ciprofloxacin, Cipro, Cipro XR, Proquin XR

  • Pharmacy Author:
    Omudhome Ogbru, PharmD

    Dr. Ogbru received his Doctorate in Pharmacy from the University of the Pacific School of Pharmacy in 1995. He completed a Pharmacy Practice Residency at the University of Arizona/University Medical Center in 1996. He was a Professor of Pharmacy Practice and a Regional Clerkship Coordinator for the University of the Pacific School of Pharmacy from 1996-99.

  • Medical and Pharmacy Editor: Jay W. Marks, MD
    Jay W. Marks, MD

    Jay W. Marks, MD

    Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.

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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 mg/100 ml, 200 mg/20 mg, 400 mg/200 ml, 400 mg/40 ml.

DRUG INTERACTIONS: Ciprofloxacin administered together with theophylline (Respbid, Slo-Bid, Theo-24, Theolair) 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.

Ciprofloxacin increases the effect of tizanidine (Zanaflex) that is used to treat muscle spasticity. Therefore, the two drugs should not be combined.

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 hours 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 hours after milk or orange juice.

Administration of ciprofloxacin with diabetic medications (for example glyburide [Micronase, Diabeta, Glynase, Prestab]) may lead to severe low blood glucose.

Ciprofloxacin may increase blood concentrations of sildenafil (Viagra) that is used for treating erectile dysfunction. This combination should be avoided if possible.

PREGNANCY AND BREASTFEEDING SAFETY: Ciprofloxacin should be avoided during pregnancy, as safe use in pregnant women has not been established.

Ciprofloxacin should be avoided in nursing mothers, as safe use in pregnant women has not been established.

STORAGE: Tablets should be stored below 30 C (86 F). Extended release tablets should be stored between 15 C to 30 C (59 F to 86 F). Microcapsules should be stored below 25 C (77 F) and protected from freezing. Injections should be stored between 5 C to 30 C (41 F to 86 F) and prevented from freezing.

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 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.

Medically reviewed by Eni Williams, PharmD

Reference: FDA Prescribing Information

Medically Reviewed by a Doctor on 3/28/2016

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