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Tendinopathy: possibly drug related

Knowing which drugs and factors can cause tendinopathy makes it possible to identify them rapidly and avoid them.

The blanket term tendinopathy covers various painful types of tendon inflammation (tendonitis etc.). The causes are not well understood but tendinopathy is often associated with over-use of the tendon. Some drug groups are known to expose patients to tendinopathy, which is generally reversible, but sometimes has debilitating after-effects. Tendinopathy often affects the Achilles tendon, sometimes even leading to rupture.

All fluoroquinolone antibiotics expose patients to tendinopathy, including single-dose treatments and ear drop medication.

In the cases reported in France, tendinopathy linked to statins (cholesterol-lowering drugs) occurred within an average of 8 months after starting the drug. Corticosteroids expose patients to tendinopathy, in whatever form they are administered, but especially oral or intra-articular injection.

Other drugs risk causing tendinopathy to a lesser degree: some oral retinoids (acne or psoriasis treatment), aromatase inhibitors (such as anastrozole).

Anabolic steroid abuse to boost muscle mass is sometimes a contributory factor in tendinopathy.

Patients are even more exposed to drug-related tendinopathy when other factors are present: old age, posture anomalies, rheumatic disease, gout, practising a sport, a history of tendinopathy or the combination of several drugs linked to tendinopathy. These risk factors should be taken into account when prescribing a drug known to expose patients to tendinopathy.

©Prescrire 1 September 2016

"Drug-induced tendon damage" Prescrire Int 2016; 25 (174): 212-213. (Pdf, subscribers only).
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