Bad Medicine For a Marathoner

All runners know that living an active lifestyle can strengthen the immune system, decrease heart disease and help keep you healthy. But runners are people too and we are all vulnerable to the occasional ache, pain and illness. Before you reach for that pain reliever or antibiotic, you should know that runners have special risks with some medications.

Non-Steroidal Anti-inflammatory Drugs (NSAIDs)

If you are a runner, the chances are good that you have taken one of these drugs during training. NSAIDs are a group of prescription and over-the-counter (OTC) medications that relieve everything from fevers, to muscle aches and minor arthritis. Frequently used NSAIDs include aspirin, Aleve (naproxen) and Motrin (ibuprofen).

Ibuprofen and naproxen are both available OTC and at prescription strength dosages. Many athletes take these drug at prescription strength regularly. The maximum OTC dosage is 400mg of ibuprofen. But ask any of your running buddies what they take for soreness after a long run and they will most likely say three or four tablets. That’s 600mg to 800mg of ibuprofen. You shouldn’t do this without talking to your doctor. While there is no disputing the effectiveness of these drugs at decreasing inflammation and reducing aches and pains, there is a dark side.

The main problem is that NSAID use after run workouts can inhibit the tissue rebuilding process and keep you from getting stronger as quickly as possible. Because the drugs slow inflammation, they also slow tissue healing. Training is really nothing more than damaging your muscles enough that you stimulate them to heal. If all goes according to plan the healed muscles, tendons and ligaments are all stronger after the healing, referred to by runners as the “recovery process,” takes place.

There is a growing body of medical evidence that shows these drugs can prevent you from recovering (and hence training) to your full potential. But they can also put you at risk of tendon injuries. If you get a bad case of tendonitis, you will lose much of your hard-earned fitness while you sit on the sidelines.

Another way runners put themselves at risk is by taking NSAIDs to prevent soreness during a long run or race. There are often ibuprofen tablets sprinkled on the ground near aid stations on the marathon course. You will hear runners with tablets jingling in there back pocket. But there have been many reports of kidney failure after taking NSAIDs during vigorous exercise. Kidney failure can kill you.


The most powerful drugs we have to reduce inflammation are corticosteroids (often referred to simply as “steroids”). Prednisone is the most commonly prescribed steroid medication in tablet form. Prednisone was considered a miraculous cure for arthritis when it was discovered and now is used to treat many other conditions including allergy symptoms and asthma. But there are several reasons runners should avoid it. Prednisone can weaken tendons, thin joint cartilage and slow your recovery after you run.

Corticosteroids are also often injected into painful ankles and around inflamed tendons to reduce pain and stop inflammation. However steroids increase the risk of tendon rupture when injected near the Achilles. If you have a sore Achilles tendon and your podiatrist injects steroids around the tendon, you just might hear a loud “pop” at the back of your leg when you head out the door for a run.


If you get a bacterial infection and need to take antibiotics, you need to explain to the doctor that you are a runner. Some antibiotics have been associated with tendon ruptures in athletes. Running places tremendous stress on the peroneal tendons and Achilles tendons. Whether you are being treated for bronchitis, pneumonia, or a urinary tract infection, your doctor can choose another class of drugs that won’t put your precious tendons at risk.

The Achilles tendon is the largest tendon in your body. But it is also the one most often ruptured. If you tear your Achilles tendon, you will most likely need surgery to repair it. Achilles tendon surgery demands that you stay off your feet for weeks and stop running for months. Obviously if you are training for the San Francisco marathon when this happens, you will not make it to the starting line.

A class of antibiotics called quinalones are well-known to reduce tendon strength and lead to tearing or complete tendon rupture. Some examples of quinalones are Cipro (ciprofloxacin), Levaquin (levofloxacin) and Avelox (moxifloxacin). Basically any drug ending in “-oxacin” is a quinalone antiobitic.

Although the FDA only recently issued a “Black Box Warning” about the risk of tendonitis and tendon ruptures with these antibiotics, the FDA was aware of the risk as long ago as 1995.

Today there is little dispute about the risk of tendon injury in runners and other active adults taking these medicines. But we also know that if you are simultaneously taking NSAID’s, corticosteroids or are over 65 years old, you are even more at risk of a tendon rupture.

The main point is not to avoid necessary medications, but that you need to emphasize your running activities with your doctor. Then you can both rest assured that you will safely recover from what ever ails you.

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