What is a major safety concern with fluoroquinolones and what counseling should be provided?

• A. Tendon rupture risk; report tendon pain; avoid in tendon disorders; caution with elderly/athletes; may prolong QT
• B. Hepatotoxicity
• C. Nephrotoxicity
• D. Ototoxicity

Answer: (B)

Tendon injury is the major safety concern with fluoroquinolones. They can cause tendonitis and, more rarely, tendon rupture, with higher risk in older adults, people on corticosteroids, and those with a history of tendon disorders.

Counseling should emphasize:

• Report any sudden tendon pain, swelling, or weakness (most often in the Achilles but any tendon can be affected). If pain occurs, stop the medication and seek medical evaluation promptly.

• Avoid strenuous activity or heavy exercise that strains the affected tendon during therapy and for a period after finishing treatment.

• Be aware of a potential for QT interval prolongation, especially in those with electrolyte disturbances, preexisting heart rhythm problems, or when taken with other QT-prolonging drugs; inform the clinician of other medications and heart conditions.

Additionally, practical use notes can help optimize safety, such as taking the drug as prescribed and discussing any history of tendon disorders or heart rhythm issues with the provider.