When I first published this on my blog five days ago I stopped at the point wherein my next subject was to be about the potential for deadly interaction that can occur when taking CIPRO & Tizanidine [brand name -Zanaflex] concomitantly.  In order to make sure that I did a good job writing about this subject, I took some time to review all the information that I had about what happens to the human body when these drugs are administered concomitantly  [definition – existing at the same time].   The reason that it has taken me this long to get back to finishing that part of this article is that it is hard to use a keyboard and cry at the same time.  Tests were done using real people so that the combined effects of these two drugs on the human body could be understood.  The dosage amount of 4 mg of Tizanidine was used, along with separate combinations of 250 mg of CIPRO and 500mg of CIPRO.  When CIPRO was given to the test subjects who were also taking the 4mg dose of Tizanidine,  there was enhancement factor of 7 to 10 times of the 4 mg dose of Tizanidine, bringing up blood levels of Tizanidine to a life threatening 28 – 40 mg dosage level.  The potential of having a dosage amount this great in the human body greatly increased the odds that serious injury and even death could occur  at the amounts used in the testing.  In 2006, as a result of information furnished by the tests, the FDA posted a warning that these two drugs should not be prescribed for use in the treatment of patients who were already taking either one of the drugs.   I’ll follow up at the end of this blog posting with the dosage increase Mark was exposed to and what happened as a result of that enhancement feature when these two drugs were used together.  By first reading about CIPRO and then Tizanidine [Zanaflex] you will have a deeper appreciation of just how close my husband came to death’s door.

Cipro or full name – Ciprofloxacin, is a member of a family of really tough drugs called Fluoroquinolones.  When taken by someone who doesn’t have an allergic reaction to them, they can drop an elephant load of bacteria in its tracks.  However, if you are allergic or reactive to one of the drugs in this family, it is wise to discuss with your doctor as to whether the taking of it is worth the risks associated with taking fluoroquinolones.  As an example, Mark was allergic and reactive to Levaquin.  Had I have known that CIPRO was in this family, I would have questioned its use in treating Mark.  Levaquin was one of the drugs on Mark’s list of medicines that he could not take.  Based on Mark’s  listing of all his current medicines and the allergic/reactive ones that we had given the treatment center, I cannot understand why this drug was given to Mark for a minor irritated area in his sigmoid colon.

The FDA has issued certain “black box” warnings for different members of the fluoroquinolone family.  CIPRO is processed via the liver and excreted from the body via the kidneys. CIPRO alone has been known to cause impairment in both hepatic and renal systems.  There is a boat-load of information available on the internet and in medical publications which acknowledges cautionary use of fluoroquinolones.  Their use is not to be taken lightly, but indeed, their use is actually quite common.  Our National Institute of Health has loads of information on CIPRO and Fluoroquinolones on the National Institute of Health’s website,  http:www.nih.gov.   One of their reports states that there is an association of acute kidney injury when using only Fluoroguinolones . Hindsight being 20/20, given the minor irritation in Mark’s colon and the fact that he was already reactive to Levaquin, it now looks like it would have been better for the treating doctor  to have used a less powerful drug in treating Mark’s health issue.  Using CIPRO is like using a hammer to kill a fly that’s sitting on my kitchen counter.  The hammer will kill the fly but I risk breaking up my tiled counters and injuring myself using the hammer.  A “Fly Swatter” drug would have more than likely worked just as well.

Now that I have perked your interest in CIPRO, let me share about Tizanidine.  This drug, which was also on Mark’s medicine list as a current medication, had, up until the time of the enhancement factor of CIPRO on Tizanidine,   [we’ll get to that danger a little farther along in this blog post]   been a helpful part of a Rex Hospital Pain Management treatment plan for Mark’s back pain.  He had a brilliant doctor there who had figured out that by taking a 12mg dose of the tizanidine at bedtime helped his back muscles to relax.  It had been a standard routine for him since late 2004.  The dosage level was gradually adjusted to the current med dosage strength of 12 mg. and it did exactly what his doctor there at Rex had said it would do.  By having this treatment, Mark’s back that had worked through more than 30 years of hard labor, was able to be maintained so that he could avoid getting a spinal fusion in the lower lumbar area.  Back in 2004, the adding of the tizanidine to his pain management treatment proved to be so great a help that he was able to continue working and loving life for years.  However, once the enhancement occurred, Mark has been instructed by Dr. Keith Hull, his neurologist, to NEVER take it again.  It is deemed too dangerous to take a chance on incurring additional injury.          Side Note: Based on my researching spinal fusion surgery for Mark,  this was and still is my opinion about a lower lumbar fusion for my Mark.  Given the current procedures used to do back fusions today, I have recommended that he’d be better off waiting until he feels that the back pain is so bad that it is either fusion or death.

