Tequin coming off the market

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judy.n - 29 Sep 2006 13:27 GMT

I was on the FDA site yesteday, and happened to check out discontinued
drugs, and found a letter from Bristo Meyers that they no longer
intended to produce tequin--dated this summer. It got a black box
warning for hyper and hypo glycemia and wasn't supposed to be used with
diabetes. I imagine they saw the law suits looming. It's just
concerning, because the other quinolones have the possiblity of
influencing blood sugars as well, and we know that quinilones can often
be the drug we finally need to get rid of a stubborn infection.
Judy

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Jack Margo - 10 Nov 2006 13:07 GMT

Judy:

There's a lot of interesting stuff about Tequin on lawsuitsearch.com.
They have a section dedicated to the issue, and I've been following the
story there for a while. Turns out it causes diabetes. And you are
correct, but its the whole family of drugs, not just Tequin causing
issues.

There are better, safer meds on the market to handle infections.

Hope this helps,
Jack

http://www.lawsuitsearch.com/drugs/tequin.aspx

> I was on the FDA site yesteday, and happened to check out discontinued
> drugs, and found a letter from Bristo Meyers that they no longer
[quoted text clipped - 5 lines]
> be the drug we finally need to get rid of a stubborn infection.
> Judy

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judy.n - 10 Nov 2006 19:32 GMT

Jack,
Unfortunately, the quinilones are the best and often only oral drugs
for gram negative infections. There was a NE journal article about
tequin and it's tendency to raise and lower blood sugar, and they did
compare it to the other quinilones: levaquin had a modest effect,
avelox had no effect nor did cipro. So, the class can effect blood
sugars, but these are powerful antibiotics, that are often the only
choice for oral treatment of certain infections. Factive has problems
with frequent rashes--up to 30%. I think the problem is that they have
prescribed like candy, when safer, cheaper, older drugs will do the
job.
Ketek (a modified macrolide) has been heavily promoted, and now has
been associated with several cases of liver failure. The FDA admitted
this and researched it, and since liver failure is associated with
other antibiotics, they let it stay on the market, with a warning.
I'd hate to let law suits dictate what drugs are available. At this
point in time, if you have an infection with a gram negative drug,
there are really no other choices than quinilones, unless you have to
resort to IV antibiotics.
The quinilones can cause tendon rupture also. They're not without
risk, but they also have tremendous benefit.
Judy

> Judy:
>
[quoted text clipped - 20 lines]
> > be the drug we finally need to get rid of a stubborn infection.
> > Judy

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Steven L. - 11 Nov 2006 01:44 GMT

> Jack,
> Unfortunately, the quinilones are the best and often only oral drugs
[quoted text clipped - 5 lines]
> choice for oral treatment of certain infections. Factive has problems
> with frequent rashes--up to 30%.

Cite?

That's not the data I saw from the manufacturer. They claim 0.9% for
rash, nowhere near 30%

http://www.rxlist.com/cgi/generic3/factive_ad.htm

> I'd hate to let law suits dictate what drugs are available. At this
> point in time, if you have an infection with a gram negative drug,
> there are really no other choices than quinilones, unless you have to
> resort to IV antibiotics.

Even if you resort to IV antibiotics, IV Levaquin is often the best
choice for a really bad infection. If there's a terrorist attack using
pulmonary anthrax, IV Levaquin or IV Cipro is what they will give the
patients.

Side effects experienced to a drug are heavily idiosyncratic. For
example, zillions of people take pseudoephedrine safely for sinus
congestion. But I can't tolerate even the children's dose of it. On me
it works like amphetamines, sending me into orbit.

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Steven L. - 11 Nov 2006 01:48 GMT

Jack Margo wrote:

> Judy:
>
[quoted text clipped - 5 lines]
>
> There are better, safer meds on the market to handle infections.

Not for some of us.

