Diverticulitis treatment and CLL

[sheilamarie]

I have been diagnosed with diverticulitis and prescribed a 10 day regime of Cipro and Flagyl. I am on a low dose of imbruvica for CLL. I'm aware of the side effects of Cipro and wonder if it's worth it to take Cipro. I've asked the doctor if she could prescribe something else and she prescribed augmentin, but it is "not the drug of choice." Not sure what direction to now take. The pharmacist will call my heme/oncology doctor to ask if I should adjust the imbruvica dose while on Cipro but I wonder if I should take Cipro at all. I'm not aware of any allergies to meds. And yes I am anxious to start the meds!

[AussieNeil Partner Administrator]

Good on you for checking out the risks associated with prescribed drugs and asking for something that you saw as safer. I'm not medically trained, so am just sharing the following so that you can appreciate the dilemma you and your doctor are in. About a decade ago, I developed cellulitis on my hand and my GP, aware of my compromised immunity, recommended that I go immediately to a private hospital, rather than risk the probable longer waiting time in a much closer public hospital. I was quickly seen in the private hospital Emergency and prescribed Cipro while waiting for a bed in an appropriate part of the hospital, given my compromised immunity, where I could be given IV antibiotics. I thought I remembered reading a warning about Cipro in this community, checked the antibiotic warnings (later upgraded to a black box warning) and asked the admitting doctor in Emergency if it was possible for me to not have the Cipro. He didn't prescribe another antibiotic, given I was going to be given IV antibiotics, but did note that Cipro was appropriate given my circumstances.

Four days later I was discharged from hospital, the cellulitis gone. Three weeks later it came back with a vengeance - the swelling worse than before. With my hand rapidly swelling, I saw the local GP. He prescribed Cipro and held off admitting me to hospital for IV antibiotics. 1 week later the cellulitis was gone, never to return.

With something like diverticulitis, it's not practical to do a culture to find out what is causing the infection, so you can prescribe the best drug. Hence the need for broad spectrum drugs. There may also be challenges, getting a high enough antibiotic concentration through the gut or blood supply, so you want something that is powerful enough to work in the circumstances - enter Cipro supporting Flagyl. Being aware of the potential side effects is good in that you're more likely to quickly seek medical attention should you think you are experiencing one. I was very much aware of my risk of tendon rupture when out walking for my daily exercise.

Neil

[sheilamarie in reply to AussieNeil]

Thank you Neil for your personal story and a fuller explanation of why Cipro is the “drug of choice.” I am grateful to - and for - you.

[ElMaga]

i get diverticulitis as well. cipro messed me up. will never take it again.

[sheilamarie in reply to ElMaga]

I’m sorry to hear about your bad experience - I hope you’ve recovered fully.

[blowinginthewind]

A note about Flagyl, from dire personal experience; it should say on the packet something about avoiding alcohol. However, some years ago I was prescribed it for something, and I was in M&S (UK chain store) and they were offering little shot glass tastes of some new wine product of theirs. Thinking "that tiny amount" won't hurt. Oh but it did hurt, enough for my husband to call GP at 2.00 am. It was then that I learnt it is also marketed as Antabuse - given to alcoholics to stop them drinking - it isn't a very successful treatment because it only works if you actually take it! In your case, remember alcohol in foods - put into fruit cakes after baking, in trifles, in steak and ale pies etc.

I am telling you this because of how very poorly I was - the doctor who came out gave me tramadol for the pain, and I would hate anyone else to go through the same thing.

I hope the Flagyl works well for your diverticulitis.

Liz in UK

[sheilamarie in reply to blowinginthewind]

Thank you for the advisory re “just a little bit of alcohol” won’t matter.

[SeymourB in reply to blowinginthewind]

blowinginthewind -

I had never heard that antabuse is flagyl.

Just to be clear, they are not the same at all, and are actually contraindicated together:

drugs.com/drug-interactions...

Antabuse is disulfiram.

Flagyl is metronidazole.

But Flagyl should not be used with alcohol because of a similar reaction that disulfiram causes in alcoholics:

drugs.com/food-interactions...

"Consumption of alcoholic beverages or products containing alcohol or propylene glycol during treatment with metroNIDAZOLE is not recommended. Doing so may occasionally trigger a reaction in some patients similar to the disulfiram reaction, which includes unpleasant effects such as flushing, throbbing in head and neck, throbbing headache, difficulty breathing, nausea, vomiting, sweating, thirst, chest pain, rapid heartbeat, palpitation, low blood pressure, dizziness, lightheadedness, blurred vision, and confusion. "

"Patients treated with metroNIDAZOLE should continue to avoid using any products containing alcohol or propylene glycol for at least 3 days until after completion of therapy."

=seymour=

[blowinginthewind in reply to SeymourB]

It was my doctor who told me that. I don't know which country you are in, I don't think they used antabuse here in UK. They do 3 day medical detox, usually with diazepam, to let the alcohol get out of their system, and then if they are lucky they will get 6-8 weeks in rehab and deal with the psychological effects of the addiction - here in UK that is usually 12 step based.

Liz in UK

[SeymourB in reply to blowinginthewind]

Liz -

I'm in the U.S. I really don't know how often antabuse is prescribed here - it sounds dangerous.