As with all drugs, if someone is thinking about whether or not to use tizanidine, talk with your own doctor(s) and do your own research.  What works for one doesn’t always work for someone else.  FYI here:  I have noticed that it is becoming more common to hear someone ask for something for a headache or stomach ache or some kind of something from a friend or co-worker and out comes a prescription bottle.   Look, in my opinion,  there is a reason for WHY you should NEVER take any prescription drugs or actually for that matter any combination of herbs or drugs without talking to your doctor about it first.  What works great for Sister Sue for her headaches JUST might KILL you.  To me the foolishness of taking random prescription drugs given to me by a BFF of the moment or a family member is like sitting at a table and playing Russian Roulette.  Res ipsa loquitor, Latin for “the thing speaks for itself”.  Whether anyone is playing a game or taking other people’s drugs for any reason, in my opinion,  it’s opening up a door to possible serious injury or death.   It’s just not worth the risk.

As I mentioned at the start of this posting, I will now discuss what happened to my Mark when he took his regular nightly dose of 12mg of Tizanidine and swallowed the two  250mg tablets of CIPRO.  When we had returned home from the hospital, the afternoon and evening had been pleasant.  The small irritated spot on his colon had stopped oozing any blood.  We had eaten after we had left the hospital and since that had been a late lunch, we both weren’t really hungry.  Around 6:00, I baked a couple of potatoes and we ate those for supper.  Mark wasn’t really hungry and just picked at his,  but he did drink part of a coke and some water.  I wound up eating all of mine.  I put Mark’s potato in the frig because he might eat it later or we could have it for breakfast.   Costco has these big bags of baking potatoes and boy are they ever good!  Two of them baked will not only feed two people, but in our case, we always have enough left over for steam-fried hash-browns the next day.  I’ll try to share the recipe in a later post.

I just realized something.  I am, in writer fashion, stalling about what happened when those pills were swallowed by Mark.  It was a little after 11:00 pm.  I had earlier gotten into bed and found the movie, “Knowing” running and left Mark watching the end of “Blue Bloods”.  Mark came in and put his housecoat on, asking me how much of the movie was left that I was watching.  He said I had watched that movie 1200 times.  I told him I liked it and it was good to go to sleep listening to it.  I had laid out his medicine for him so that he would take them.  Mark is one of those people who, once they start to feel better, “why continue to take medicine”.  If you think that’s bad, I am one of those people who hates taking new medicine.  Shortly after my brain injury Mark realized that when I needed to take a new medicine he had to make sure I took it.  If he didn’t, I would hold it in my hand and wait, trying to get my nerve up to swallow the pill.  So, knowing that Mark had told me he was feeling better, I knew to ask, “did you take all of your medicine”?  Adding the three pills to his regular night meds made it look like a lot of medicine.   He gave me “the look” and said he had done so.  He said he was going to eat some ice cream and come back in about 15 minutes.  By then he knew I’d be asleep and he could turn the television to something he wanted to watch.  In thinking about it now I smile,  because he is telling the truth, I have been blessed with being able to go to sleep quickly and unless I get up to go to the bathroom, I sleep and dream all night.  Mark called our dogs and said that he would bring in some ice cream from the shop.  We swapped “I love you’s” and I snuggled down in the covers.

