What is Cipro (ciprofloxacin) and what is it used for?

Cipro (ciprofloxacin) is a fluoroquinolone antibiotic used to treat bacterial infections including infections of the skin, lung or airways; for example:

Common side effects of Cipro and Cipro XR include

Serious side effects of Cipro and Cipro XR include

Anaphylaxis, or shock, is a rare allergic reaction and a medical emergency. Seek medical immediately if you experience symptoms of shock including cardiovascular collapse, facial or throat swelling, shortness of breath, hives, or itching.

Drug interactions of Cipro and Cipro XR include theophylline, tizanidine, iron salts (for example, ferrous sulfate), warfarin, sevelamer, diabetic medications, sildenafil, and sulfonylureas.

Milk, orange juice, and antacids may reduce the absorption of ciprofloxacin.

Use of Cipro and Cipro XR is not recommended if you are pregnant or breastfeeding because it is unknown if it is safe.

What are the important side effects of Cipro (ciprofloxacin)?

Cipro and Cipro XR as well as other antibiotics in the fluoroquinolone class of antibiotics has been associated with tendonitis and even tendon rupture, particularly the Achilles tendon. Some doctors and other medical professionals recommend that their patients discontinue vigorous exercise while they are taking fluoroquinolone antibiotics.

Fluoroquinolones have neuromuscular blocking activity and can worsen muscle weakness in individuals with myasthenia gravis.

The most common side effects of Cipro, Cipro XR are:

Anaphylaxis, or shock, is a rare allergic reaction to this drug. This allergic reaction is a medical emergency and you are experiencing these symptoms seek medical immediately.

Symptoms of shock include:

  • Cardiovascular collapse
  • Facial or throat swelling
  • Shortness of breath
  • Hives
  • Itching

Other possible serious side effects of Cipro, Cipro XR include:

  • Peripheral neuropathy
  • Central nervous system effects (CNS), for example,
  • Hyperglycemia
  • Clostridiumdifficile-associated diarrhea (CDAD)
  • Abnormal heartbeats
  • Liver dysfunction
  • Stroke
  • Convulsions
  • Toxic epidermal necrolysis
  • Stevens-Johnson syndrome
  • Vasculitis
  • Allergic pneumonitis
  • Interstitial nephritis
  • Acute kidney failure
  • Hepatitis
  • Jaundice
  • Liver failure
  • Anemia
  • Leukopenia
  • Cardiac arrest
  • Respiratory failure

Other serious side effects and adverse events of Cipro, Cipro XR include:

Cipro, Cipro XR should be used with caution in patients with central nervous system diseases such as seizures, because rare seizures have been reported in patients receiving Cipro, Cipro XR.

Cipro, Cipro XR 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 Cipro, Cipro XR, can alter the normal bacteria in the colon and encourage overgrowth of a bacterium responsible for the development of inflammation of the colon, (C. difficile or pseudomembranous colitis). Patients who develop signs of pseudomembranous colitis after starting Cipro, Cipro XR (diarrhea, fever, abdominal pain, and possibly shock) should contact their doctor immediately.

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Cipro (ciprofloxacin) side effects list for healthcare professionals

The following serious and otherwise important adverse drug reactions are discussed in greater detail in other sections of labeling:

  • Disabling and Potentially Irreversible Serious Adverse Reactions
  • Tenditits and Tendon Rupture
  • Peripheral Neuropathy
  • Central Nervous System Effects
  • Exacerbation of Myasthenia Gravis
  • Other Serious and Sometimes Fatal Adverse Reactions
  • Hypersensitivity Reactions
  • Hepatotoxicity
  • Serious Adverse Reactions with Concomitant Theophylline
  • Clostridium difficile-Associated Diarrhea
  • Prolongation of the QT Interval
  • Musculoskeletal Disorders in Pediatric Patients
  • Photosensitivity/Phototoxicity
  • Development of Drug Resistant Bacteria

Clinical Trials Experience

Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared to rates in the clinical trials of another drug and may not reflect the rates observed in practice.

Clinical trials in patients with urinary tract infections enrolled 961 patients treated with 500 mg or 1000 mg CIPRO XR. The overall incidence, type and distribution of adverse reactions were similar in patients receiving both 500 mg and 1000 mg of CIPRO XR. The adverse reaction information from clinical studies does, however, provide a basis for identifying the adverse events that appear to be related to drug use and for approximating rates.

In the clinical trial of uncomplicated UTIs, CIPRO XR (500 mg once daily) in 444 patients was compared to ciprofloxacin immediate-release tablets (250 mg twice daily) in 447 patients for 3 days. Discontinuations due to adverse reactions thought to be drug-related occurred in 0.2% (1/444) of patients in the CIPRO XR arm and in 0% (0/447) of patients in the control arm.

