ciprofloxacin 500 mg drug study - کامل (هلپ کده)

خواص دارویی و گیاهی

Generic Name: ciprofloxacin (oral) (SIP roe FLOX a sin)Brand Names: Cipro, Cipro XR, Proquin XR

Medically reviewed by Kaci Durbin, MD Last updated on Dec 13, 2018.

Ciprofloxacin is a fluoroquinolone (flor-o-KWIN-o-lone) antibiotic that fights bacteria in the body. It is used to treat different types of bacterial infections, including skin infections, bone and joint infections, respiratory or sinus infections, urinary tract infections, and certain types of diarrhea. It is also used to treat gonorrhea.

Ciprofloxacin is also used to treat people who have been exposed to anthrax or certain types of plague.

Ciprofloxacin should be used only for infections that cannot be treated with a safer antibiotic.ciprofloxacin 500 mg drug study

Fluoroquinolone antibiotics can cause serious or disabling side effects that may not be reversible, such as tendon rupture or nerve problems.

Ciprofloxacin can cause serious side effects, including tendon problems, nerve damage, serious mood or behavior changes, or low blood sugar.

Stop using this medicine and call your doctor at once if you have symptoms such as: headache, hunger, irritability, numbness, tingling, burning pain, confusion, agitation, paranoia, problems with memory or concentration, thoughts of suicide, or sudden pain or movement problems in any of your joints.

In rare cases, ciprofloxacin may cause damage to your aorta, which could lead to dangerous bleeding or death. Get emergency medical help if you have severe and constant pain in your chest, stomach, or back.

You may not be able to use ciprofloxacin if you have a muscle disorder. Tell your doctor if you have a history of myasthenia gravis.

You should not use ciprofloxacin if you are allergic to it, or if:

you also take tizanidine; or

you are allergic to other fluoroquinolones (gemifloxacin, levofloxacin, moxifloxacin, norfloxacin, ofloxacin, and others).

You also take theophylline

Ciprofloxacin may cause swelling or tearing of a tendon (the fiber that connects bones to muscles in the body), especially in the Achilles’ tendon of the heel. This can happen during treatment or up to several months after you stop taking this medicine. Tendon problems may be more likely in certain people (children and older adults, or people who use steroid medicine or have had an organ transplant).

To make sure this medicine is safe for you, tell your doctor if you have ever had:

tendon problems, bone problems, arthritis, or other joint problems (especially in children);

blood circulation problems, aneurysm, narrowing or hardening of the arteries;

heart problems, high blood pressure;

a genetic disease such as Marfan syndrome or Ehler’s-Danlos syndrome;

diabetes;

a muscle or nerve disorder, such as myasthenia gravis;

kidney disease;

seizures or epilepsy;

a head injury or brain tumor;

long QT syndrome (in you or a family member); or

low levels of potassium in your blood (hypokalemia).

Do not give this medicine to a child without medical advice.

It is not known whether this medicine will harm an unborn baby. Tell your doctor if you are pregnant.

You should not breast-feed while using this medicine.

Take ciprofloxacin exactly as prescribed by your doctor. Follow all directions on your prescription label and read all medication guides or instruction sheets.

You may take ciprofloxacin with or without food, at the same time each day.

Shake the oral suspension (liquid) for 15 seconds before you measure a dose. Use the dosing syringe provided, or use a medicine dose-measuring device (not a kitchen spoon). Do not give ciprofloxacin oral suspension through a feeding tube.

Swallow the extended-release tablet whole and do not crush, chew, or break it.

Use ciprofloxacin for the full prescribed length of time, even if your symptoms quickly improve. Skipping doses can increase your risk of infection that is resistant to medication. This medicine will not treat a viral infection such as the flu or a common cold.

Do not share ciprofloxacin with another person.

Store at room temperature away from moisture and heat. Do not allow the liquid medicine to freeze. Throw away any unused liquid after 14 days.

Ciprofloxacin dosage information (in more detail)

Take the medicine as soon as you can, but skip the missed dose if it is almost time for your next dose. Do not take two doses at one time.

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.

ciprofloxacin 500 mg drug study

Do not take ciprofloxacin with dairy products such as milk or yogurt, or with calcium- fortified juice. You may eat or drink these products with your meals, but do not use them alone when taking ciprofloxacin. They could make the medication less effective.

Using caffeine while taking ciprofloxacin can increase the effects of the caffeine.

Antibiotic medicines can cause diarrhea, which may be a sign of a new infection. If you have diarrhea that is watery or bloody, call your doctor before using anti-diarrhea medicine.

Ciprofloxacin could make you sunburn more easily. Avoid sunlight or tanning beds. Wear protective clothing and use sunscreen (SPF 30 or higher) when you are outdoors. Tell your doctor if you have severe burning, redness, itching, rash, or swelling after being in the sun.

Avoid driving or hazardous activity until you know how this medicine will affect you. Your reactions could be impaired.

Get emergency medical help if you have signs of an allergic reaction to ciprofloxacin (hives, difficult breathing, swelling in your face or throat) or a severe skin reaction (fever, sore throat, burning in your eyes, skin pain, red or purple skin rash that spreads and causes blistering and peeling).

Ciprofloxacin can cause serious side effects, including tendon problems, side effects on your nerves (which may cause permanent nerve damage), serious mood or behavior changes (after just one dose), or low blood sugar (which can lead to coma).

Stop taking this medicine and call your doctor at once if you have:

low blood sugar – headache, hunger, sweating, irritability, dizziness, nausea, fast heart rate, or feeling anxious or shaky;

nerve symptoms in your hands, arms, legs, or feet – numbness, weakness, tingling, burning pain;

serious mood or behavior changes – nervousness, confusion, agitation, paranoia, hallucinations, memory problems, trouble concentrating, thoughts of suicide; or

signs of tendon rupture – sudden pain, swelling, bruising, tenderness, stiffness, movement problems, or a snapping or popping sound in any of your joints (rest the joint until you receive medical care or instructions).

In rare cases, ciprofloxacin may cause damage to your aorta, the main blood artery of the body. This could lead to dangerous bleeding or death. Get emergency medical help if you have severe and constant pain in your chest, stomach, or back.

Also, stop using this medicine and call your doctor at once if you have:

severe stomach pain, diarrhea that is watery or bloody;

fast or pounding heartbeats, fluttering in your chest, shortness of breath, and sudden dizziness (like you might pass out);

the first sign of any skin rash, no matter how mild;

muscle weakness, breathing problems;

little or no urination;

jaundice (yellowing of the skin or eyes); or

increased pressure inside the skull – severe headaches, ringing in your ears, dizziness, nausea, vision problems, pain behind your eyes.

Common ciprofloxacin side effects may include:

nausea, vomiting, diarrhea, stomach pain;

vaginal itching or discharge;

headache; or

abnormal liver function tests.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

Ciprofloxacin side effects (in more detail)

Some medicines can make ciprofloxacin much less effective when taken at the same time. If you take any of the following medicines, take your dose 2 hours before or 6 hours after you take the other medicine.

the ulcer medicine sucralfate, or antacids that contain calcium, magnesium, or aluminum (such as Maalox, Milk of Magnesia, Mylanta, Pepcid Complete, Rolaids, Tums, and others);

didanosine (Videx) powder or chewable tablets;

lanthanum carbonate or sevelamer; or

vitamin or mineral supplements that contain calcium, iron, magnesium, or zinc.