I awoke, startled by my being so awake so quick.  I realized Mark was not in bed and I reached for my housecoat.  I heard a voice in my head say “Go Check Your Husband!”  I started calling Mark’s name and as I ran through the kitchen I could see Mark, in a sitting position, slumped in a dead man, head on chest position.  He wasn’t responding to my voice.  I took his head in my hands and called his name, I shook his shoulder and lifted his arms up as he fell back onto the couch but there was no response.  I remember hearing my voice screaming his name.  Nothing!   I couldn’t hear or feel any air movement from Mark.  I felt for a neck pulse and put my head to his chest and there was no pulse or heart beat.  In the middle of all this our sensitive Lazyboy recliner couch flipped back causing Mark to lie back with the light from the table lamp shining in his face.  He had a purplish ting to his lips.  By now, I am lying on top of him and  I did a quick sternum rub [no response] and checked his pupils, which looked small but even. I called 911 and told her what I had found.  The 911 operator dispatched a unit and asked if I could start CPR.  I told her I had EMT experience and could do what she wanted.  First thing was to get him to the floor.  I grabbed him by his right hand and pulled him over to the side of the couch.  I got him by the shoulders and dropped his body to the floor.  I will never forget the thud sound made by his body hitting the floor.  The impact was enough that I heard stuff make noise.  Since I already had his upper shoulders and head in my hands, I quickly moved his head into the rescue breathing position and then switched to the front right side of his body to start compressions.   I had always been instructed to check for a heartbeat BEFORE starting CPR so I did that, feeling deep against the side of his neck.  I felt a weak beat under my touch.  In addition to that, I had heard the air come out of Mark’s lungs.  If you have ever heard anyone struggle to get air in, it sounds like a ragged “uuuuhhhh” and snorting or gasping type sound.  I just cannot describe it.   I’ve heard it before in other people who have died but I couldn’t connect that to Mark.  I tried calling his name but he was not responding to it.  I placed my head against his chest and there it was, a faint but audible heartbeat!  I believe that I gave him a rescue breath but I am not sure.  My hands are shaking right now as I am trying to recall details.

The 911 operator told me the rescue unit had arrived and to go to the door to let them in.  It was then that I realized my housecoat was lying in the floor of the dining room.  I grabbed it up and tossed it on as I opened the door.  Actually given the circumstances, being seen naked by anybody at that point really didn’t matter.  Mark and I are bona-fide members of the “Sleep au Natural Club”.  The rescue guys came in and 911 hung up.  They started trying to arouse him but they had no more success than I had.    The paramedic asked me if Mark could have taken a narcotic overdose.  I told him, no, he had only taken 20mg of Oxicontin,  12mg of Tizanidine,  3mg Lunesta, an antiacid and 75 mg of Lyrica.  It was the same medicines that he had taken safely for years.  The only difference was that he had taken two antibiotics, Flagyl and CIPRO with those medicines.  He nodded and now, in recalling that nod, I don’t know if it was an “Ahha” nod or an “Okay” nod.  They proceeded to do a pack and go so they could get him into the ambulance and start oxygen.  I told them to take him back to the hospital that he had been at earlier in the day.  They would have his records from that previous day’s visit and thus, I thought, lessen the delay in getting to the reason of why this had happened to him. Over and over in my mind I could not figure it out.  All he had taken were two antibiotics.  It just made no sense.  I was scared but at least he was breathing shallow breaths and his heart was beating.  That was a comforting thought because at that time as I was driving behind the ambulance, there was a bucket load of things I didn’t know.

What I didn’t know was that his blood pressure was in the process of going to the basement and that is NOT a good thing at all. What I didn’t know was that because of the combination of CIPRO along with 12mg of Tizanidine, Mark was suffering from an enhancement of the Tizanidine to blood levels of approx. 84 to 120 mg of that drug in his system.  What I didn’t know that as of to date, neither the drug manufacturer of Tizanidine or I have been able to find anyone who has survived that large of a dosage enhancement of Tizanidine.  What I didn’t know was that because we had been to this hospital for same day surgery several times, we still weren’t really safe in their care.  What I didn’t know was that while I was following that ambulance to the hospital and praying for Mark to be okay, I was actually following him into the fourth medical mistake that would continue the string of erroneous actions and  assumptions which were changing our lives forever.