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Muscle pain due to co-trimoxazole
- Question
- Dear expert team,
I (CF, 24) recently got my long-term antibiotic switched from azithromycin to co-trimoxazole (960mg three times a day).
Since the fourth day after the switch, I suddenly have severe muscle pain when jogging. With each movement of the foot, the pain spreads from the back of the foot to the shinbone and, after 2 km latest, becomes so unbearable that I cannot continue running. During the first minutes after stopping I can hardly move my feet up and down; after a break of a few minutes everything is back to normal again. If I resume running, it immediately starts again. It feels like the muscles were stuck together with glue and I had to tear them apart with each new step. The pain occurs only during jogging, not in everyday life.
Lack of fitness cannot be the reason, since I ran long distances without problems before switching antibiotics. I have also tried stretching the respective muscles before running, but that does not help.
I can only think of co-trimoxazol as an explanation, since the package insert mentions muscle pain as a very rare side effect. Could that be the cause? Is it harmful if I run nevertheless, at least the 2 km until the pain becomes too severe? Is there anything one can do about it, or is switching antibiotics again the only solution? I am reluctant to give up running due to the good training for the lungs.
Many thanks in advance.
S. - Answer
- Dear questioner,
many thanks for this exciting question.
In rare cases, co-trimoxazol can indeed cause muscle pain and partially also inflammations of the muscles. I would therefore strongly suggest you pause the therapy and reduce your sporting activities until the pain is completely gone. Of course, you should absolutely also tell your doctors about this, also to see about an alternative antibiotics therapy. Potentially you are also taking other drugs that can cause problems in combination with co-trimoxazol.
Kind regards,
Dr. med. M. Hofer
Adult CF clinic
Zurich University Hospital
- 14.02.2012
