Understanding the Risks: Can You Take PredniSONE and Levofloxacin Together?

October 9, 2025 •

2 min read

According to the FDA, fluoroquinolone antibiotics like levofloxacin carry a Black Box Warning for an increased risk of tendon damage, and this risk is significantly higher when used with corticosteroids such as predniSONE. While your doctor may prescribe these medications concurrently, it is essential to understand the potential for serious interactions and follow their guidance closely.

Quick Summary

Taking levofloxacin with prednisone substantially increases the risk of tendinitis and tendon rupture. This combination requires careful medical supervision, especially for high-risk patients like older adults and transplant recipients.

Key Points

Significant Tendon Risk: The combination of predniSONE and levofloxacin dramatically increases the risk of tendinitis and tendon rupture.
FDA Black Box Warning: Fluoroquinolones like levofloxacin carry a serious warning about tendon risks, which is heightened by concurrent corticosteroid use.
High-Risk Individuals: Older adults, organ transplant recipients, and those with renal impairment are at a particularly high risk of tendon damage with this drug combination.
Immediate Action Required: If you experience tendon pain or swelling, stop taking levofloxacin immediately and contact your doctor for an evaluation.
Consultation is Crucial: Never take these medications together without explicit medical supervision, and always discuss your full medication list with your healthcare provider.
Alternatives Exist: In many cases, alternative antibiotics or treatment plans can be used to avoid the risky combination of these drug classes.
Recovery Can Be Prolonged: Tendon ruptures can cause prolonged disability or require surgery, emphasizing the need for caution and prevention.

The Serious Interaction Between PredniSONE and Levofloxacin

PredniSONE is a corticosteroid used to reduce inflammation. Levofloxacin, an antibiotic, treats bacterial infections. Combining these medications significantly increases the risk of tendinitis and tendon rupture. This interaction is serious enough to be included in the FDA's Black Box Warning for fluoroquinolones.

Who is at Highest Risk?

Certain groups face a higher risk of tendon injury when taking this combination. These include older adults (over 60), organ transplant recipients, and individuals with kidney problems.

Recognizing the Signs of Tendon Injury

Symptoms of tendon injury can vary and appear quickly or after some time. Watch for pain, swelling, or inflammation, especially in the Achilles tendon. Other signs include a snapping sound, difficulty moving the affected area, or bruising. Contact your doctor immediately if you notice these symptoms.

Management and Alternative Strategies

Doctors carefully consider the risks when prescribing these medications together. They may monitor patients closely or suggest alternative treatments to avoid the combination, especially for high-risk individuals. The lowest effective dose and shortest duration of treatment are recommended for both drugs.

What to Do If Symptoms Occur

If you experience any signs of tendon damage, immediately:

Stop taking levofloxacin.
Rest the affected area and avoid strenuous activity.
Contact your doctor right away to discuss your symptoms and potential treatment changes.

Comparing Risks: Levofloxacin Alone vs. With PredniSONE


Feature	Levofloxacin Alone	Levofloxacin with PredniSONE	Observations
Tendon Injury Risk	Increased risk.	Significantly higher risk.	The combination poses a greater danger.
Risk Factors	Age, renal issues, transplants.	Same factors, increased risk with corticosteroids.	Older patients on both are at highest risk.
Severity of Injury	Tendinopathy, possible rupture.	Higher chance of severe rupture, potentially needing surgery.	Risk of severe damage is increased with combined use.
Mechanism	May affect tendon cells and collagen.	PredniSONE's effects may worsen levofloxacin's damage.	The exact process involves a harmful interaction.

Conclusion

Taking predniSONE and levofloxacin together significantly raises the risk of severe tendon problems, including rupture. For many, particularly those with existing risk factors, alternative treatments might be safer. Healthcare providers should use this combination cautiously and monitor patients for tendon issues. Patients must be aware of the risks and seek immediate medical help if symptoms arise. Always inform your doctor about all your medications.

Optional Outbound Link

For more information on the FDA's warnings about fluoroquinolone antibiotics, consult resources like the FDA's website, accessible through sources such as MedlinePlus.

Frequently Asked Questions

The primary danger is a significantly increased risk of developing tendinitis, which is tendon inflammation, or a complete tendon rupture. This can occur in various tendons, most commonly the Achilles tendon.

If your doctor prescribes both medications, they will likely be closely weighing the risks versus the benefits. You must follow their instructions precisely, monitor for any signs of tendon issues, and report them immediately.

You should watch for pain, swelling, or inflammation in any tendon area. Other signs include a snap or pop, bruising, or difficulty moving the affected joint.

Tendon damage can occur while you are taking the medication, and cases have been reported up to several months after treatment has been completed.

Stop taking levofloxacin immediately, rest the affected area, and contact your doctor right away for guidance. They may need to switch you to a different antibiotic.

The risk is higher for older patients (over 60), individuals with kidney, heart, or lung transplants, and those with other risk factors like underlying conditions affecting tendons or joints.

No. The dose should only be adjusted by your doctor. If a lower dose or shorter duration is deemed safe and effective, your doctor will prescribe it, but self-adjusting medication is not recommended.