Aortic Dissection and Rupture Risk Linked to Cipro Antibiotic

A new study appears to add to the growing body of evidence that links side effects of Cipro and similar antibiotics to a potential increased risk of deadly aortic dissections and ruptures. 

Researchers with Baylor College of Medicine and the Texas Heart Institute warn doctors to be cautious in prescribing fluoroquinolone antibiotics to patients at high risk of aortic aneurysm and dissection (AAD), due to an increased risk of both seen in mice. The findings were published July 25 in JAMA Surgery, and build on prior research suggesting that popular drugs like Cipro, Levaquin, Avelox an others may cause degredation within the layers of the aorta.

Aortic aneurysm is a painful and potentially serious condition involving a bulge in the aorta, where the walls of the artery have weakened. They can cause severe chest pain, as well as carry the risk of rupturing. Aortic dissections are similar, but a potentially more serious and life-threatening condition, involving degradation within the layers of the aorta. Both pose a serious health risk and usually require invasive surgery to treat.

In this latest study, researchers conducted animal studies on mice, comparing the effects of Cipro on the aortas of mice who had been provided high fat diets and subcutaneous angiotensin II infusions to simulate high aortic aneurysm and dissection risks, with normal mice. Some of the “challenged” and “unchallenged” mice were given Cipro, while others were not.

According to the findings, there was no sign that Cipro increased the risk of aortic problems in so-called unchallenged mice. However, they observed a significantly increased risk of aortic dissection, aortic aneurysm, aortic ruptures and deaths when comparing challenged mice given Cipro to challenged mice not given the drug.

The findings indicated that 98% of high-risk mice given Cipro suffered severe aortic disease with significantly increased incidents of dilatation. In addition, 78% of those mice developed aortic aneurysm or dissection, compared to 45% of the challenged mice not given the antibiotic. In addition, 15% of the mice from the Cipro group suffered aortic rupture and premature death. None of the challenged mice not given Cipro suffered ruptures or premature deaths.

“Although the causal effect cannot be determined by the results of these observational studies, this alarming association raises the concern that taking fluoroquinolones may promote AAD formation or increase the risk of disease progression and rupture in patients with AAD,” the researchers determined. “We showed that although ciprofloxacin alone did not induce spontaneous AAD in the absence of exogenous stress, it significantly increased the incidence and severity of challenge-induced AAD, particularly with respect to dissection and rupture.”

Antibiotic Side Effects

Concerns about the risk of aortic dissection and aortic aneurysm with fluoroquinolones emerged in late 2015, following the publication of a report in the medical journal JAMA Internal Medicine, which found that current use of Levaquin, Avelox or other similar antibiotics was associated with a two-fold increased risk of suffering an aortic aneurysm or dissection injury.

That research was initiated to examine whether the known risk of collagen degredation associated with fluoroquinolones, which have previously been associated with reports of tendon ruptures and retinal detachment, may also cause problems with the aorta, which is the main artery of the body, supplying oxygenated blood to the circulatory system.

The FDA issued a major fluoroquinolone antibiotics warning in May 2016, due to a variety of “disabling and potentially serious side effects,” which led the agency to conclude that the risks may outweigh the benefits associated with using the medications to treat uncomplicated infections.

That warning concerned reports of permanent nerve damage, known as peripheral neuropathy, as well as tendon ruptures and other health risks. However, the statement did not address concerns about the risk of aortic aneurysm and aortic dissection from the antibiotics, which emerged with the publication of an independent study months earlier.

In May 2017, the FDA issued another drug safety communication indicating that it found no link between Cipro and similar antibiotics and an increased risk of aortic aneurysm and aortic dissection. However, this latest study seems to provide some additional information about the potential link and biological mechanism, which may cause the regulatory agency to re-evaluate the prior communication.

There are currently hundreds of Levaquin lawsuits, Avelox lawsuits and Cipro lawsuits filed throughout the federal court system over side effects allegedly caused by the antibiotics, including claims for individuals diagnosed with an aortic aneurysm or dissection injury.