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Drug-Induced Tendinopathy

Certain medications, especially fluoroquinolones and corticosteroids, are associated with tendinopathy and tendon rupture, particularly in older and physically active patients.

Key Offending Agents:

  • Fluoroquinolones (e.g., ciprofloxacin, levofloxacin)
    Tendon damage (especially Achilles tendon)
    Risk increased in elderly, renal failure, corticosteroid co-use
    Tendon symptoms may appear within hours to weeks

  • Corticosteroids (systemic or local injection)
    Weakening of collagen matrix
    Risk increases with repeated injections

  • Statins (less common)
    May cause tendinopathy or myopathy

  • Aromatase inhibitors (e.g., in breast cancer treatment)
    Associated with musculoskeletal pain and rare tendinopathy

Commonly Affected Sites:

  • Achilles tendon

  • Rotator cuff

  • Patellar tendon

  • Biceps tendon

Clinical Presentation:

  • Pain, swelling, or tenderness over tendon

  • May lead to partial or complete rupture (especially Achilles)

  • Often bilateral in fluoroquinolone-related cases

Management:

  • Immediate discontinuation of the causative drug

  • Rest, ice, NSAIDs

  • Immobilisation if needed

  • MRI/USG for suspected rupture

  • Surgical repair for full rupture in selected cases

Prevention:

  • Avoid fluoroquinolones in high-risk populations

  • Limit steroid injections to <3/year per tendon area

  • Counsel patients on early symptoms

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