Ciprofloxacin 100mg Pack
WARNING: This drug may cause severe side effects like irritated or torn tendons; nerve problems in the arms, hands, legs, or feet; and nervous system problems. These can happen alone or at the same time. They can happen within hours to weeks after starting this drug. Some of these effects may not go away, and may lead to disability or death.The chance of irritated or torn tendons is greater in people over the age of 60; heart, kidney, or lung transplant patients; or people taking steroid drugs. Tendon problems can happen as long as several months after treatment. Call your doctor right away if you have pain, bruising, or swelling in the back of the ankle, shoulder, hand, or other joints. Call your doctor right away if you are not able to move or bear weight on a joint or if you hear or feel a snap or pop.Call your doctor right away if you have signs of nerve problems. These may include not being able to handle heat or cold; change in sense of touch; or burning, numbness, tingling, pain, or weakness in the arms, hands, legs, or feet.Call your doctor right away if you have signs of nervous system problems. These may include anxiety, bad dreams, trouble sleeping, change in eyesight, dizziness, feeling confused, feeling nervous or agitated, feeling restless, hallucinations (seeing or hearing things that are not there), new or worse behavior or mood changes like depression or thoughts of suicide, seizures, or very bad headaches.Do not take if you have myasthenia gravis. Very bad and sometimes deadly breathing problems have happened with this drug in people who have myasthenia gravis.For some health problems, this drug is only for use when other drugs cannot be used or have not worked. Talk with the doctor to be sure that the benefits of this drug are more than the risks. @ COMMON USES: It is used to treat or prevent bacterial infections.
Drug Class
Antibiotic
Pharmacologic Class
Fluoroquinolone Antibiotic
Pregnancy Category
Category C
FDA Approved
Oct 1987
DEA Schedule
Not Controlled
Overview
What is this medicine?
Ciprofloxacin is an antibiotic that belongs to a group of medicines called fluoroquinolones. It works by killing bacteria that cause infections. It's used to treat various bacterial infections like those of the urinary tract, respiratory system, skin, bones, and joints. It's important to take it exactly as prescribed and finish the entire course, even if you feel better.
How to Use This Medicine
Taking Your Medication Correctly
To get the most benefit from your medication, follow these instructions carefully:
Take your medication exactly as directed by your doctor.
Read all the information provided with your medication and follow the instructions closely.
Take your medication at the same time every day.
You can take your medication with or without food.
Swallow your medication with a full glass of water.
However, do not take your medication with dairy products like milk or yogurt, or with calcium-rich juices. If you are having a meal that contains these products, you can take your medication with the meal.
If you take other medications, your doctor may need to adjust the timing of your doses. Take your medication at least 2 hours before or 6 hours after taking antacids, didanosine, lanthanum, sucralfate, quinapril, bismuth, sevelamer, multivitamins, or other products that contain magnesium, calcium, aluminum, iron, or zinc.
Continue taking your medication as directed by your doctor or healthcare provider, even if you start to feel better.
Swallow your medication whole; do not chew or crush it.
Some tablet strengths may have a score line, which allows you to split the tablet in half if needed for your dose. If you need to split your tablet, only split it along the score line.
Storing and Disposing of Your Medication
To ensure the safety and effectiveness of your medication:
Store your medication at room temperature in a dry place, away from the bathroom.
Keep all medications in a safe place, out of the reach of children and pets.
Dispose of unused or expired medications properly. Do not flush them down the toilet or pour them down the drain unless instructed to do so by your pharmacist.
Check with your pharmacist for guidance on the best way to dispose of your medication. You may also be able to participate in a drug take-back program in your area.
What to Do If You Miss a Dose
If you miss a dose of your medication:
Take the missed dose as soon as you remember.
However, if it is less than 6 hours until your next scheduled dose, skip the missed dose and take your next dose at the regular time.
* Do not take two doses at the same time or take extra doses to make up for a missed dose.
To get the most benefit from your medication, follow these instructions carefully:
Take your medication exactly as directed by your doctor.
Read all the information provided with your medication and follow the instructions closely.
Take your medication at the same time every day.
You can take your medication with or without food.
Swallow your medication with a full glass of water.
However, do not take your medication with dairy products like milk or yogurt, or with calcium-rich juices. If you are having a meal that contains these products, you can take your medication with the meal.
If you take other medications, your doctor may need to adjust the timing of your doses. Take your medication at least 2 hours before or 6 hours after taking antacids, didanosine, lanthanum, sucralfate, quinapril, bismuth, sevelamer, multivitamins, or other products that contain magnesium, calcium, aluminum, iron, or zinc.