Tell your doctor about all your other medicines, especially:

cyclosporine, methotrexate, metoclopramide, phenytoin, probenecid, ropinirole, sildenafil, or theophylline;

a blood thinner (warfarin, Coumadin, Jantoven);

a diuretic or “water pill”;

heart rhythm medication;

insulin or oral diabetes medicine (check your blood sugar regularly);

medicine to treat depression or mental illness;

steroid medicine (such as prednisone); or

NSAIDs (nonsteroidal anti-inflammatory drugsa>) – ibuprofen (Advil, Motrin), naproxen (Aleve), celecoxib, diclofenac, indomethacin, meloxicam, and others.

This list is not complete. Other drugs may interact with ciprofloxacin, including prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible drug interactions are listed here.

Ciprofloxacin drug interactions (in more detail)

Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use ciprofloxacin only for the indication prescribed.

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

Copyright 1996-2019 Cerner Multum, Inc. Version: 22.01.

Medical Disclaimer

Other brands: Cipro, Cipro I.V., Proquin XR

prednisone, amoxicillin, doxycycline, albuterol, ranitidine, metronidazole, clindamycin, cephalexin, Augmentin, azithromycin

Ciprofloxacin reviews

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schwach gelber, pulverförmiger Feststoff[1]

Antibiotikum

Gyrasehemmer

fest

318–320 °C (Ciprofloxacin·Hydrochlorid·Monohydrat)[2]

ciprofloxacin 500 mg drug study

6,09[3]

Ciprofloxacin ist ein synthetisches Antibiotikum mit breitem Wirkspektrum aus der Gruppe der Fluorchinolone. Die Substanz wurde 1981 von einem Forschungschemiker der Firma Bayer (Klaus Grohe) entwickelt und 1983 patentiert.
[7][8] Antibiotika dieser Gruppe hemmen die Gyrase von Bakterien und damit deren DNA-Replikation und Zellteilung. Sie verhindern dadurch die Zellteilung, und zwar vor allem von gramnegativen Keimen. Fluorchinolone haben weiterhin eine bakterizide Wirkung, deren Ursache bislang ungeklärt ist.[9][10]

Wegen starker Nebenwirkungen geriet das Medikament zunehmend in die Kritik. Die FDA informierte 2008 und 2013 über neu beobachtete schwere Nebenwirkungen bei systemisch angewendeten Fluorchinolon und ordnete entsprechende Maßnahmen an. 2015 hat sie nach ärztlichen Meldeberichten das Nutzen-Risiko-Verhältnis von Cipro-, Levo-, Moxi- und Ofloxacin neu bewertet und 2016 die Anwendung deutlich eingeschränkt.[11] Auch in EU-Ländern wurden mehrmals Warnhinweise und Anwendungsbeschränkungen für Fluorchinolone verfügt. Die Europäische Arzneimittelagentur hat die schwerwiegenden, potentiell dauerhaften und Lebensqualität beeinträchtigenden Nebenwirkungen zuletzt 2018 neu bewertet und Anwendungseinschränkungen empfohlen.[12] Das Bundesinstitut für Arzneimittel und Medizinprodukte hat daraufhin am 8. April 2019 in einem umfassenden Bescheid die Indikationen für Fluorchinolone weiter eingeschränkt und eine weitere Aktualisierung der Gebrauchs- und Fachinformationen angeordnet, um auf möglicherweise irreversible Nebenwirkungen hinzuweisen. Ärzte wurden über einen Rote-Hand-Brief am 8. April 2019 informiert, Fluorchinolone bei einfachen Infektionen nicht mehr einzusetzen.[13]

Ciprofloxacin eignet sich gut gegen alle bakteriellen Erreger einer infektiösen Darmerkrankung. Außerdem ist es wirksam gegen den Problemkeim Pseudomonas aeruginosa. Bei komplizierten Harnwegsinfektionen, die auch von Darmbakterien oder unter Umständen von Pseudomonaden ausgelöst werden, gilt es als Reserveantibiotikum. Weitere Anwendungsgebiete sind Infektionen der Vorsteherdrüse, der Gallenwege, der Atemwege, der Bauchhöhle (Peritonitis) und viele andere Infektionskrankheiten bei Nachweis eines entsprechend empfindlichen Erregers; auf diesen Nachweis kann z. B. bei Infekten des äußeren Gehörgangs verzichtet werden[14]. Ciprofloxacin ist auch zur Behandlung des Milzbrands zugelassen.
Ciprofloxacin kann wie andere moderne Chinolone neben Makroliden und Rifampicin zur Behandlung der Pneumonie durch Legionellen eingesetzt werden. Ciprofloxacin hemmt E. Coli-Topoisomerasen ab einer Konzentration von 0.012 mg/l. Dies ist die minimale Hemmkonzentration (MHK). Sie verursacht bei E. Coli zwar reversible, aber nachweisliche DNA-Schäden.[15] Die MHK anderer Spezies beträgt: Enterobacter cloacae 0,03–1 mg/l, Proteus mirabilis 0,03–0,5 mg/l, Pseudomonas aeruginosa 0,25–8 mg/l, Klebsiella spp. 0,06–1 mg/l, Streptococcus spp. 0,5–4 mg/l, Bacteroides spp. 8 mg/l, Enterococcus faecalis 0,5–64 mg/l und Staphylococcus aureus 0,46–2 mg/l.[16] Ciprofloxacin wirkt weiterhin zytotoxisch und zytostatisch auf menschliches Gewebe: Nekrose von Knorpelzellen wurde ab 1 mg/l beobachtet[17], DNA-Fragmentierung und Apoptose von T-Zellen ab 2,5 mg/l[18], Mitochondrienschäden und Apoptose von Sehnenzellen ab 3 mg/l[19], Proliferationshemmung von Fibroblasten ab 5 mg/l[20], Schädigung der mitochondrialen DNA (mtDNA) und Wachstumshemmung ab 20 mg/l[21], und Unterbrechung des Zellzyklus, Genommutation sowie Verlust der mtDNA ab 25 mg/l.[22][23] Die zytotoxische und zytostatische Wirkung von Ciprofloxacin ist für eine mögliche Anwendung in der Chemotherapie zur Behandlung von Krebszellen von Interesse.[24] Im umu-Test zeigte Ciprofloxacin jedoch eine deutlich stärkere genotoxische Wirkung als die Chemotherapeutika Etoposid, Doxorubicin, Cisplatin, Fluorouracil, Dacarbazin, Bleomycin und Mitomycin C (siehe auch Genotoxisches Potential).[25]

Die Anwendung und damit auch Dosierung von Ciprofloxacin ist abhängig von der zu behandelnden Infektionserkrankung. Allgemein wird
Ciprofloxacin zweimal täglich verabreicht, vorzugsweise peroral (p.o.), alternativ auch intravenös. Zur Therapie der Gonorrhoe (Tripper) ist schon eine einmalige Gabe von 500 mg Ciprofloxacin p.o. in Tablettenform ausreichend. Es sind auch Zubereitungen für eine örtliche Anwendung als Ohren- und Augentropfen erhältlich.

