Pharmacy Author: Omudhome Ogbru, PharmD
Medical and Pharmacy Editor: Jay W. Marks, MD
GENERIC NAME: ciprofloxacin
BRAND NAME: Cipro, Cipro XR, Proquin XR
DRUG CLASS AND MECHANISM: Ciprofloxacin is an antibiotic that is used to
treat bacterial infections. Ciprofloxacin belongs to the fluoroquinolone class
of antibiotics which includes levofloxacin (Levaquin), ofloxacin (Floxin),
gatifloxacin (Tequin),
norfloxacin (Noroxin),
moxifloxacin (Avelox),
trovafloxacin (Trovan) and others. Ciprofloxacin stops the multiplication of
bacteria by inhibiting the reproduction and repair of their genetic material
(DNA). The FDA approved ciprofloxacin in October 1987.
PRESCRIPTION: Yes
GENERIC AVAILABLE: Yes
PREPARATIONS: Tablets: 250, 500, and 750 mg. Tablets extended release (XR):
500 and 1000 mg. Microcapsules for suspension: 250 mg/5 ml, 500 mg/5 ml.
Injection or Injection concentrate: 200 and 400 mg.
STORAGE: Immediate release tablets: store below 30C (86F). Extended release
tablets: store between 15-30C (59-86F). Microcapsules: store below 25C (77F)
and protect from freezing. Injection: Store between 5-30C (41-86F) and avoid
freezing.
PRESCRIBED FOR: Ciprofloxacin is used to treat infections of the skin, lungs,
airways, bones, and joints caused by susceptible bacteria. Ciprofloxacin is also
frequently used to treat urinary infections caused by bacteria such as
E. coli.
Ciprofloxacin is effective in treating
infectious diarrheas caused by E. coli,
Campylobacter jejuni, and Shigella bacteria.
DOSING: For most infections the recommended oral dose for adults is 250-750
mg (immediate release tablets) every 12 hours or 500-1000 mg (extended release
tablets) every 24 hours. The usual intravenous dose is 200-400 mg every 8-12
hours.
DRUG INTERACTIONS: Ciprofloxacin administered together with theophylline can
lead to elevated, toxic blood levels of theophylline. Theophylline is used to
open airways in the treatment of asthma. Toxic levels of theophylline can lead
to seizures, and
disturbances in heart rhythm. If concurrent use of
ciprofloxacin and theophylline cannot be avoided, frequent blood tests to
monitor theophylline blood levels are recommended.
Iron salts (for example, ferrous sulfate) may reduce the absorption of ciprofloxacin
because of formation of a ciprofloxacin-iron complex that is not absorbable.
Antacids also may reduce the absorption of ciprofloxacin. If patients are
receiving iron salts or antacids and ciprofloxacin, the ciprofloxacin should be
given two hours before or six ours after the iron salt or antacid.
Ciprofloxacin may increase the blood thinning effect of warfarin
(Coumadin). The reason
for this is unknown. Anticoagulant activity should be monitored after starting
or stopping ciprofloxacin.
Sevelamer (Renagel) may reduce the absorption of ciprofloxacin and possibly
reduce the effectiveness of ciprofloxacin. Milk and orange juice also may reduce
the absorption of ciprofloxacin. Ciprofloxacin, as with iron and antacids,
should be given two hours before or six ours after milk or orange juice.
PREGNANCY: Ciprofloxacin should be avoided in
pregnancy, as safe use in
pregnant women has not been established.
NURSING MOTHERS: Ciprofloxacin should be avoided in
nursing mothers, as safe
use in pregnant women has not been established.
SIDE EFFECTS: The most frequent side effects of ciprofloxacin include
nausea,
vomiting, diarrhea, abdominal pain, rash, headache, and restlessness. Rare
allergic reactions have been described, such as hives and anaphylaxis (shock).
Ciprofloxacin should be used with caution in patients with central nervous
system diseases such as seizures, because rare seizures have been reported in
patients receiving ciprofloxacin. Ciprofloxacin should be avoided in children
and adolescents less than 18 years of age, as safe use in these patients has not
been established.
Many antibiotics, including ciprofloxacin, can alter the normal bacteria in
the colon and encourage overgrowth of a bacterium responsible for the
development of inflammation of the colon (pseudomembranous colitis). Patients
who develop signs of pseudomembranous colitis after starting ciprofloxacin
(diarrhea, fever, abdominal pain, and possibly
shock) should contact their
physician. Patients taking ciprofloxacin can develop sensitivity of the skin to
direct sunlight (photosensitivity) and should avoid exposure to sunlight or use
sun protection and sunscreens.
Ciprofloxacin as well as other antibiotics in the fluoroquinolone class of
antibiotics, has been associated with
tendinitis and even rupture of tendons,
particularly the Achilles tendon. Some physicians recommend that their
patients discontinue vigorous exercise while they are taking fluoroquinolone
antibiotics.
Last Editorial Review: 7/12/2008
Report Problems to the Food and Drug Administration
You are encouraged to report negative side effects of prescription drugs to the FDA. Visit the FDA MedWatch website or call 1-800-FDA-1088.
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