Continue taking your medication as directed by your doctor or healthcare provider, even if you start to feel better.
Swallow your medication whole; do not chew or crush it.
Some tablet strengths may have a score line, which allows you to split the tablet in half if needed for your dose. If you need to split your tablet, only split it along the score line.
Storing and Disposing of Your Medication
To ensure the safety and effectiveness of your medication:
Store your medication at room temperature in a dry place, away from the bathroom.
Keep all medications in a safe place, out of the reach of children and pets.
Dispose of unused or expired medications properly. Do not flush them down the toilet or pour them down the drain unless instructed to do so by your pharmacist.
Check with your pharmacist for guidance on the best way to dispose of your medication. You may also be able to participate in a drug take-back program in your area.
What to Do If You Miss a Dose
If you miss a dose of your medication:
Take the missed dose as soon as you remember.
However, if it is less than 6 hours until your next scheduled dose, skip the missed dose and take your next dose at the regular time.
* Do not take two doses at the same time or take extra doses to make up for a missed dose.
Lifestyle & Tips
- Avoid taking antacids, sucralfate, iron, zinc, or multivitamins containing these minerals within 2 hours before or 6 hours after taking ciprofloxacin.
- Avoid dairy products (milk, yogurt) and calcium-fortified juices immediately before or with your dose, as they can reduce absorption. Food generally does not affect absorption significantly, but avoid taking with dairy alone.
- Drink plenty of fluids to prevent crystal formation in the urine.
- Avoid excessive exposure to sunlight or artificial UV light (tanning beds) as ciprofloxacin can increase sensitivity to light, leading to severe sunburn. Use sunscreen and wear protective clothing.
- Avoid strenuous exercise during treatment and for several weeks after, due to the risk of tendon problems. Report any new pain, swelling, or bruising around joints or tendons immediately.
- Be aware of potential dizziness or lightheadedness, and avoid driving or operating machinery until you know how the medication affects you.
Available Forms & Alternatives
Available Strengths:
- Ciprofloxacin 0.3% Op Sol 5ml-Eye
- Ciprofloxacin 0.3% Op Sol 2.5ml-Eye
- Ciprofloxacin 100mg Pack
- Ciprofloxacin 250mg Tablets
- Ciprofloxacin 0.3% Op Sol 10ml-Eye
- Ciprofloxacin 500mg Tablets
- Ciprofloxacin 250mg Tablets
- Ciprofloxacin 750mg Tablets
- Ciprofloxacin 0.2% Pf Earsol 14 Sgl
- Ciprofloxacin 500mg Tablets
- Ciprofloxacin 250mg Tablets
- Ciprofloxacin 750mg Tablets
- Ciprofloxacin I.V. 400mg Sol, 200ml
- Ciprofloxacin 250mg Tablets
- Ciprofloxacin 750mg Tablets
Dosing & Administration
Adult Dosing
Standard Dose:
Varies by indication. For uncomplicated UTI: 100 mg twice daily (immediate-release) or 250 mg twice daily (extended-release). For complicated UTI/pyelonephritis: 500 mg twice daily. For respiratory tract/skin/bone/joint infections: 500-750 mg twice daily.
Dose Range:
100 - 750 mg
Condition-Specific Dosing:
Uncomplicated UTI (immediate-release):
100 mg orally every 12 hours for 3 days
Complicated UTI/Pyelonephritis:
500 mg orally every 12 hours for 7-14 days
Acute Sinusitis:
500 mg orally every 12 hours for 10 days
Chronic Bacterial Prostatitis:
500 mg orally every 12 hours for 28 days
Lower Respiratory Tract Infections:
500-750 mg orally every 12 hours for 7-14 days
Skin and Skin Structure Infections:
500-750 mg orally every 12 hours for 7-14 days
Bone and Joint Infections:
500-750 mg orally every 12 hours for 4-6 weeks or longer
Infectious Diarrhea:
500 mg orally every 12 hours for 5-7 days
Pediatric Dosing
Neonatal:
Not established (generally avoided due to arthropathy risk)
Infant:
Not established (generally avoided due to arthropathy risk)
Child:
Generally 10-20 mg/kg/dose orally every 12 hours (max 750 mg/dose) for specific indications (e.g., complicated UTI, pyelonephritis, inhalational anthrax post-exposure prophylaxis, cystic fibrosis exacerbations) when benefits outweigh risks. Not for routine use.