Bei normaler Anwendung (500 mg Einzeldosis bei einer 70 kg schweren Person) beträgt die Konzentration 3 mg/l in Serum/Muskeln, 6–9 mg/l in Prostata/Darm, 18–21 mg/l in Granulozyten, 6–30 mg/l in der Lunge und 15–30 mg/l in der Galle.[26] Die maximale Serumkonzentration von Ciprofloxacin wird eine Stunde nach Einnahme erreicht. Die Halbwertszeit beträgt 4 Stunden. Ciprofloxacin wird zu 40–50 % unverändert über den Urin ausgeschieden[27][28] und zu 25–40 % metabolisiert.[29] Von den identifizierten Metaboliten wirken einige schwächer und andere stärker als das ursprüngliche Ciprofloxacin.[30]

Bei Infektionen die unbehandelt besser werden oder nicht schwerwiegend sind, wird empfohlen Fluorchinolone nicht mehr anzuwenden. Hierzu zählen Infekte des Halses, abakterielle (chronische) Prostatitis, Bronchitis, Sinusitis, Prophylaxe der Reisediarrhoe sowie wiederkehrende Infektionen der unteren Harnwege (Harnwegsinfekte, die nicht über die Blase hinausgehen). Zur Behandlung leichter oder mittelschwerer bakterieller Infektionen sollen sie nur angewendet werden, falls andere üblicherweise für diese Infektionen empfohlene Antibiotika nicht verwendet werden können. Es ist wichtig, dass Fluorchinolone generell bei Patienten, die zuvor schwerwiegende Nebenwirkungen mit einem Fluorchinolon- oder Chinolon-Antibiotikum hatten, vermieden werden sollten. Sie sollten bei älteren Patienten, Patienten mit Nierenerkrankungen und Patienten, die sich einer Organtransplantation unterzogen haben, mit besonderer Vorsicht angewendet werden, da bei diesen Patienten ein höheres Risiko für eine Sehnenverletzung besteht.[31][32]

Häufigste Nebenwirkungen (jedoch unter 10 %) sind Übelkeit, Durchfall und Hautausschläge. Nach prophylaktischer Gabe einer Einzeldosis Ciprofloxacin an 1.390 Schüler wurde eine Nebenwirkungshäufigkeit von 44 % beobachtet, wobei es am häufigsten zu Störungen des Nervensystems kam.[33] Akute Leberschäden treten mit einer Häufigkeit von 1:154 auf.[34] Das Risiko für Sehnenschäden beträgt bei Ciprofloxacin 1:227.[35] In einer Gruppe von 65+ jährigen Patienten erlitten nach der Einnahme von Fluorchinolonen 2,1 % einen Sehnenriss, 1,1 % ein Aortenaneurysma und 0,2 % eine Netzhautablösung.[36] Nebenwirkungen können um Tage bis Wochen verzögert auftreten und langfristig an Intensität zunehmen. Die Nebenwirkungen halten im Durchschnitt 14 Monate bis 9 Jahre an[37] und äußern sich häufig als Konstellation verschiedener Symptome (Erschöpfung, Konzentrationsprobleme, Neuropathien, Tendinopathien und mehr).[38]

Schwerwiegende Nebenwirkungen von Fluorchinolonen sind nicht effektiv behandelbar, daher führen sie in 29,3 % der Fälle zu einer körperlichen Behinderung. Im Vergleich zu anderen gängigen Antibiotika sind Fluorchinolone für die meisten dauerhaften Behinderungen verantwortlich.[39] Der FDA wurden für Fluorchinolone bis 2016 insgesamt 210.705 Verdachtsfälle auf Nebenwirkungen sowie 2.991 Todesfälle gemeldet. Für Ciprofloxacin wurden davon bei 22.488 Patienten insgesamt 100.865 Verdachtsfälle auf Nebenwirkungen und 2.072 Todesfälle gemeldet.[40] Aufgrund der geringen Melderate von 1–10 % wird in den USA die Dunkelziffer an fluorchinolonassoziierten Nebenwirkungen auf 2–21 Millionen sowie die Dunkelziffer an Todesfällen auf 29.000 bis über 299.000 geschätzt.[41] Todesfälle sind bereits ab der ersten Tagesdosis möglich.[3][42]

Ciprofloxacin kann aufgrund seiner Chondrotoxizität Knorpelschäden bei Kindern und Erwachsener verursachen.[17] Fluorchinolone haben im Tierversuch bei jungen Hunden Störungen des Knorpelwachstums verursacht, deshalb sollen sie nicht in der Schwangerschaft, Stillzeit und nicht bei Kindern eingesetzt werden. Davon abweichend ist Ciprofloxacin aufgrund seiner Wirksamkeit gegen Pseudomonas jedoch zur Behandlung von Kindern und Jugendlichen (5–17 Jahre) mit akuten, durch P. aeruginosa verursachten Infektionsschüben einer zystischen Fibrose zugelassen. Weitere Nebenwirkungen sind Neurotoxizität, Lebertoxizität und allergische Reaktionen, auch das Red man syndrome wurde beschrieben. Des Weiteren gibt es mehrere Studien, die den Nachweis erbrachten, dass Ciprofloxacin die Krampfschwelle senken kann: Ein Einsatz bei Patienten mit Anfallsleiden sollte daher nur unter strenger Indikationsstellung erfolgen.[43][44]

2015 wurde in einer Studie gezeigt, dass Fluorchinolone durch Eisen-Chelation der α-Ketoglutarat-abhängigen Dioxygenase den Cofaktor Eisen entziehen. Das könnte die Kollagenreifung stören sowie epigenetische Veränderungen auslösen. Die Autoren schlagen das als eine Ursache für die Fluorchinolon-induzierten Nierenschäden und Tendopathien (Sehnenschädigungen) vor.[45]

Es können Schmerzen, Schwellungen, Risse und Entzündungen der Sehnen aufkommen, einschließlich der Rückseite des Knöchels (auch Schulter-, Hand-, oder andere Sehnensysteme). Dies gilt für Menschen aller Altersgruppen, die Fluorchinolon-Antibiotika einschließlich Ciprofloxacin einnehmen. Der häufigste Bereich der Schmerzen und Schwellungen ist die Achillessehne. Sehnenrupturen können während oder auch noch mehrere Monate nach der Einnahme von Ciprofloxacin erfolgen. Das Risiko von Sehnen-Schäden ist bei Patienten über 60 Jahren höher, vor allem bei Einnahme von Steroiden (Kortikosteroide) oder nach Nieren-, Herz- oder Lungentransplantation. Sehnenschwellungen (Tendinitis) und -risse (Bruch) wurden auch bei Patienten, die Fluorchinolone einnahmen, aber keine der übrigen v.g. Risikofaktoren aufwiesen, festgestellt. Nach einer Feststellung besagter Folgen sollen Bewegungen vermieden werden.[47] Erklärt wird die Nebenwirkung mit einer erhöhten Wirksamkeit von Matrix-Metalloproteinasen, die die Festigkeit der Sehnen herabsetzen können.[48]

Vor den teilweise irreversiblen schwerwiegenden Nebenwirkungen wird in den USA auf dem Beipackzettel des Antibiotikums mittels einer Black-Box-Warnung gewarnt. In der Warnung wird auch darauf hingewiesen, dass das Mittel nicht erste Wahl sein sollte bei akuten Exazerbationen der chronischen Bronchitis, bei akuten unkomplizierten Blasenentzündungen und akuten Sinusitiden.[49]

Selten sind psychotische Störungen mit Suizidtendenz.[50][51] Auf Pharmakovigilanz-Erhebungen der WHO beruhende Studienergebnisse legen jedoch nahe, dass Fluorchinolone mit einem signifikant erhöhten Risiko für Suizidalität und vollendeten Suizid assoziiert sind. Entsprechende Fälle nahmen seit 2008 deutlich zu und wurden am häufigsten nach der Einnahme von Ciprofloxacin beobachtet.[52] Laut Bekanntmachung der Arzneimittelkommission der deutschen Ärzteschaft ist eine hohe Dunkelziffer vollendeter Suizide nach Fluorchinolonanwendung anzunehmen.[53]

