Combining sertraline (Zoloft) with ciprofloxacin is associated with an increased risk of which adverse event?

• A. Serotonin syndrome
• B. Tendon rupture
• C. Hypertension
• D. QT prolongation

Answer: (B)

Tendon injury is a well-established risk with fluoroquinolone antibiotics like ciprofloxacin. These drugs can weaken tendons and cause tendinopathy, even rupture, particularly in older adults or when other risk factors (like corticosteroid use) are present. Sertraline does not create a strong new risk for serotonin syndrome or QT prolongation in this specific drug pairing, and while fluoroquinolones can carry a small QT risk, the classic, most emphasized adverse event associated with this combination is tendon rupture. If a patient on ciprofloxacin reports sudden tendon pain or swelling, especially in the Achilles or other large tendons, prompt evaluation is important and stopping the fluoroquinolone is often advised.