Adolescent:
Dosing similar to adult for specific indications, generally 10-20 mg/kg/dose orally every 12 hours (max 750 mg/dose).
Dose Adjustments
Renal Impairment:
Mild:
CrCl 30-50 mL/min: No adjustment for 100mg dose. For higher doses, reduce dose by 25-50% or extend dosing interval.
Moderate:
CrCl 30-50 mL/min: For 250-500mg doses, administer usual dose every 18 hours or 250-500mg every 24 hours. For 750mg dose, administer 500mg every 24 hours.
Severe:
CrCl <30 mL/min: For 250-500mg doses, administer usual dose every 24 hours or 250-500mg every 24 hours. For 750mg dose, administer 500mg every 24 hours.
Dialysis:
Hemodialysis/Peritoneal Dialysis: Administer dose after dialysis. For 250-500mg doses, administer usual dose every 24 hours. For 750mg dose, administer 500mg every 24 hours. Supplemental dose after dialysis may be needed for some indications.
Hepatic Impairment:
Mild:
No adjustment needed.
Moderate:
No adjustment needed.
Severe:
No adjustment needed (primary elimination is renal, but monitor for increased adverse effects due to potential altered metabolism in severe impairment).
Pharmacology
Mechanism of Action
Ciprofloxacin is a fluoroquinolone antibacterial agent. It exerts its bactericidal effect by inhibiting bacterial DNA gyrase (topoisomerase II) and topoisomerase IV, enzymes essential for bacterial DNA replication, transcription, repair, and recombination. This leads to DNA strand breaks and bacterial cell death.
Pharmacokinetics
Absorption:
Bioavailability:
70-80%
Tmax:
0.5-2 hours (oral)
FoodEffect:
Food delays Tmax but does not significantly alter Cmax or AUC. Dairy products and calcium-fortified juices can significantly decrease absorption.
Distribution:
Vd:
2.1-2.7 L/kg
ProteinBinding:
20-40%
CnssPenetration:
Limited (achieves therapeutic concentrations in CSF, but lower than in serum)
Elimination:
HalfLife:
3-5 hours (normal renal function)
Clearance:
30-40 L/hr (total body clearance)
ExcretionRoute:
Renal (primarily unchanged drug and metabolites), fecal (minor)
Unchanged:
50-70% (renal)
Pharmacodynamics
OnsetOfAction:
Rapid (within hours for antibacterial effect)
PeakEffect:
Within 1-2 hours of oral administration
DurationOfAction:
12 hours (due to twice-daily dosing)
Safety & Warnings
BLACK BOX WARNING
Fluoroquinolones, including ciprofloxacin, are associated with disabling and potentially irreversible serious adverse reactions that have occurred together, including tendinitis and tendon rupture, peripheral neuropathy, and central nervous system effects. Discontinue ciprofloxacin immediately and avoid use of fluoroquinolones in patients who experience any of these serious adverse reactions. Fluoroquinolones may exacerbate muscle weakness in patients with myasthenia gravis. Avoid ciprofloxacin in patients with a known history of myasthenia gravis. Because fluoroquinolones, including ciprofloxacin, have been associated with serious adverse reactions, reserve ciprofloxacin for use in patients who have no alternative treatment options for acute bacterial sinusitis, acute exacerbation of chronic bronchitis, and uncomplicated urinary tract infections.