Ferner wurde ein erhöhtes Risiko für das Auftreten von Aortenaneurysmen und -dissektionen festgestellt. In Deutschland ordnete das
Bundesinstitut für Arzneimittel und Medizinprodukte im Oktober 2018 für alle systemisch und inhalativ angewendete Fluorchinolone, inklusive Ciprofloxacin, eine entsprechende Information in den Produktinformationstexten an.[54]

Aufgrund von Störungen des Blutzuckerspiegels, einschließlich Hypoglykämie und Hyperglykämie, durch Fluorchinolone[55] ordnete das Bundesinstitut für Arzneimittel und Medizinprodukte im Februar 2019 eine weitere Aktualisierung der Produktinformationstexte für Ciprofloxacin (für die systemische Anwendung) an.[56] Bei Diabetikern kann Ciprofloxacin schon nach einer Einzeldosis lebensbedrohliche Hypoglykämien auslösen.[57] Auch bei Nicht-Diabetikern kann es unter Ciprofloxacin zu Dysglykämien kommen.[58] Mögliche Komplikationen Fluorchinolon-induzierter Blutzuckerstörungen bestehen in zentralnervösen Effekten (Krampfanfall, Koma) mit dauerhaften neurologischen Defiziten.[59] Der Pathomechanismus ist mit erhöhten zytosolischen Calciumkonzentrationen und Beeinträchtigungen der Mitochondrienfunktion in pankreatischen Betazellen assoziiert.[60][61][62] Fluorchinolone stehen im Verdacht, für eine Zunahme des Typ-2-Diabetes in den USA verantwortlich zu sein.[63]

Patienten mit Herzrhythmusstörungen oder Krampfanfällen in der Vorgeschichte sollten coffeinhaltige Lebens- (z. B.: Kaffee, Cola, schwarzen Tee, grünen Tee) und Arzneimittel (häufig Schmerzmittelkombination, Erkältungsmittel) meiden. Der Abbau von Coffein wird durch Cytochrom P450 (Isoenzym 1A2) katalysiert. Einige Gyrasehemmer greifen in den Coffeinmetabolismus ein und blockieren das Cytochrom P450, wodurch der Hauptabbauweg der N-Demethylierung zum Paraxanthin betroffen ist. Dadurch kommt es zu einer Wirkungsverstärkung des Coffeins. Eine vergleichbare Wechselwirkung tritt mit dem strukturähnlichen Methylxantin Theophyllin auf.

Ciprofloxacin hemmt auch das Cytochrom P450 3A4.[64] Dieses Isoenzym metabolisiert 50 % der gängigen Arzneimittel und zählt somit zu den wichtigsten Vertretern der CYP-Familie. Eine Hemmung von CYP3A4 beeinträchtigt gleichzeitig die Entgiftungskapazität der PGP-Pumpe.[65]

Ciprofloxacin darf nicht zusammen mit Quetiapin eingenommen werden, da der Abbau vom Quetiapin deutlich verlangsamt werden kann.

Ciprofloxacin darf nicht zusammen mit Lebens- oder Arzneimitteln, die über einen (hohen) Anteil mehrfach geladener Metallionen verfügen, eingenommen werden (nicht zusammen z. B. mit Milch oder Milchprodukten (Ca2+) oder Antazida (z. B. Mg2+)), da es hier im Rahmen einer Komplexbildung zwischen Metallionen und Wirkstoff zu einer relevanten Abschwächung der Wirkung desselben kommt.[66]

Da Ciprofloxacin zu den Fluorchinolonen gehört, könnte es, wie andere Antibiotika dieser Gruppe, die Wirksamkeit hormoneller Kontrazeptiva herabsetzen. Für den speziellen Fall von Ciprofloxacin hat sich ein solcher Verdacht jedoch bisher nicht bestätigt. In der aktuellen Packungsbeilage von Ciprofloxacin (Stand 2006) wird eine Wechselwirkung zwischen diesem Antibiotikum und hormonellen Kontrazeptiva nicht erwähnt. Mindestens zwei klinische Studien belegen, dass Ciprofloxacin die Wirksamkeit der Antibabypille nicht beeinträchtigt.[67][68] Die Nicht-Beeinträchtigung hormoneller Kontrazeptiva war auch der Grund, dass Ciprofloxacin statt Rifampicin an 4253 Student(inn)en der Universität Oxford ausgegeben wurde, um die Ausbreitung einer Meningokokken-Meningitis zu verhindern.[69]

Grapefruits und deren Saft können die Bioverfügbarkeit, also die Wirksamkeit von Ciprofloxacin, signifikant verringern (siehe hierzu den Artikel Grapefruit, Abschnitt „Wechselwirkung mit Arzneimitteln“). Auch ein zeitlicher Abstand zwischen der Einnahme von Ciprofloxacin und dem Genuss von Grapefruit(saft) im Tagesverlauf verhindert diese Wechselwirkung nicht, da der Abbau der hierfür verantwortlichen Inhaltsstoffe der Grapefruit mehrere Tage dauert.

Ciprofloxacin kann mit einer Schilddrüsenhormon-Ersatztherapie wechselwirken und die Wirkung von Levothyroxin beeinträchtigen.[70]

In prokaryotischen Testsystemen hat sich Ciprofloxacin als stark genotoxisch und hoch mutagen erwiesen.[71][72][73][25] In humanspezifischen Testsystemen induziert Ciprofloxacin Chromosomenaberrationen und Aneuploidie.[74][75] Die hierbei untersuchten Konzentrationen (5 – 25 µg/ml) entsprechen therapeutischen Gewebespiegeln.[76] Im Mausmodell führte Ciprofloxacin bei einer dem humantherapeutischen Dosisbereich vergleichbaren Exposition zu Erbgutschäden.[77][78] Neben der nukleären DNA kann auch die mitochondriale DNA geschädigt werden.[79] Die Einnahme von Ciprofloxacin erhöht möglicherweise das Hautkrebsrisiko.[80] Klinische Beobachtungen legen nahe, dass Ciprofloxacin speziell bei langfristiger Behandlung immunsupprimierter Patienten hochaggressive, metastatische und rezidivierende Plattenepithelkarzinome induzieren kann.[81]

Ciprofloxacin verfügt über reproduktionstoxisches Potential: in vivo kam es bei therapeutisch relevanten Dosierungen zu embryotoxischen (u. a. Früh-, Fehl- und Totgeburten, Fehlbildungen, Organschäden)[82][83][84][85][86] und die Fortpflanzungsfähigkeit beeinträchtigenden Effekten (u. a. hormonelle Störungen, Störungen der Spermatogenese, ultrastrukturelle Spermienschäden, Hodenatrophie). So wurden u. a. DNA Schäden der Spermien nachgewiesen, welche reduzierte Fruchtbarkeit und embryonale Missbildungen im Mausmodell zur Folge hatten.[87][88][89][90] In begrenzten Untersuchungen an exponierten Schwangeren wurden Totgeburten beobachtet.[91][92] Laut Fachinformation (Stand 01/2019) zeigen verfügbare Daten zur Anwendung von Ciprofloxacin bei schwangeren Frauen keine Hinweise auf Fehlbildungen oder fötale/neonatale Toxizität.[93] Zudem liegen laut Fachinformation keine tierexperimentellen Hinweise auf Reproduktionstoxizität vor.[93] Es wird darauf hingewiesen, dass Ciprofloxacin in die Muttermilch übergeht und in der Schwangerschaft und während der Stillzeit wegen möglicher gelenkschädigender Wirkungen nicht eingenommen werden sollte.[93] Laut Zulassungsdaten der Europäischen Arzneimittel-Agentur sind auch andere schwere embryotoxische Effekte möglich.[94]

Agyr (A), Ciloxan (D, A, CH), Ciprobay (D), Ciproxin (A, CH), InfectoCipro (D), Keciflox (D), Otanol (A), Panotile Cipro (D), Quinox (T) zahlreiche Generika (D, A, CH)

Ciproxin HC (CH) [95][96][97]

schwach gelber, pulverförmiger Feststoff[1]

Antibiotikum

Gyrasehemmer

fest

318–320 °C (Ciprofloxacin·Hydrochlorid·Monohydrat)[2]

ciprofloxacin 500 mg drug study

6,09[3]

Ciprofloxacin darf nicht zusammen mit Quetiapin eingenommen werden, da der Abbau vom Quetiapin deutlich verlangsamt werden kann.

