be vigelent of what health care professionals are giving you. I would like it so much better if a doctor just was able to take care of everything.
Hello, did you find out what antibiotic you could tolerate? I am having issues with antibiotics and I have low comt I believe it’s AA or something like that. I have never been on benzos but have severe akathesia with certain medications
Did brad end up healing before he passed.
I recall that Brad ultimately committed suicide due to the unrelenting cruelty of long-term akathisia caused by his being cold turkeyed then floxed years earlier. There have been countless brilliant hearts and minds lost to this needless and tragic suffering. God rest their souls.
This is why I’m so sick. I’m suffering from having had Chronic Bladder infections and Lyme Disease, both treated with Antibiotics. I have been suffering. My feet are burning constantly.
I don’t know how long I can’t do this.
Fluoroquinolones can also seriously inhibit the absorption of vitamin b12, a vitamin that is essential in forming red blood cells, repairing DNA, regulating homocysteine and MMA levels (high levels of homocysteine have been shown to cause plaque build up in arteries, leading to cardio and cerebral vascular disease),as well as being part of the myelin sheath (the fatty tissue that surrounds and protects our nerves) Lack of b12 causes serious health problems and is potentially debilitating and even fatal.
b12 deficiency also causes or can exacerbate neurological symptoms such as confusion, brain fog or aphasia.
I tend to have strange and uncomfortable side effects from all types of medications. Benzos dependancy has left me in a quandary as to whether I take a prescribed medication together with the valium or not. Nine out of 10 times I get weird symptoms or just feel off. No one believes me when I say the benzos mess with other drugs in a way that someone not knowledgeable in this field would never believe. Most wash their hands of me, basically insinuating it’s all in my head.
That is so standard!! These doctors should lose the license to practice. They aren’t even following the most basic recommendations on benzos. 2-4 weeks!!! How do they get away with it? And this Levaquin , why in the world are docs still prescribing this????? I’m so disappointed in these United States, and Big Pharma. They would rather kill us than lose a dollar. Sickening!!!!! I was flicked 21/2 yrs ago, still have not recovered.
That’s exactly what the globalist are intentionally doing. They’re plan to Kill off the population. It’s in their Agenda21-2030. Read it on Rockefeller Foundation doc, World Economic Forum Klaus Schwab describes it on their website and in his New book COVID 19 The Great Reset. Also Bill Gates said publicly -” if we do it right we can reduce the population with vaccines.” Watch him on Ted Talk. US medical tyranny 2021. Its been they’re agenda for decades. They’re a bunch of Psychopathic Criminals.
Does anyone know what helps? I’m considering TMS/Neurostar for intractible depression, PTSD and anxiety.
I use TMS in research and the current literature says that it does not work for depression/anxiety but in fact can cause memory loss
BY THE WAY. I have been told that I am NOT to withdraw until the levoquin symptoms are gone. I am having withdrawls symptoms without withdrawing
Nancy
Did they say why you aren’t to down dose until symptoms go away?
Wow! So grateful for this article. As a regular Benzo user for chronic insomnia, i found this very helpful. I am certain I had a contraindicated response from Levaquin and ibuprofen years ago. Though no doctor has ever believed me.
IT has been 9 months and I am left with the horrendous pain of the withdrawl syndrome. I have been seeing a homeopath who has me trying so many different remedies to help the intense feeling. I cannot tolerate it. What did some of you try. Today I was on the ground in a ball crying and crying from the withdrawl pain. I have taken 1/4 of a mg. of clonopin a night and took one levoquin and my life has been altered. I cannot work. It is too inconsistent.
The only thing that I have found that offers relief is a vitamin complex called A-D-K 5
What symptoms does it help with? I usually can’t tolerate vitamins, but I’m willing to try these if they might help me.
Where do you get this supplement ? Is it still working ?
Wow…thank you for such a comprehensive post. This explains so much. Nancy, I am so sorry for your pain. I realize your post was over a year ago. I hope you are doing better. I was only on a bento for insomnia for 3 months. I also had taken ibuprophen for 3 months straight…doctors orders and had a long history of antibiotic prescription. It took me five months to feel half way descent. The only way I felt better was to have large amounts of magnesium spread out throughout the day…watch the laxative effect and back down or spread out dose if this occurs. I also ate and continue to eat all whole foods…nothing excitatory (no high glutamate foods). No grains…no dairy. I then went to see a functional medicine doctor which helped a lot. Find a provider at institute for functional medicine online. I pray for healing to all. It takes a completely changed lifestyle for me to live without pain now.
I learned the hard way. On benzodiazepines for years, prescribed Avelox 1 time, have no idea why my physician would order for the garden variety sinus infection, but but day 4 I complained I felt weird, day 10 I went psychotic and attempted suicide and have never been the same, the ramifications and residual issues … and no recourse. No one believed me that Avelox pushed me to psychosis, and my physician ignored my request to submit the AE to the FDA. 4 years later it gets the black box warning that was well overdue. I look forward to some more published research on the pleiotropic effects quinolones and other antibiotics have, since some are effective in treating schizophrenia.
amazing post …so sorry about this . I understand how one med can become the antagonists for a disastrous result. Its like one is the match n the other drug is gasoline. Adding valium to the colozapin that was in my system once caused a wild fire in my life . I do hope u will get well in time. i believe u will.
Sadie, Were you trying to transition from Clonazepam to Valium? I was planning on doing this as the Ashton Manuel Suggest. I was going to slowly taped over and switch to Valium for my nighttime Clonazepam dose and see how I do. please tell me what happened to you? I was prescribed Xifaxan was I floxed?
Unfortunately, I didn’t know this back in 2013. Since I have experienced it on my skin, I am trying to raise awareness of any MD I meet. At most of the time, they think I’m crazy. Anyway, I’m doing it.
I too was a log time Lorezapam user for insomnia. I was given a Levaquin script for a sinus infection and went into immediate acute benzo withdrawal. I can’t believe the doctors and pharmacists aren’t privy to this info and they should be held responsible. I was able to find the info, so should they. Going to sue, if .I can. On disability still going through withdrawals 4 months later, on Valium. Which they tried to stabilize me.