Side Effects
Urgent Side Effects: Seek Medical Help Right Away
Although rare, some people may experience severe and potentially life-threatening side effects while taking this medication. If you notice any of the following symptoms, contact your doctor or seek medical attention immediately:
Signs of an allergic reaction, such as:
+ Rash
+ Hives
+ Itching
+ Red, swollen, blistered, or peeling skin (with or without fever)
+ Wheezing
+ Tightness in the chest or throat
+ Trouble breathing, swallowing, or talking
+ Unusual hoarseness
+ Swelling of the mouth, face, lips, tongue, or throat
Signs of kidney problems, including:
+ Inability to pass urine
+ Changes in urine output
+ Blood in the urine
+ Sudden weight gain
Chest pain or pressure
Shortness of breath
Shakiness
Difficulty walking
Vaginal itching or discharge
White patches in the mouth (oral thrush)
Sunburn
Fever, chills, or sore throat
Unexplained bruising or bleeding
Feeling extremely tired or weak
Muscle pain or weakness
Difficulty focusing
Memory problems or loss
Severe Skin Reaction
A rare but serious skin reaction called Stevens-Johnson syndrome or toxic epidermal necrolysis may occur. This condition can cause severe health problems and may be life-threatening. Seek medical help immediately if you experience:
Red, swollen, blistered, or peeling skin (with or without fever)
Red or irritated eyes
Sores in your mouth, throat, nose, or eyes
Diarrhea and Bowel Problems
Diarrhea is a common side effect of antibiotics. However, a severe form of diarrhea called C. diff-associated diarrhea (CDAD) may occur, which can lead to life-threatening bowel problems. Contact your doctor right away if you experience:
Stomach pain
Cramps
Very loose, watery, or bloody stools
Rare but Serious Vascular Problem
A rare but severe problem with the main blood vessel that comes out of the heart (aorta) has been reported in some patients, especially older adults. This condition can cause severe bleeding and may be life-threatening. Seek medical help immediately if you experience:
Sudden, severe pain in the stomach, chest, or back that does not go away
Other Side Effects
Most people do not experience severe side effects, but some may occur. If you notice any of the following side effects, contact your doctor or seek medical attention if they bother you or do not go away:
Diarrhea
Upset stomach
Vomiting
Headache
Reporting Side Effects
If you have questions or concerns about side effects, contact your doctor. You can also report side effects to the FDA at 1-800-332-1088 or online at https://www.fda.gov/medwatch.
Although rare, some people may experience severe and potentially life-threatening side effects while taking this medication. If you notice any of the following symptoms, contact your doctor or seek medical attention immediately:
Signs of an allergic reaction, such as:
+ Rash
+ Hives
+ Itching
+ Red, swollen, blistered, or peeling skin (with or without fever)
+ Wheezing
+ Tightness in the chest or throat
+ Trouble breathing, swallowing, or talking
+ Unusual hoarseness
+ Swelling of the mouth, face, lips, tongue, or throat
Signs of kidney problems, including:
+ Inability to pass urine
+ Changes in urine output
+ Blood in the urine
+ Sudden weight gain
Chest pain or pressure
Shortness of breath
Shakiness
Difficulty walking
Vaginal itching or discharge
White patches in the mouth (oral thrush)
Sunburn
Fever, chills, or sore throat
Unexplained bruising or bleeding
Feeling extremely tired or weak
Muscle pain or weakness
Difficulty focusing
Memory problems or loss
Severe Skin Reaction
A rare but serious skin reaction called Stevens-Johnson syndrome or toxic epidermal necrolysis may occur. This condition can cause severe health problems and may be life-threatening. Seek medical help immediately if you experience:
Red, swollen, blistered, or peeling skin (with or without fever)
Red or irritated eyes
Sores in your mouth, throat, nose, or eyes
Diarrhea and Bowel Problems
Diarrhea is a common side effect of antibiotics. However, a severe form of diarrhea called C. diff-associated diarrhea (CDAD) may occur, which can lead to life-threatening bowel problems. Contact your doctor right away if you experience:
Stomach pain
Cramps
Very loose, watery, or bloody stools
Rare but Serious Vascular Problem
A rare but severe problem with the main blood vessel that comes out of the heart (aorta) has been reported in some patients, especially older adults. This condition can cause severe bleeding and may be life-threatening. Seek medical help immediately if you experience:
Sudden, severe pain in the stomach, chest, or back that does not go away
Other Side Effects
Most people do not experience severe side effects, but some may occur. If you notice any of the following side effects, contact your doctor or seek medical attention if they bother you or do not go away:
Diarrhea
Upset stomach
Vomiting
Headache
Reporting Side Effects
If you have questions or concerns about side effects, contact your doctor. You can also report side effects to the FDA at 1-800-332-1088 or online at https://www.fda.gov/medwatch.
Seek Immediate Medical Attention If You Experience:
- New or worsening pain, swelling, or bruising in a tendon (especially Achilles tendon in the heel, shoulder, elbow, or wrist)
- Numbness, tingling, burning, or weakness in the arms or legs (signs of peripheral neuropathy)
- Confusion, hallucinations, anxiety, depression, insomnia, or seizures
- Severe or watery diarrhea, especially if it contains blood or mucus (may be C. difficile infection)
- Rash, hives, itching, or swelling of the face, lips, tongue, or throat (signs of allergic reaction)
- Chest pain, palpitations, or fainting (signs of heart rhythm problems)
- Severe dizziness or lightheadedness
- Yellowing of the skin or eyes, dark urine, or persistent nausea/vomiting (signs of liver problems)
- Any new or unusual joint pain or swelling, especially in children
Before Using This Medicine
Before Taking This Medication: Important Information to Share with Your Doctor
It is essential to inform your doctor about the following conditions and situations to ensure safe treatment:
Any allergies you have, including allergies to this medication, its components, or other substances, such as foods or drugs. Describe the allergic reaction and its symptoms.