I think the reaction to alcohol with Flagyl is similar to alcohol with Antabuse, but they're not the same drug. The degree of reaction would depend on the amount of alcohol, and oral vs. IV Flagyl, I think. So, I'd say, have some tea instead in any case.

=seymour=

[blowinginthewind in reply to SeymourB]

I don't drink alcohol or eat anything with alcohol in it, haven't for many years now. I drink decaf tea in quantity though

[CLLCalifornia-USA]

I had diverticulitis three weeks ago. Because of CLL and Ibrutinib my doctor prescribed Augmentin. Not the drug of choice so it took a second week of Augmentin to get through it. I feel great now and I don’t have the worries of Cipro. Good luck and feel better. Sally

[sheilamarie]

Thanks, Jammin, no communication between them - different organizations. It’s difficult to get timely responses from my CLL doc….

[sheilamarie]

Thank you for responding to my query, Sally. I’m hoping to reach my doc soon to get his take - yes, Cipro is worrisome.

[cllady01 Former Volunteer]

The following Mayo Clinic lists (scroll down) medicines that can be a problem when Cipro is also taken.

Ibrutinib is listed and you would be wise to be certain your CLL Dr. is on board with your taking Cipro.

mayoclinic.org/drugs-supple...

[sheilamarie in reply to cllady01]

Thank you - waiting for a call now from my Cll doc.

[Horatio2]

I have had 2 episodes of diverticulitis within the past year and was prescribed Cipro and Flagyl. I am on W&W. Is it not recommended for anyone with CLL or only those who are on certain treatments?

[cllady01 Former Volunteer in reply to Horatio2]

Here is the FDA statement for the class of drugs called Fluoroquinolones, of which Cipro is one. . I am especially aware of the following because I have a spleenic artery anuerysm. The fact of the bleeding possibilities for the BTKis would also concern me were I taking one of those and being given a Fluoroquinolone for an infection:

"Fluoroquinolones should not be used in patients at increased risk unless there are no other treatment options available.  People at increased risk include those with a history of blockages or aneurysms (abnormal bulges) of the aorta or other blood vessels, high blood pressure, certain genetic disorders that involve blood vessel changes, and the elderly.  We are requiring that a new warning about this risk be added to the prescribing information and patient Medication Guide for all fluoroquinolones."

fda.gov/drugs/drug-safety-a...

It may be necessary to be given the medication--that is what I would want understood by all Drs. concerned with the Drs. being on alert.

Note: age can be an issue and I am far down the road in that area.

[Lavinia-Blue]

It seems that Cipro is widely used, particularly for UTIs. I had kidney stones and the Doc wanted to use Cipro, I researched it and found there is a possible tendon issue so I declined—I run a lot and need the tendon. I also had diverticulitis and mentioned to the Doc that I did not want Cipro, cannot remember off hand the other two antibiotics given. For me, the only time I would consider Cipro is for anthrax, though there are others (I’d cross that bridge if I ever got there). Sounds like a matter of what is right for you.

Also, there seems to be a Ciprofloxacin taken with Dairy Products issue you may want to look into if you decide to use it.

[cllady01 Former Volunteer in reply to Lavinia-Blue]

The tendon situation was the first warning by FDA.

There has been a suggestion that more tests be run esp. on elderly to see what the UTIs are caused by--and then to treat accordingly with other than Cipro, unless absolutely necessary.

Many elderly were having hallucinations on Cipro. I have a neighbor at 99 who had a standing prescrip for Cipro to deal with UTIs---she was having hallucinations and the culprit was Cipro.

[puppy43]

Hi Sheilamarie,

I too have diverticultis and have had many a trip to my local hospital with infections.

I have had CLL now for nearly 5 years and my haematologist wrote to my GP to ask for a rescue pack on prescription for the diverticular disease. This saves constantly trying to get appointments with GP's etc.

I have Co-amoxiclav and Metronidazole together both of which work very quickly to clear

infection and I know the signs now when it is starting up ( pain on left side usually sigmoid colon ).

I know this doesn't help with the imbruvica question, but thought it might be useful to know

antibiotics can work quickly and without many side effects hopefully..

I do hope you get some help as diverticulitis is very unpleasant and impacts on your day to day life quite a lot .

I recently had a CTcolonoscopy and was unable to have a hoped for bowel resection as the

CLL was progressing and consultant was concerned about clotting and infection.

best wishes and hope you stay well

best wishes puppy43

[noeagaman in reply to puppy43]

Puppy43,

I got my colon resection about six months before starting FCR. That was about five years ago, and I have not had any more bouts of Diverticulitis since then. I hope that you are eventually able to get one. It really helped calm things down for me.

Chris

[puppy43 in reply to noeagaman]

noeagaman

hi and thanks for your reply. I was very disappointed not to have my resection and would have taken a chance as not having treatment at the moment. It was so encouraging to hear how successful your operation was.

The diverticulitis has taken over my life and i have to be careful what I eat and where I go in case of flare ups.

Maybe if I'm lucky I might get the op in the near future if things change with the CLL

as it all makes living a ' normal ' life very difficult

thanks again for your encouragement

best wishes

puppy43

[sheilamarie in reply to puppy43]

Thank you Puppy43, I have begun Augmentin and hope for the best. I wish you good health coming very soon.