Ciprofloxacin kann mit einer Schilddrüsenhormon-Ersatztherapie wechselwirken und die Wirkung von Levothyroxin beeinträchtigen.[70]

Agyr (A), Ciloxan (D, A, CH), Ciprobay (D), Ciproxin (A, CH), InfectoCipro (D), Keciflox (D), Otanol (A), Panotile Cipro (D), Quinox (T) zahlreiche Generika (D, A, CH)

Ciproxin HC (CH) [95][96][97]

schwach gelber, pulverförmiger Feststoff[1]

Antibiotikum

Gyrasehemmer

fest

318–320 °C (Ciprofloxacin·Hydrochlorid·Monohydrat)[2]

ciprofloxacin 500 mg drug study

6,09[3]

Ciprofloxacin darf nicht zusammen mit Quetiapin eingenommen werden, da der Abbau vom Quetiapin deutlich verlangsamt werden kann.

Ciprofloxacin kann mit einer Schilddrüsenhormon-Ersatztherapie wechselwirken und die Wirkung von Levothyroxin beeinträchtigen.[70]

Agyr (A), Ciloxan (D, A, CH), Ciprobay (D), Ciproxin (A, CH), InfectoCipro (D), Keciflox (D), Otanol (A), Panotile Cipro (D), Quinox (T) zahlreiche Generika (D, A, CH)

Ciproxin HC (CH) [95][96][97]

schwach gelber, pulverförmiger Feststoff[1]

Antibiotikum

Gyrasehemmer

fest

318–320 °C (Ciprofloxacin·Hydrochlorid·Monohydrat)[2]

ciprofloxacin 500 mg drug study

6,09[3]

Ciprofloxacin darf nicht zusammen mit Quetiapin eingenommen werden, da der Abbau vom Quetiapin deutlich verlangsamt werden kann.

Ciprofloxacin kann mit einer Schilddrüsenhormon-Ersatztherapie wechselwirken und die Wirkung von Levothyroxin beeinträchtigen.[70]

Agyr (A), Ciloxan (D, A, CH), Ciprobay (D), Ciproxin (A, CH), InfectoCipro (D), Keciflox (D), Otanol (A), Panotile Cipro (D), Quinox (T) zahlreiche Generika (D, A, CH)

Ciproxin HC (CH) [95][96][97]

schwach gelber, pulverförmiger Feststoff[1]

Antibiotikum

Gyrasehemmer

fest

318–320 °C (Ciprofloxacin·Hydrochlorid·Monohydrat)[2]

ciprofloxacin 500 mg drug study

6,09[3]

Ciprofloxacin darf nicht zusammen mit Quetiapin eingenommen werden, da der Abbau vom Quetiapin deutlich verlangsamt werden kann.

Ciprofloxacin kann mit einer Schilddrüsenhormon-Ersatztherapie wechselwirken und die Wirkung von Levothyroxin beeinträchtigen.[70]

Agyr (A), Ciloxan (D, A, CH), Ciprobay (D), Ciproxin (A, CH), InfectoCipro (D), Keciflox (D), Otanol (A), Panotile Cipro (D), Quinox (T) zahlreiche Generika (D, A, CH)

Ciproxin HC (CH) [95][96][97]

Ciprofloxacin is an antibiotic used to treat a number of bacterial infections.[2] This includes bone and joint infections, intra abdominal infections, certain type of infectious diarrhea, respiratory tract infections, skin infections, typhoid fever, and urinary tract infections, among others.[2] For some infections it is used in addition to other antibiotics.[2] It can be taken by mouth, as eye drops, as ear drops, or intravenously.[2][3]

Common side effects include nausea, vomiting, diarrhea and rash.[2] Ciprofloxacin increases the risk of tendon rupture.[2] In people with myasthenia gravis, there is worsening muscle weakness.[2] Rates of side effects appear to be higher than some groups of antibiotics such as cephalosporins but lower than others such as clindamycin.[4] Studies in other animals raise concerns regarding use in pregnancy.[5] No problems were identified, however, in the children of a small number of women who took the medication.[5] It appears to be safe during breastfeeding.[2] It is a second-generation fluoroquinolone with a broad spectrum of activity that usually results in the death of the bacteria.[2][6][7]

Ciprofloxacin was patented in 1980 and introduced in 1987.[8][9] It is on the World Health Organization’s List of Essential Medicines, the most effective and safe medicines needed in a health system.[10] It is available as a generic medication and is not very expensive.[2][11] The wholesale cost in the developing world is between US$0.03 and US$0.13 a dose.[12] In the United States it is sold for about US$0.40 per dose.[2] In 2016 it was the 102nd most prescribed medication in the United States with more than seven million prescriptions.[13]

Ciprofloxacin is used to treat a wide variety of infections, including infections of bones and joints, endocarditis, gastroenteritis, malignant otitis externa, respiratory tract infections, cellulitis, urinary tract infections, prostatitis, anthrax, and chancroid.[2]
ciprofloxacin 500 mg drug study

Ciprofloxacin only treats bacterial infections; it does not treat viral infections such as the common cold. For certain uses including acute sinusitis, lower respiratory tract infections and uncomplicated gonorrhea, ciprofloxacin is not considered a first-line agent.

Ciprofloxacin occupies an important role in treatment guidelines issued by major medical societies for the treatment of serious infections, especially those likely to be caused by Gram-negative bacteria, including Pseudomonas aeruginosa. For example, ciprofloxacin in combination with metronidazole is one of several first-line antibiotic regimens recommended by the Infectious Diseases Society of America for the treatment of community-acquired abdominal infections in adults.[14] It also features prominently in treatment guidelines for acute pyelonephritis, complicated or hospital-acquired urinary tract infection, acute or chronic prostatitis,[15] certain types of endocarditis,[16] certain skin infections,[17] and prosthetic joint infections.[18]

In other cases, treatment guidelines are more restrictive, recommending in most cases that older, narrower-spectrum drugs be used as first-line therapy for less severe infections to minimize fluoroquinolone-resistance development. For example, the Infectious Diseases Society of America recommends the use of ciprofloxacin and other fluoroquinolones in urinary tract infections be reserved to cases of proven or expected resistance to narrower-spectrum drugs such as nitrofurantoin or trimethoprim/sulfamethoxazole.[19] The European Association of Urology recommends ciprofloxacin as an alternative regimen for the treatment of uncomplicated urinary tract infections, but cautions that the potential for “adverse events have to be considered”.[15]