Certain heart conditions, including:
+ Abnormal heartbeat patterns, such as a prolonged QTc interval on an electrocardiogram (ECG)
+ Slow heartbeat
+ Low potassium or magnesium levels
+ Heart failure (a weakened heart)
+ Recent heart attack
Nerve problems or tendon problems, including:
+ Previous irritation or tearing of tendons when taking this medication or similar drugs
Aortic aneurysm (a bulging or ballooning of the aorta, the main blood vessel that carries blood from the heart) or risk factors for this condition, such as:
+ Other blood vessel problems
+ High blood pressure
+ Certain health conditions, including Marfan syndrome or Ehlers-Danlos syndrome
Concurrent use of medications that can cause abnormal heartbeat patterns (prolonged QT interval). Many drugs can have this effect, so ask your doctor or pharmacist if you are unsure.
Use of specific medications, including:
+ Duloxetine
+ Theophylline
+ Tizanidine
+ Zolpidem
* Breastfeeding status: Do not breastfeed while taking this medication and for at least 2 days after the last dose.
This list is not exhaustive, and it is crucial to inform your doctor and pharmacist about all your medications, including prescription and over-the-counter drugs, natural products, and vitamins, as well as any health problems you have. This will help ensure that it is safe to take this medication with your other treatments. Never start, stop, or change the dose of any medication without consulting your doctor.
It is essential to inform your doctor about the following conditions and situations to ensure safe treatment:
Any allergies you have, including allergies to this medication, its components, or other substances, such as foods or drugs. Describe the allergic reaction and its symptoms.
Certain heart conditions, including:
+ Abnormal heartbeat patterns, such as a prolonged QTc interval on an electrocardiogram (ECG)
+ Slow heartbeat
+ Low potassium or magnesium levels
+ Heart failure (a weakened heart)
+ Recent heart attack
Nerve problems or tendon problems, including:
+ Previous irritation or tearing of tendons when taking this medication or similar drugs
Aortic aneurysm (a bulging or ballooning of the aorta, the main blood vessel that carries blood from the heart) or risk factors for this condition, such as:
+ Other blood vessel problems
+ High blood pressure
+ Certain health conditions, including Marfan syndrome or Ehlers-Danlos syndrome
Concurrent use of medications that can cause abnormal heartbeat patterns (prolonged QT interval). Many drugs can have this effect, so ask your doctor or pharmacist if you are unsure.
Use of specific medications, including:
+ Duloxetine
+ Theophylline
+ Tizanidine
+ Zolpidem
* Breastfeeding status: Do not breastfeed while taking this medication and for at least 2 days after the last dose.
This list is not exhaustive, and it is crucial to inform your doctor and pharmacist about all your medications, including prescription and over-the-counter drugs, natural products, and vitamins, as well as any health problems you have. This will help ensure that it is safe to take this medication with your other treatments. Never start, stop, or change the dose of any medication without consulting your doctor.
Precautions & Cautions
Important Warnings and Cautions
It is essential to inform all your healthcare providers, including doctors, nurses, pharmacists, and dentists, that you are taking this medication. This will help ensure your safety and prevent any potential interactions with other treatments.
Caution with Daily Activities
Until you know how this medication affects you, avoid driving and engaging in activities that require you to be alert. This will help prevent accidents and ensure your safety.
Lab Tests and Monitoring
This medication may interfere with certain lab tests. Be sure to inform all your healthcare providers and lab personnel that you are taking this medication. If you are taking this medication long-term, your doctor may recommend regular blood work to monitor your condition.
Blood Sugar Control
Medications like this one can cause changes in blood sugar levels. If you have diabetes and are taking medications to lower your blood sugar, such as insulin, you may be at risk for low blood sugar (hypoglycemia). Symptoms of high or low blood sugar include:
- Breath that smells like fruit
- Dizziness
- Fast breathing
- Fast heartbeat
- Feeling confused
- Feeling sleepy
- Feeling weak
- Flushing
- Headache
- Unusual thirst or hunger
- Passing urine more often
- Shaking
- Sweating
Check your blood sugar levels as directed by your doctor, and report any symptoms to your doctor immediately. In rare cases, very low blood sugar can lead to coma or even death.
