European Journal of Clinical Pharmacology

, Volume 75, Issue 10, pp 1431–1443 | Cite as

Fluoroquinolones and the risk of tendon injury: a systematic review and meta-analysis

  • Carlos AlvesEmail author
  • Diogo Mendes
  • Francisco Batel Marques
Pharmacoepidemiology and Prescription



Tendinopathy is a known adverse reaction associated to fluoroquinolones, but a meta-analysis was not yet published. The aim of this study was to conduct a systematic review and a meta-analysis of the scientific evidence evaluating the risk of tendon injury associated with fluoroquinolones.


A literature search was conducted to identify observational studies which reported results on the risk of Achilles tendon rupture (ATR), risk of Achilles tendinitis (AT), or risk of any tendon disorders (ATD). A meta-analysis was performed by pooling odds ratios (ORs) with their 95% confidence intervals (CIs).


Fifteen studies were included in the meta-analysis. Treatment with fluoroquinolones was associated with an increased risk of ATR (OR 2.52 (95% CI 1.81–3.52), p < 0.001, I2 = 76.7%), an increased risk of AT (OR 3.95 (95% CI 3.11–5.01), p < 0.001, I2 = 0%), and increased risk of ATD (OR 1.98 (95% CI 1.62–2.43), p < 0.001, I2 = 84.5%). The initial risk estimates remained statistically significant among patients aged ≥ 60 years old. Risk estimates did not significantly change after depending on the concomitant use of corticosteroids or studies methodological quality assessment. The analysis according to the type of fluoroquinolones was only possible for ATR, which were ofloxacin and norfloxacin were found to increase the risk of this outcome, but not ciprofloxacin and levofloxacin.


The results of this meta-analysis confirm the risk of tendon injuries associated with fluoroquinolones. Older age and concomitant use of corticosteroids seem to be additional risk factors for tendinopathy.


Fluoroquinolones Tendinopathy Pharmacovigilance Risk assessment Meta-analysis 


Author contribution

Carlos Alves conceived and designed the study, performed research, analyzed data, and wrote the paper. Diogo Mendes and Francisco Batel Marques conceived the study and wrote the paper.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Supplementary material

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Supplemental Table 3 (DOCX 17 kb)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Laboratory of Social Pharmacy and Public Health, School of PharmacyUniversity of CoimbraCoimbraPortugal
  2. 2.AIBILI – Association for Innovation and Biomedical Research on Light and Image, CHAD – Centre for Health Technology Assessment and Drug ResearchCoimbra Regional Pharmacovigilance Unit (UFC)CoimbraPortugal

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