Cipro also known as ciprofloxacin remains one of the most popular antibiotics in America although its reputation appears to be suffering as a result of a continued barrage of new warnings from the FDA. It seems oddly disconcerting that a drug originally approved in 1987 would still be accumulating reports of previously unrecognized toxicity. To make matters even worse, a significant percent of prescription for Cipro fall outside FDA guidelines. In these situations the drug can only lead to harm without offering even the remotest possibility of benefit. Among the problems associated with Cipro are peripheral neuropathy. This may present as pain, burning, tingling, numbness or weakness especially in the legs. It occurs soon after beginning therapy or it may be delayed. Cipro may also lead to tendonitis or tendon rupture in otherwise healthy individuals. At special risk are seniors, those engaging in strenuous physical activity, people treated with cortisone/prednisone, individuals with kidney disease, and transplant recipients. Cipro may worsen muscle weakness in individuals with myasthenia gravis. Recent warnings caution Cipro may lead to hypoglycemia and potential coma, attention disturbances, agitation, memory loss and delirium. And now more warnings caution of an increase in aortic aneurysms and dissecting aneurysms especially in the elderly and those with high blood pressure. As if all of this were not sufficient to deter doctors from prescribing Cipro, the FDA finally accepted the existence of a potentially permanent syndrome associated with Cipro and its relatives. After the FDA recognized the condition in 2016, their equivalent in Canada followed suit in 2017 with the European Medicines Agency joining in 2018. The condition formally is referred to as fluoroquinolone associated disability but the colloquial name “floxed” rolls off the tongue so much more easily. Symptoms associated with being “floxed” primarily include neuropsychiatric abnormalities, memory loss, panic attacks and depression in previously healthy individuals. Symptoms may be long lasting or permanent. Experts suggest an unusual gene variant present in about 1 in 11 people may be to blame. Special precautions are in order when taking Cipro. It should not be taken 2 hours before of 6 hours after an aluminum or magnesium containing antacids. These decrease Cipro blood levels by up to 90%. Supplements containing calcium or calcium rich foods depress serum concentration of Cipro by 40%. Iron and zinc may also prevent adequate absorption of the antibiotic. Given all of this, it now seems an increasing number of previously sensitive bacteria are now resistant to Cipro. Your choice to take an antibiotic should include sufficient information to make an informed decision. The idea of needing an antibiotic as a remedy for every assumed infection must by now be put to rest.