Duration of Use
Do not take this medication for longer than prescribed by your doctor. Taking it for an extended period can increase the risk of a second infection.
Caffeine Interactions
If you consume products containing caffeine, such as tea, coffee, cola, or chocolate, or take medications that contain caffeine, inform your doctor. This can help prevent any potential interactions with your medication.
Sun Protection
This medication can increase your risk of sunburn. To protect yourself, avoid sun exposure, sunlamps, and tanning beds. Use sunscreen and wear protective clothing and eyewear when going outside.
Hydration
Drink plenty of non-caffeinated liquids, unless your doctor advises you to limit your fluid intake.
Rare but Serious Side Effects
In rare cases, this medication can cause severe and potentially life-threatening side effects, including muscle or joint problems, kidney or liver damage, blood disorders, and other complications. If you have any concerns or questions, discuss them with your doctor.
Abnormal Heartbeat
This medication can cause a type of abnormal heartbeat known as prolonged QT interval. If you experience a fast heartbeat, an irregular heartbeat, or fainting, seek medical attention immediately.
Liver Problems
If you notice any signs of liver problems, such as dark urine, tiredness, decreased appetite, stomach pain, light-colored stools, vomiting, or yellow skin or eyes, contact your doctor right away.
Age-Related Precautions
If you are over 60 years old, use this medication with caution, as you may be more susceptible to side effects. If the patient is a child, use this medication with caution, as the risk of joint problems may be higher in children.
Pregnancy and Breastfeeding
If you are pregnant or plan to become pregnant, discuss the benefits and risks of taking this medication with your doctor. This will help you make an informed decision about your treatment.
It is essential to inform all your healthcare providers, including doctors, nurses, pharmacists, and dentists, that you are taking this medication. This will help ensure your safety and prevent any potential interactions with other treatments.
Caution with Daily Activities
Until you know how this medication affects you, avoid driving and engaging in activities that require you to be alert. This will help prevent accidents and ensure your safety.
Lab Tests and Monitoring
This medication may interfere with certain lab tests. Be sure to inform all your healthcare providers and lab personnel that you are taking this medication. If you are taking this medication long-term, your doctor may recommend regular blood work to monitor your condition.
Blood Sugar Control
Medications like this one can cause changes in blood sugar levels. If you have diabetes and are taking medications to lower your blood sugar, such as insulin, you may be at risk for low blood sugar (hypoglycemia). Symptoms of high or low blood sugar include:
- Breath that smells like fruit
- Dizziness
- Fast breathing
- Fast heartbeat
- Feeling confused
- Feeling sleepy
- Feeling weak
- Flushing
- Headache
- Unusual thirst or hunger
- Passing urine more often
- Shaking
- Sweating
Check your blood sugar levels as directed by your doctor, and report any symptoms to your doctor immediately. In rare cases, very low blood sugar can lead to coma or even death.
Duration of Use
Do not take this medication for longer than prescribed by your doctor. Taking it for an extended period can increase the risk of a second infection.
Caffeine Interactions
If you consume products containing caffeine, such as tea, coffee, cola, or chocolate, or take medications that contain caffeine, inform your doctor. This can help prevent any potential interactions with your medication.
Sun Protection
This medication can increase your risk of sunburn. To protect yourself, avoid sun exposure, sunlamps, and tanning beds. Use sunscreen and wear protective clothing and eyewear when going outside.
Hydration
Drink plenty of non-caffeinated liquids, unless your doctor advises you to limit your fluid intake.
Rare but Serious Side Effects
In rare cases, this medication can cause severe and potentially life-threatening side effects, including muscle or joint problems, kidney or liver damage, blood disorders, and other complications. If you have any concerns or questions, discuss them with your doctor.
Abnormal Heartbeat
This medication can cause a type of abnormal heartbeat known as prolonged QT interval. If you experience a fast heartbeat, an irregular heartbeat, or fainting, seek medical attention immediately.
Liver Problems
If you notice any signs of liver problems, such as dark urine, tiredness, decreased appetite, stomach pain, light-colored stools, vomiting, or yellow skin or eyes, contact your doctor right away.
Age-Related Precautions
If you are over 60 years old, use this medication with caution, as you may be more susceptible to side effects. If the patient is a child, use this medication with caution, as the risk of joint problems may be higher in children.