I have chronic sinusitis. Here's the list of other antibiotics and
whether they are effective on my sinus infections:

Penicillins (e.g., amoxicillin): Allergic (hives)
Cephalosporins (e.g., Ceftin): Allergic (maculopapular rash)
Clindamycin: Allergic (hives)
Sulfas (e.g., Bactrim): Ineffective
Macrolides (e.g., Biaxin): Ineffective
Tetracyclines (e.g, Doxycycline): Ineffective

For me, the quinolones (and possibly the ketolides which I haven't tried
yet) are my only remaining options.

In fact, if I ever need major surgery requiring IV antibiotics, the only
one most hospitals stock that I can take is IV Cipro. The hospitals
aren't used to dealing with a surgery case who is allergic to all the
penicillins and cephalosporins, like me. I know. Been there, done that.

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judy.n - 11 Nov 2006 13:58 GMT

Steven,
IV there are aminoglycosides- for example, gentamicin, and the
"penems" --imipenem, which many penicillin and cephalosporin patients
can tolerate. Also, if ever needed, you can be desensitized to
penicillin in the hospital--it only lasts while you receive the drug.
Once you stop it, you can redevelop the allergy: but using increasing
doses, much like allergy shots--you can be densensitized in an
emergency.
There are few new antibiotics in th pipeline, and most are for gram
positive infections.
So, quinilones should not be tossed out due to liability concerns.
I'll find the factive stat--it's for women vs. men.
It's why it didn't get approval for ABS.
Judy

> Jack Margo wrote:
> > Judy:
[quoted text clipped - 31 lines]
> Email: sdlitvin@earthlinkNOSPAM.net
> Remove the NOSPAM before replying to me.

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Steven L. - 11 Nov 2006 19:04 GMT

> Steven,
> IV there are aminoglycosides- for example, gentamicin,

We both know what the problems and risks are with gentamicin.

> and the
> "penems" --imipenem, which many penicillin and cephalosporin patients
> can tolerate. Also, if ever needed, you can be desensitized to
> penicillin in the hospital--it only lasts while you receive the drug.

For me, that would be extremely tough. I was skin-tested for penicillin
allergy a couple of years ago, to see if I were still allergic to
it--and sure enough, I reacted at the very lowest concentration of
antigen. So my allergy to penicillin is severe, so desensitization
would need to be done very carefully and very slowly. For a really
severe fulminating infection, I would be dead by then.

And for a severe penicillin allergy like mine, imipenem isn't prescribed
either. Too risky.

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judy.n - 11 Nov 2006 19:32 GMT

Steven,
I don't think we're disagreeing here: the quinilones are very
powerful and very useful antibiotics and do have side effects (as do
many drugs), but I would hate to see our litigious society force them
out of use. The hypo/hyper gylecemic reaction was primarily seen with
tequin, less with levaquin.
Trovan seems to be off the market: there were liver issues, Tequin is
gone now also, due to inability to use with diabetics,
From FDA labeling study: the incidence of rash in women <40, taking
Factive for 14 days was 22.6%.
http://www.fda.gov/cder/foi/label/2003/21158_factive_lbl.pdf
There is entity of "multiple antibiotic sensitivities": it's seen in
allergic people, but personally I just think the risk of adverse events
and allergic sensitivity just goes up the more you are exposed.
I agree, you have limited options at this point.
It worries me that there are websites dedicated to lawsuits against
quinilones.
Judy

> > Steven,
> > IV there are aminoglycosides- for example, gentamicin,
[quoted text clipped - 20 lines]
> Email: sdlitvin@earthlinkNOSPAM.net
> Remove the NOSPAM before replying to me.

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preesi - 11 Nov 2006 16:53 GMT

Jack Margo wrote:

> Judy:
>
[quoted text clipped - 21 lines]
>> stubborn infection.
>> Judy

OMG My Stupid Irresponsible Nurse Practitioner INSISTED I keep taking it
and contributed my side effects to my Panic attack/anxiety problems...
I HATE HER!
Im trying to get her written up due to a slew of other issues but this
takes the cake!

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