In the clinical trial of cUTI and acute uncomplicated pyelonephritis (AUP) defined as infections occurring in premenopausal, non-pregnant women with no known urological abnormalities or comorbidities, CIPRO XR (1000 mg once daily) in 517 patients was compared to ciprofloxacin immediate-release tablets (500 mg twice daily) in 518 patients for 7 to 14 days. Discontinuations due to adverse reactions thought to be drug-related occurred in 3.1% (16/517) of patients in the CIPRO XR arm and in 2.3% (12/518) of patients in the control arm. The most common reasons for discontinuation in the CIPRO XR arm were nausea/vomiting (4 patients) and dizziness (3 patients). In the control arm the most common reason for discontinuation was nausea/vomiting (3 patients).

In these clinical trials, the following events occurred in ≥ 2% of all CIPRO XR patients: nausea (4%), headache (3%), dizziness (2%), diarrhea (2%), vomiting (2%) and vaginal moniliasis (2%).

Adverse reactions, judged by investigators to be at least possibly drug-related, occurring in greater than or equal to 1% of all CIPRO XR treated patients were: nausea (3%), diarrhea (2%), headache (1%), dyspepsia (1%), dizziness (1%), and vaginal moniliasis (1%). Vomiting (1%) occurred in the 1000 mg group.

Table 2: Medically Important Adverse Reactions That Occurred In <1% of CIPRO XR Patients
System Organ ClassAdverse Reactions
Body as a WholeAbdominal pain
Asthenia
Malaise
CardiovascularBradycardia
Migraine
Syncope
Central Nervous SystemAbnormal dreams
Convulsive seizures (including status epilepticus) Depersonalization
Depression (potentially culminating in self-injurious behavior, such as suicidal ideations/thoughts and attempted or completed suicide)
Hypertonia
Incoordination
Insomnia
Somnolence
Tremor
Vertigo
GastrointestinalConstipation
Dry mouth
Flatulence
Thirst
Hepatobiliary DisordersLiver function tests abnormal
InvestigationsProthrombin decrease
MetabolicHyperglycemia
Hypoglycemia
Psychiatric DisordersAnorexia
Skin/HypersensitivityDry skin
Maculopapular rash
Photosensitivity/phototoxicity reactions
Pruritus
Rash
Skin disorder
Urticarial
Vesiculobullous rash
Special SensesDiplopia
Taste perversion
UrogenitalDysmenorrhea
Hematuria
Kidney function abnormal
Vaginitis

Postmarketing Experience

The following adverse reactions have been reported from worldwide marketing experience with fluoroquinolones, including CIPRO XR. Because these reactions are reported voluntarily from a population of uncertain size, it is not always possible to reliably estimate their frequency or establish a causal relationship to drug exposure (Table 3).

Table 3: Postmarketing Reports of Adverse Drug Reactions
System Organ ClassAdverse Reactions
CardiovascularQT prolongation
Torsade de Pointes
Vasculitis and ventricular arrhythmia
Central Nervous SystemHypertonia
Myasthenia
Exacerbation of myasthenia gravis
Peripheral neuropathy
Polyneuropathy
Twitching
Eye DisordersNystagmus
GastrointestinalPseudomembranous colitis
Hemic/LymphaticPancytopenia (life threatening or fatal outcome)
Methemoglobinemia
HepatobiliaryHepatic failure (including fatal cases)
Infections and InfestationsCandidiasis (oral, gastrointestinal, vaginal)
InvestigationsProthrombin time prolongation or decrease
Cholesterol elevation (serum)
Potassium elevation (serum)
MusculoskeletalMyalgia
Myoclonus
Tendinitis
Tendon rupture
Psychiatric DisordersAgitation
Confusion
Delirium
Psychosis (toxic)
Skin/HypersensitivityAcute generalized exanthematous pustulosis (AGEP)
Fixed eruption
Serum sickness-like reaction
Special SensesAnosmia
Hyperesthesia
Hypesthesia
Taste loss

Adverse Laboratory Changes

Changes in laboratory parameters while on CIPRO are listed below:

Hepatic – Elevations of ALT (SGPT), AST (SGOT), alkaline phosphatase, LDH, serum bilirubin.

Hematologic – Eosinophilia, leukopenia, decreased blood platelets, elevated blood platelets, pancytopenia.

Renal – Elevations of serum creatinine, BUN, crystalluria, cylindruria, and hematuria have been reported.

Other changes occurring were: elevation of serum gammaglutamyl transferase, elevation of serum amylase, reduction in blood glucose, elevated uric acid, decrease in hemoglobin, anemia, bleeding diathesis, increase in blood monocytes, and leukocytosis.

What drugs interact with Cipro (ciprofloxacin)?

Ciprofloxacin is an inhibitor of human cytochrome P450 1A2 (CYP1A2) mediated metabolism. Co-administration of CIPRO XR with other drugs primarily metabolized by CYP1A2 results in increased plasma concentrations of these drugs and could lead to clinically significant adverse events of the co-administered drug.