Pregnancy and Breastfeeding
If you are pregnant or plan to become pregnant, discuss the benefits and risks of taking this medication with your doctor. This will help you make an informed decision about your treatment.
Overdose Information
Overdose Symptoms:
- Dizziness
- Tremor
- Headache
- Tiredness
- Seizures
- Abdominal pain
- Nausea
- Vomiting
- Diarrhea
- Renal impairment (reversible)
What to Do:
Call 1-800-222-1222 (Poison Control). Treatment is supportive. Gastric lavage may be performed. Maintain adequate hydration. Hemodialysis or peritoneal dialysis removes only a small amount of ciprofloxacin.
Drug Interactions
Contraindicated Interactions
- Tizanidine (increased tizanidine levels, severe hypotension, somnolence)
Major Interactions
- Antacids (aluminum, magnesium, calcium), sucralfate, iron, zinc, multivitamins (decreased ciprofloxacin absorption)
- Theophylline (increased theophylline levels, toxicity)
- Warfarin (increased anticoagulant effect, bleeding risk)
- Cyclosporine (increased cyclosporine levels, nephrotoxicity)
- Methotrexate (increased methotrexate levels, toxicity)
- Phenytoin (altered phenytoin levels)
- Clozapine (increased clozapine levels, adverse effects)
- Duloxetine (increased duloxetine levels)
- Sildenafil (increased sildenafil levels)
- Ropinirole (increased ropinirole levels)
- Caffeine (increased caffeine levels)
- QT-prolonging drugs (e.g., Class IA and III antiarrhythmics, tricyclic antidepressants, macrolides, antipsychotics) (additive QT prolongation risk)
- Corticosteroids (increased risk of tendon rupture)
Moderate Interactions
- Oral hypoglycemics (e.g., glyburide) (altered glucose levels, hypoglycemia)
- NSAIDs (increased risk of CNS stimulation, seizures)
- Metoclopramide (accelerated ciprofloxacin absorption)
- Omeprazole (reduced ciprofloxacin absorption)
- Probenecid (decreased ciprofloxacin renal clearance)
- Mycophenolate mofetil (reduced mycophenolic acid exposure)
Minor Interactions
- Not available
Monitoring
Baseline Monitoring
Renal function (SCr, CrCl)
Rationale: To adjust dose in patients with renal impairment and assess baseline kidney health.
Timing: Prior to initiation of therapy.
Liver function tests (ALT, AST, bilirubin)
Rationale: To assess baseline liver health, though hepatic impairment rarely requires dose adjustment, severe impairment may increase adverse effects.
Timing: Prior to initiation of therapy.
ECG
Rationale: To assess baseline QT interval, especially in patients with risk factors for QT prolongation (e.g., known QT prolongation, uncorrected hypokalemia/hypomagnesemia, bradycardia, concomitant QT-prolonging drugs).
Timing: Prior to initiation of therapy, if risk factors present.
Routine Monitoring
Clinical response to therapy (resolution of infection symptoms)
Frequency: Daily during acute treatment, then as clinically indicated.
Target: Improvement or resolution of signs/symptoms of infection.
Action Threshold: Lack of improvement or worsening symptoms may indicate treatment failure, resistance, or alternative diagnosis.
Adverse effects (e.g., GI upset, CNS effects, tendon pain, rash)
Frequency: Daily during therapy.
Target: Absence or mild, tolerable adverse effects.
Action Threshold: Severe or persistent adverse effects (e.g., severe diarrhea, new onset tendon pain, psychiatric changes, rash) require immediate evaluation and potential discontinuation.
Blood glucose (for diabetic patients or those on oral hypoglycemics)
Frequency: Regularly, as per diabetes management plan, or if symptoms of hypo/hyperglycemia occur.
Target: Within target glycemic range.
Action Threshold: Significant fluctuations (hypo/hyperglycemia) require dose adjustment of antidiabetic agents or ciprofloxacin discontinuation.
INR (for patients on warfarin)
Frequency: More frequently (e.g., 2-3 times per week) during and immediately after ciprofloxacin therapy.
Target: Within therapeutic range for indication.
Action Threshold: INR outside target range requires warfarin dose adjustment.
