{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T01:04:00Z","timestamp":1792717440593,"version":"4.5.0"},"reference-count":56,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2016,6,11]],"date-time":"2016-06-11T00:00:00Z","timestamp":1465603200000},"content-version":"vor","delay-in-days":10,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100007819","name":"Allergan","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100007819","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100004334","name":"Merck","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100004334","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["accpjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pharmacotherapy"],"published-print":{"date-parts":[[2016,6]]},"abstract":"<jats:p>Fluoroquinolone antibiotics recently have gained increased national attention due to safety concerns. A well\u2010described and serious adverse event associated with receipt of fluoroquinolones is tendinitis and tendon rupture. These tendon injuries can result in long\u2010term sequelae, including chronic pain and mobility restrictions, and may warrant surgery. Due to the severity of these adverse events, a black box warning is included in the product labeling of all fluoroquinolones. In light of the mounting concerns surrounding fluoroquinolone\u2010associated toxicities, the purpose of this clinical review is to provide a comprehensive summary of the risk of tendinopathy associated with levofloxacin, one of the most widely prescribed antibiotics in the United States, across in vitro, animal, and clinical studies, relative to other antibiotics. As part of this review, clinical presentation and onset, proposed mechanisms, patient\u2010specific risk factors, and management of fluoroquinolone\u2010induced tendon injury are summarized. Data were obtained from a comprehensive PubMed literature search and a review of U.S. Food and Drug Administration documents. Although tendinopathy is considered a fluoroquinolone class\u2013wide toxicity, data from in vitro studies, animal studies, patient\u2010level analyses, and large national and international surveillance reports suggest that levofloxacin, as well as its parent compound ofloxacin, possess higher propensities to cause tendon damage relative to other fluoroquinolones. Risk with ofloxacin and levofloxacin appears to be exposure dependent, with higher doses and longer durations being most commonly associated with tendinopathy. Other well\u2010described patient risk factors for fluoroquinolone\u2010associated tendinopathy include older age (older than 60 yrs), receipt of concomitant corticosteroid therapy, presence of renal dysfunction, and history of solid organ transplantation. Given widespread use of levofloxacin across patient care settings, knowledge of both patient\u2010 and drug\u2010specific characteristics associated with increased risk of tendinitis and tendon rupture can promote safe use of levofloxacin and other fluoroquinolones.<\/jats:p>","DOI":"10.1002\/phar.1761","type":"journal-article","created":{"date-parts":[[2016,5,3]],"date-time":"2016-05-03T07:18:59Z","timestamp":1462259939000},"page":"679-693","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":80,"title":["Fluoroquinolone\u2010Associated Tendinopathy: Does Levofloxacin Pose the Greatest Risk?"],"prefix":"10.1002","volume":"36","author":[{"given":"Monique R.","family":"Bidell","sequence":"first","affiliation":[{"name":"Albany College of Pharmacy and Health Sciences Albany New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas P.","family":"Lodise","sequence":"additional","affiliation":[{"name":"Albany College of Pharmacy and Health Sciences Albany New York"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2016,6,11]]},"reference":[{"key":"e_1_2_12_2_1","unstructured":"Antimicrobial Drugs Advisory Committee and Drug Safety and Risk Management Advisory Committee.FDA Briefing Document.2015. 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