Table 4: Drugs That are Affected by and Affecting CIPRO
Drugs That are Affected by CIPRO
Drug(s)RecommendationComments
TizanidineContraindicatedConcomitant administration of tizanidine and CIPRO XR is contraindicated due to the potentiation of hypotensive and sedative effects of tizanidine.
TheophyllineAvoid Use (Plasma Exposure Likely to be Increased and Prolonged)Concurrent administration of CIPRO XR with theophylline may result in increased risk of a patient developing central nervous system (CNS) or other adverse reactions. If concomitant use cannot be avoided, monitor serum levels of theophylline and adjust dosage as appropriate.
Drugs Known to Prolong QT IntervalAvoid UseCipro XR may further prolong the QT interval in patients receiving drugs known to prolong the QT interval (for example, class IA or III antiarrhythmics, tricyclic antidepressants, macrolides, antipsychotics).
Oral antidiabetic drugsUse with caution Glucose-lowering effect potentiatedHypoglycemia sometimes severe has been reported when CIPRO XR and oral antidiabetic agents, mainly sulfonylureas (for example, glyburide, glimepiride), were co-administered, presumably by intensifying the action of the oral antidiabetic agent. Fatalities have been reported. Monitor blood glucose when CIPRO XR is co-administered with oral antidiabetic drugs.
PhenytoinUse with caution Altered serum levels of phenytoin (increased and decreased)To avoid the loss of seizure control associated with decreased phenytoin levels and to prevent phenytoin overdose-related adverse reactions upon CIPRO XR discontinuation in patients receiving both agents, monitor phenytoin therapy, including phenytoin serum concentration during and shortly after co-administration of CIPRO XR with phenytoin.
CyclosporineUse with caution (transient elevations in serum creatinine)Monitor renal function (in particular serum creatinine) when CIPRO XR is co-administered with cyclosporine.
Anti-coagulant drugsUse with caution (Increase in anticoagulant effect)The risk may vary with the underlying infection, age and general status of the patient so that the contribution of CIPRO XR to the increase in INR (international normalized ratio) is difficult to assess. Monitor prothrombin time and INR frequently during and shortly after co-administration of CIPRO XR with an oral anti-coagulant (for example, warfarin).
MethotrexateUse with caution Inhibition of methotrexate renal tubular transport potentially leading to increased methotrexate plasma levelsPotential increase in the risk of methotrexate associated toxic reactions. Therefore, carefully monitor patients under methotrexate therapy when concomitant CIPRO XR therapy is indicated.
RopiniroleUse with cautionMonitoring for ropinirole-related adverse reactions and appropriate dose adjustment of ropinirole is recommended during and shortly after co-administration with CIPRO XR.
ClozapineUse with cautionCareful monitoring of clozapine associated adverse reactions and appropriate adjustment of clozapine dosage during and shortly after co-administration with CIPRO XR are advised.
NSAIDsUse with cautionNon-steroidal anti-inflammatory drugs (but not acetyl salicylic acid) in combination of very high doses of quinolones have been shown to provoke convulsions in pre-clinical studies and in postmarketing.
SildenafilUse with caution Two-fold increase in exposureMonitor for sildenafil toxicity.
DuloxetineAvoid Use Five-fold increase in duloxetine exposureIf unavoidable monitor, for duloxetine toxicity
Caffeine/Xanthine DerivativesUse with caution Reduced clearance resulting in elevated levels and prolongation of serum half-lifeCIPRO XR inhibits the formation of paraxanthine after caffeine administration (or pentoxifylline containing products). Monitor for xanthine toxicity and adjust dose as necessary.
ZolpidemAvoid UseCo-administration with ciprofloxacin may increase blood levels of zolpidem, concurrent use is not recommended
Drug(s) Affecting Pharmacokinetics of CIPRO XR
Antacids, Sucralfate, Multivitamins and Other Products Containing Multivalent Cations (magnesium/aluminum antacids; polymeric phosphate binders (for example, sevelamer, lanthanum carbonate); sucralfate; Videx®(didanosine) chewable/buffered tablets or pediatric powder; other highly buffered drugs; or products containing calcium, iron, or zinc and dairy products)CIPRO XR should be taken at least two hours before or six hours after Multivalent cation-containing products administration.Decrease CIPRO XR absorption, resulting in lower serum and urine levels considerably lower than desired for concurrent administration of these agents with CIPRO XR
ProbenecidUse with caution (interferes with renal tubular s ecretion of CI PRO XR and increases CIPRO XR serum levels)Potentiation of CIPRO XR toxicity may occur.

QUESTION

Bowel regularity means a bowel movement every day. See Answer

Summary

Cipro (ciprofloxacin) is a fluoroquinolone antibiotic used to treat bacterial infections including infections of the skin, lung or airways, lower respiratory tract, bones, joints, urinary tract, and many other types of bacterial infections.

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Medically Reviewed on 10/17/2019
References
FDA Prescribing Information

Professional side effects list and drug interactions sections courtesy of the U.S. Food and Drug Administration.