Although approved by regulatory authorities for the treatment of respiratory infections, ciprofloxacin is not recommended for respiratory infections by most treatment guidelines due in part to its modest activity against the common respiratory pathogen Streptococcus pneumoniae.[20][21][22] “Respiratory quinolones” such as levofloxacin, having greater activity against this pathogen, are recommended as first line agents for the treatment of community-acquired pneumonia in patients with important co-morbidities and in patients requiring hospitalization (Infectious Diseases Society of America 2007). Similarly, ciprofloxacin is not recommended as a first-line treatment for acute sinusitis.[23][24]

Ciprofloxacin is approved for the treatment of gonorrhea in many countries, but this recommendation is widely regarded as obsolete due to resistance development.[25][26][27]

In the United States ciprofloxacin is pregnancy category C.[28] This category includes drugs for which no adequate and well-controlled studies in human pregnancy exist, and for which animal studies have suggested the potential for harm to the fetus, but potential benefits may warrant use of the drug in pregnant women
despite potential risks. An expert review of published data on experiences with ciprofloxacin use during pregnancy by the Teratogen Information System concluded therapeutic doses during
pregnancy are unlikely to pose a substantial teratogenic risk (quantity and quality of data=fair), but the data are insufficient to state no risk exists.[29] Exposure to quinolones, including levofloxacin, during the first-trimester is not associated with an increased risk of stillbirths, premature births, birth defects, or low birth weight.[30]

Two small post-marketing epidemiology studies of mostly short-term, first-trimester exposure found that fluoroquinolones did not increase risk of major malformations, spontaneous abortions, premature birth, or low birth weight.[31][32] The label notes, however, that these studies are insufficient to reliably evaluate the definitive safety or risk of less common defects by ciprofloxacin in pregnant women and their developing fetuses.

Fluoroquinolones have been reported as present in a mother’s milk and thus passed on to the nursing child.[33][34] The U.S. FDA recommends that because of the risk of serious adverse reactions (including articular damage) in infants nursing from mothers taking ciprofloxacin, a decision should be made whether to discontinue nursing or discontinue the drug, taking into account the importance of the drug to the mother.

Oral and intravenous ciprofloxacin are approved by the FDA for use in children for only two indications due to the risk of permanent injury to the musculoskeletal system:

1) Inhalational anthrax (postexposure)[35]

2) Complicated urinary tract infections and pyelonephritis due to Escherichia coli,[36] but never as first-line agents. Current recommendations by the American Academy of Pediatrics note the systemic use of ciprofloxacin in children should be restricted to infections caused by multidrug-resistant pathogens or when no safe or effective alternatives are available.[37]

Its spectrum of activity includes most strains of bacterial pathogens responsible for community-acquired pneumonias, bronchitis, urinary tract infections, and gastroenteritis.[38] Ciprofloxacin is particularly effective against Gram-negative bacteria (such as Escherichia coli, Haemophilus influenzae, Klebsiella pneumoniae, Legionella pneumophila, Moraxella catarrhalis, Proteus mirabilis, and Pseudomonas aeruginosa), but is less effective against Gram-positive bacteria (such as methicillin-sensitive Staphylococcus aureus, Streptococcus pneumoniae, and Enterococcus faecalis) than newer fluoroquinolones.[39]

As a result of its widespread use to treat minor infections readily treatable with older, narrower spectrum antibiotics, many bacteria have developed resistance to this drug in recent years, leaving it significantly less effective than it would have been otherwise.[40][41]

Resistance to ciprofloxacin and other fluoroquinolones may evolve rapidly, even during a course of treatment. Numerous pathogens, including enterococci, Streptococcus pyogenes and Klebsiella pneumoniae (quinolone-resistant) now exhibit resistance.[42] Widespread veterinary usage of the fluoroquinolones, particularly in Europe, has been implicated.[43] Meanwhile, some Burkholderia cepacia, Clostridium innocuum and Enterococcus faecium strains have developed resistance to ciprofloxacin to varying degrees.[44]

Fluoroquinolones had become the class of antibiotics most commonly prescribed to adults in 2002.[45] Nearly half (42%) of those prescriptions in the U.S. were for conditions not approved by the FDA, such as acute bronchitis, otitis media, and acute upper respiratory tract infection, according to a study supported in part by the Agency for Healthcare Research and Quality.[45] Additionally, they were commonly prescribed for medical conditions that were not even bacterial to begin with, such as viral infections, or those to which no proven benefit existed.

Contraindications include:[46]

Ciprofloxacin is also considered to be contraindicated in children (except for the indications outlined above), in pregnancy, to nursing mothers, and in people with epilepsy or other seizure disorders.

Adverse effects can involve the tendons, muscles, joints, nerves, and the central nervous system.[47][48]

Rates of adverse effects appear to be higher than with some groups of antibiotics such as cephalosporins but lower than with others such as clindamycin.[4] Compared to other antibiotics some studies find a higher rate of adverse effects[49][50] while others find no difference.[51]

In clinical trials most of the adverse events were described as mild or moderate in severity, abated soon after the drug was discontinued, and required no treatment.[28] Some adverse effects may be permanent.[47] Ciprofloxacin was stopped because of an adverse event in 1% of people treated with the medication by mouth. The most frequently reported drug-related events, from trials of all formulations, all dosages, all drug-therapy durations, and for all indications, were nausea (2.5%), diarrhea (1.6%), abnormal liver function tests (1.3%), vomiting (1%), and rash (1%). Other adverse events occurred at rates of <1%.[52]

Ciprofloxacin includes a black box warning in the United States of an increased risk of tendinitis and tendon rupture, especially in people who are older than 60 years, people who also use corticosteroids, and people with kidney, lung, or heart transplants.[53] Tendon rupture can occur during therapy or even months after discontinuation of the medication.[54] One study found that fluoroquinolone use was associated with a 1.9-fold increase in tendon problems. The risk increased to 3.2 in those over 60 years of age and to 6.2 in those over the age of 60 who were also taking corticosteroids. Among the 46,766 quinolone users in the study, 38 (0.08%) cases of Achilles tendon rupture were identified.[55]

The fluoroquinolones, including ciprofloxacin, are associated with an increased risk of cardiac toxicity, including QT interval prolongation, torsades de pointes, ventricular arrhythmia, and sudden death. [56][57]

The 2013 FDA label warns of nervous system effects. Ciprofloxacin, like other fluoroquinolones, is known to trigger seizures or lower the seizure threshold, and may cause other central nervous system adverse effects. Headache, dizziness, and insomnia have been reported as occurring fairly commonly in postapproval review articles, along with a much lower incidence of serious CNS adverse effects such as tremors, psychosis, anxiety, hallucinations, paranoia, and suicide attempts, especially at higher doses.[4] Like other fluoroquinolones, it is also known to cause peripheral neuropathy that may be irreversible, such as weakness, burning pain, tingling or numbness.[58]

Ciprofloxacin is active in six of eight in vitro assays used as rapid screens for the detection of genotoxic effects, but is not active in in vivo assays of genotoxicity.[28] Long-term carcinogenicity studies in rats and mice resulted in no carcinogenic or tumorigenic effects due to ciprofloxacin at daily oral dose levels up to 250 and 750 mg/kg to rats and mice, respectively (about 1.7 and 2.5 times the highest recommended therapeutic dose based upon mg/m2). Results from photo co-carcinogenicity testing indicate ciprofloxacin does not reduce the time to appearance of UV-induced skin tumors as compared to vehicle control.[citation needed]

