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.

Reference: FDA Prescribing Information