Symptom Monitoring
- Tendon pain, swelling, inflammation, or rupture (especially Achilles tendon)
- Peripheral neuropathy (pain, burning, tingling, numbness, weakness)
- CNS effects (dizziness, confusion, hallucinations, seizures, anxiety, depression, insomnia)
- Severe or persistent diarrhea (especially if bloody or watery, suggestive of C. difficile infection)
- Rash, hives, itching, swelling (suggestive of hypersensitivity reaction)
- Chest pain, palpitations, fainting (suggestive of QT prolongation/arrhythmia)
- Joint pain or swelling (especially in children)
- Vision changes
- Signs of liver injury (e.g., dark urine, jaundice, persistent nausea/vomiting)
Special Patient Groups
Pregnancy
Ciprofloxacin is classified as Pregnancy Category C. Studies in animals have shown adverse effects on fetal development (arthropathy in immature animals). There are no adequate and well-controlled studies in pregnant women. Use during pregnancy only if the potential benefit justifies the potential risk to the fetus.
Trimester-Specific Risks:
First Trimester:
Potential for arthropathy in the developing fetus, though human data are limited and do not consistently show this risk.
Second Trimester:
Similar theoretical risks as first trimester; generally avoided unless no safer alternative.
Third Trimester:
Similar theoretical risks as first trimester; generally avoided unless no safer alternative.
Lactation
Ciprofloxacin is excreted into human milk. Due to the potential for serious adverse reactions in breastfed infants (e.g., arthropathy, alteration of gut flora), a decision should be made whether to discontinue nursing or to discontinue the drug, taking into account the importance of the drug to the mother. Lactation Risk Category L3 (Moderately Safe).
Infant Risk:
Potential for arthropathy, disruption of infant gut flora, and theoretical risk of cartilage damage. Monitor infant for gastrointestinal disturbances (diarrhea, candidiasis) and rash.
Pediatric Use
Generally not recommended for routine use in pediatric patients due to the risk of arthropathy (damage to cartilage in weight-bearing joints). Use is reserved for specific severe infections (e.g., complicated UTI, pyelonephritis, inhalational anthrax, cystic fibrosis exacerbations) where the benefits outweigh the risks and no safer alternative exists. Close monitoring for musculoskeletal adverse events is crucial.
Geriatric Use
Elderly patients may be at increased risk for severe tendon disorders, including tendon rupture, and QT prolongation. Renal function should be assessed, and dose adjusted if necessary. Increased susceptibility to CNS effects (e.g., confusion, hallucinations) may also occur.
Clinical Information
Clinical Pearls
- Ciprofloxacin is a broad-spectrum antibiotic, but its use should be reserved for appropriate indications due to the risk of serious adverse effects and to combat antimicrobial resistance.
- Always advise patients about the Black Box Warnings, especially regarding tendon rupture and peripheral neuropathy. Instruct them to stop the medication and seek immediate medical attention if these symptoms occur.
- Counsel patients on avoiding concomitant administration with polyvalent cations (antacids, iron, calcium, dairy products) to ensure adequate absorption.
- Ensure patients are well-hydrated to prevent crystalluria.
- Monitor for C. difficile-associated diarrhea (CDAD), which can occur during or after therapy.
- Be mindful of drug interactions, particularly with warfarin, theophylline, and tizanidine.
- The 100mg tablet strength is typically used for uncomplicated urinary tract infections (UTIs) in adults, often as a 3-day course.
Alternative Therapies
- Other fluoroquinolones (e.g., Levofloxacin, Moxifloxacin - note different spectrums and adverse effect profiles)
- Beta-lactam antibiotics (e.g., Amoxicillin/clavulanate, Cephalexin, Cefdinir)
- Macrolides (e.g., Azithromycin, Clarithromycin)
- Tetracyclines (e.g., Doxycycline)
- Sulfonamides (e.g., Trimethoprim/sulfamethoxazole)
- Aminoglycosides (e.g., Gentamicin, Tobramycin - typically IV for severe infections)
Cost & Coverage
Average Cost:
$10 - $100 per 30 tablets (generic)
Generic Available:
Yes
Insurance Coverage:
Tier 1 or Tier 2 (Generic)
General Drug Facts
If your symptoms or health issues persist or worsen, it is essential to contact your doctor promptly. To ensure safe use, never share your medication with others or take someone else's medication. This medication is accompanied by a Medication Guide, which is a crucial patient fact sheet. Please read it carefully and review it again whenever you receive a refill. If you have any questions or concerns about this medication, consult your doctor, pharmacist, or other healthcare provider. In the event of a suspected overdose, immediately call your local poison control center or seek emergency medical attention. Be prepared to provide detailed information about the overdose, including the substance taken, the amount, and the time it occurred.