The other black box warning is that ciprofloxacin should not be used in people with myasthenia gravis due to possible exacerbation of muscle weakness which may lead to breathing problems resulting in death or ventilator support. Fluoroquinolones are known to block neuromuscular transmission.[28] There are concerns that fluoroquinolones including ciprofloxacin can affect cartilage in young children.[59]

Clostridium difficile-associated diarrhea is a serious adverse effect of ciprofloxacin and other fluoroquinolones; it is unclear whether the risk is higher than with other broad-spectrum antibiotics.[60]

A wide range of rare but potentially fatal adverse effects reported to the U.S. FDA or the subject of case reports includes aortic dissection,[61] toxic epidermal necrolysis, Stevens-Johnson syndrome, low blood pressure, allergic pneumonitis, bone marrow suppression, hepatitis or liver failure, and sensitivity to light.[28][62] The medication should be discontinued if a rash, jaundice, or other sign of hypersensitivity occurs.[28]

Children and the elderly are at a much greater risk of experiencing adverse reactions.[63][64]

Overdose of ciprofloxacin may result in reversible renal toxicity. Treatment of overdose includes emptying of the stomach by induced vomiting or gastric lavage, as well as administration of antacids containing magnesium, aluminum, or calcium to reduce drug absorption. Renal function and urinary pH should be monitored. Important support includes adequate hydration and urine acidification if necessary to prevent crystalluria. Hemodialysis or peritoneal dialysis can only remove less than 10% of ciprofloxacin.[65] Ciprofloxacin may be quantified in plasma or serum to monitor for drug accumulation in patients with hepatic dysfunction or to confirm a diagnosis of poisoning in acute overdose victims.[66]

Ciprofloxacin interacts with certain foods and several other drugs leading to undesirable increases or decreases in the serum levels or distribution of one or both drugs.

Ciprofloxacin should not be taken with antacids containing magnesium or aluminum, highly buffered drugs (sevelamer, lanthanum carbonate, sucralfate, didanosine), or with supplements containing calcium, iron, or zinc. It should be taken two hours before or six hours after these products. Magnesium or aluminum antacids turn ciprofloxacin into insoluble salts that are not readily absorbed by the intestinal tract, reducing peak serum concentrations by 90% or more, leading to therapeutic failure. Additionally, it should not be taken with dairy products or calcium-fortified juices alone, as peak serum concentration and the area under the serum concentration-time curve can be reduced up to 40%. However, ciprofloxacin may be taken with dairy products or calcium-fortified juices as part of a meal.[65][67][68]

Ciprofloxacin inhibits the drug-metabolizing enzyme CYP1A2 and thereby can reduce the clearance of drugs metabolized by that enzyme. CYP1A2 substrates that exhibit increased serum levels in ciprofloxacin-treated patients include tizanidine, theophylline, caffeine, methylxanthines, clozapine, olanzapine, and ropinirole. Co-administration of ciprofloxacin with the CYP1A2 substrate tizanidine (Zanaflex) is contraindicated due to a 583% increase in the peak serum concentrations of tizanidine when administered with ciprofloxacin as compared to administration of tizanidine alone. Use of ciprofloxacin is cautioned in patients on theophylline due to its narrow therapeutic index. The authors of one review recommended that patients being treated with ciprofloxacin reduce their caffeine intake. Evidence for significant interactions with several other CYP1A2 substrates such as cyclosporine is equivocal or conflicting.[68][69][70]

The Committee on Safety of Medicines and the FDA warn that central nervous system adverse effects, including seizure risk, may be increased when NSAIDs are combined with quinolones.[69][71] The mechanism for this interaction may involve a synergistic increased antagonism of GABA neurotransmission.[72][73]

Altered serum levels of the antiepileptic drugs phenytoin and carbamazepine (increased and decreased) have been reported in patients receiving concomitant ciprofloxacin.[69][74][75]

Ciprofloxacin is a potent inhibitor of CYP1A2, CYP2D6, and CYP3A4.[76]

ciprofloxacin 500 mg drug study

Ciprofloxacin is a broad-spectrum antibiotic of the fluoroquinolone class. It is active against both Gram-positive and Gram-negative bacteria. It functions by inhibiting DNA gyrase, and a type II topoisomerase, topoisomerase IV,[77][78] necessary to separate bacterial DNA, thereby inhibiting cell division.

Ciprofloxacin for systemic administration is available as immediate-release tablets, extended-release tablets, an oral suspension, and as a solution for intravenous administration.
When administered over one hour as an intravenous infusion,[28] ciprofloxacin rapidly distributes into the tissues, with levels in some tissues exceeding those in the serum. Penetration into the central nervous system is relatively modest, with cerebrospinal fluid levels normally less than 10% of peak serum concentrations. The serum half-life of ciprofloxacin is about 4–6 hours, with 50-70% of an administered dose being excreted in the urine as unmetabolized drug. An additional 10% is excreted in urine as metabolites. Urinary excretion is virtually complete 24 hours after administration. Dose adjustment is required in the elderly and in those with renal impairment.[citation needed]

Ciprofloxacin is weakly bound to serum proteins (20-40%), but is an inhibitor of the drug-metabolizing enzyme cytochrome P450 1A2, which leads to the potential for clinically important drug interactions with drugs metabolized by that enzyme.[medical citation needed]

Ciprofloxacin is about 70% orally available when administered orally, so a slightly higher dose is needed to achieve the same exposure when switching from IV to oral administration[28]

The extended release oral tablets[79] allow once-daily administration by releasing the drug more slowly in the gastrointestinal tract. These tablets contain 35% of the administered dose in an immediate-release form and 65% in a slow-release matrix. Maximum serum concentrations are achieved between 1 and 4 hours after administration. Compared to the 250- and 500-mg immediate-release tablets, the 500-mg and 1000-mg XR tablets provide higher Cmax, but the 24‑hour AUCs are equivalent.

Ciprofloxacin immediate-release tablets contain ciprofloxacin as the hydrochloride salt, and the XR tablets contain a mixture of the hydrochloride salt as the free base.[citation needed]

Ciprofloxacin is 1-cyclopropyl-6-fluoro-1,4-dihydro-4-oxo-7-(1-piperazinyl)-3-quinolinecarboxylic acid. Its empirical formula is C17H18FN3O3 and its molecular weight is 331.4 g/mol. It is a faintly yellowish to light yellow crystalline substance.[65]

Ciprofloxacin hydrochloride (USP) is the monohydrochloride monohydrate salt of ciprofloxacin. It is a faintly yellowish to light yellow crystalline substance with a molecular weight of 385.8 g/mol. Its empirical formula is C17H18FN3O3HCl•H2O.[65]

Ciprofloxacin is the most widely used of the second-generation quinolones.[80][81] In 2010, over 20 million prescriptions were written, making it the 35th-most commonly prescribed generic drug and the 5th-most commonly prescribed antibacterial in the U.S.[82]

The first members of the quinolone antibacterial class were relatively low-potency drugs such as nalidixic acid, used mainly in the treatment of urinary tract infections owing to their renal excretion and propensity to be concentrated in urine.[83] In 1979, the publication of a patent[84] filed by the pharmaceutical arm of Kyorin Seiyaku Kabushiki Kaisha disclosed the discovery of norfloxacin, and the demonstration that certain structural modifications including the attachment of a fluorine atom to the quinolone ring leads to dramatically enhanced antibacterial potency.[85] In the aftermath of this disclosure, several other pharmaceutical companies initiated research and development programs with the goal of discovering additional antibacterial agents of the fluoroquinolone class.

The fluoroquinolone program at Bayer focused on examining the effects of very minor changes to the norfloxacin structure.[86][87] In 1983, the company published in vitro potency data for ciprofloxacin, a fluoroquinolone antibacterial having a chemical structure differing from that of norfloxacin by the presence of a single carbon atom.[88] This small change led to a two- to 10-fold increase in potency against most strains of Gram-negative bacteria. Importantly, this structural change led to a four-fold improvement in activity against the important Gram-negative pathogen Pseudomonas aeruginosa, making ciprofloxacin one of the most potent known drugs for the treatment of this intrinsically antibiotic-resistant pathogen.[medical citation needed]

The oral tablet form of ciprofloxacin was approved in October 1987,[89] just one year after the approval of norfloxacin.[90] In 1991, the intravenous formulation was introduced. Ciprofloxacin sales reached a peak of about 2 billion euros in 2001, before Bayer’s patent expired in 2004, after which annual sales have averaged around €200 million.[91][92]

The name probably originates from the International Scientific Nomenclature: ci- (alteration of cycl-) + propyl + fluor- + ox- + az- + -mycin.[93]

It is available as a generic medication and not very expensive.[2][11] Wholesale it costs between US$0.03 and US$0.13 a dose.[12] In the United States it is sold for about US$0.40 per dose.[2]

On 24 October 2001, the Prescription Access Litigation (PAL) project filed suit to dissolve an agreement between Bayer and three of its competitors which produced generic versions of drugs (Barr Laboratories, Rugby Laboratories, and Hoechst-Marion-Roussel) that PAL claimed was blocking access to adequate supplies and cheaper, generic versions of ciprofloxacin. The plaintiffs charged that Bayer Corporation, a unit of Bayer AG, had unlawfully paid the three competing companies a total of $200 million to prevent cheaper, generic versions of ciprofloxacin from being brought to the market, as well as manipulating its price and supply. Numerous other consumer advocacy groups joined the lawsuit. On 15 October 2008, five years after Bayer’s patent had expired, the United States District Court for the Eastern District of New York granted Bayer’s and the other defendants’ motion for summary judgment, holding that any anticompetitive effects caused by the settlement agreements between Bayer and its codefendants were within the exclusionary zone of the patent and thus could not be redressed by federal antitrust law,[94] in effect upholding Bayer’s agreement with its competitors.

Ciprofloxacin for systemic administration is available as immediate-release tablets, as extended-release tablets, as an oral suspension, and as a solution for intravenous infusion. It is also available for local administration as eye drops and ear drops.

A class action was filed against Bayer AG on behalf of employees of the Brentwood Post Office in Washington, D.C., and workers at the U.S. Capitol, along with employees of American Media, Inc. in Florida and postal workers in general who alleged they suffered serious adverse effects from taking ciprofloxacin in the aftermath of the anthrax attacks in 2001. The action alleged Bayer failed to warn class members of the potential side effects of the drug, thereby violating the Pennsylvania Unfair Trade Practices and Consumer Protection Laws. The class action was defeated and the litigation abandoned by the plaintiffs.[95] A similar action was filed in 2003 in New Jersey by four New Jersey postal workers but was withdrawn for lack of grounds, as workers had been informed of the risks of ciprofloxacin when they were given the option of taking the drug.[96][97]

As resistance to ciprofloxacin has grown, research has been conducted to discover and develop analogs that can be effective against resistant bacteria; some have been looked at in antiviral models as well.[98]

Ciprofloxacin is a second generation fluoroquinolone that has spawned many derivative antibiotics.9 It is formulated for oral, intravenous, intratympanic, ophthalmic, and otic administration for a number of bacterial infections.18,19,20,21,22,23,24,25,26

The first ciprofloxacin containing product was FDA approved on 22 October 1987.17

A unique ID assigned by the FDA when a product is submitted for approval by the labeller.

A governmentally-recognized ID which uniquely identifies the product within its regulatory market.

A unique ID assigned by the FDA when a product is submitted for approval by the labeller.ciprofloxacin 500 mg drug study

A governmentally-recognized ID which uniquely identifies the product within its regulatory market.

Ciprofloxacin is only indicated in infections caused by susceptible bacteria.18,19,20,21,22,23,24,25,26

Ciprofloxacin immediate release tablets, oral suspensions, and intravenous injections are indicated for the treatment of skin and skin structure infections, bone and joint infections, complicated intra-abdominal infections, nosocomial pneumonia, febrile neutropenia, adults who have inhaled anthrax, plague, chronic bacterial prostatitis, lower respiratory tract infections including acute exacerbations of chronic bronchitis, urinary tract infections, complicated urinary tract infections in pediatrics, complicated pyelonephritis in pediatrics, and acute sinusitis.22,21

A ciprofloxacin otic solution and otic suspension with hydrocortisone are indicated for acute otitis externa.18,23 Ciprofloxacin suspension with dexamethasone is indicated for acute otitis media in pediatric patients with tympanostomy tubes or acute otitis externa.25 A ciprofloxacin intratympanic injection is indicated for pediatric patients with bilateral otitis media with effusion who are having tympanostomy tubes placed or pediatric patients 6 months or older with acute otitis externa.26

A ciprofloxacin eye drop is indicated for bacterial corneal ulcers and conjunctivitis.19 A ciprofloxacin eye ointment is indicated for bacterial conjunctivitis.20

A ciprofloxacin extended release tablet is indicated for uncomplicated urinary tract infections, complicated urinary tract infections, and acute uncomplicated pyelonephritis.24

Ciprofloxacin is a second generation fluoroquinolone that is active against many Gram negative and Gram positive bacteria.9,18,19,20,21,22,23,24,25,26 It produces its action through inhibition of bacterial DNA gyrase and topoisomerase IV.12 Ciprofloxacin binds to bacterial DNA gyrase with 100 times the affinity of mammalian DNA gryase.13 There is no cross resistance between fluoroquinolones and other classes of antibiotics, so it may be of clinical value when other antibiotics are no longer effective.13 Ciprofloxain and its derivatives are also being investigated for its action against malaria, cancers, and AIDS.12

Ciprofloxacin acts on bacterial topoisomerase II (DNA gyrase) and topoisomerase IV.12 Ciprofloxacin’s targeting of the alpha subunits of DNA gyrase prevents it from supercoiling the bacterial DNA which prevents DNA replication.10,11

Comprehensive structured data on known drug adverse effects with statistical prevalence. MedDRA and ICD10 ids are provided for adverse effect conditions and symptoms.

Structured data covering drug contraindications. Each contraindication describes a scenario in which the drug is not to be used. Includes restrictions on co-administration, contraindicated populations, and more.

Structured data representing warnings from the black box section of drug labels. These warnings cover important and dangerous risks, contraindications, or adverse effects.

A 250mg oral dose of ciprofloxacin reaches an average maximum concentration of 0.94mg/L in 0.81 hours with an average area under the curve of 1.013L/h*kg.8 The FDA reports an oral bioavailability of 70-80%Label,1 while other studies report it to be approximately 60%.8 An early review of ciprofloxacin reported an oral bioavailability of 64-85% but recommends 70% for all practical uses.10

Cirpofloxacin follws a 3 compartment distribution model with a central compartment volume of 0.161L/kg8 and a total volume of distribution of 2.00-3.04L/kg.10

20-40%.Label,10

Ciprofloxacin is primarily metabolized by CYP1A2.22 The primary metabolites oxociprofloxacin and sulociprofloxacin make up 3-8% of the total dose each.24 Ciprofloxacin is also converted to the minor metabolites desethylene ciprofloxacin and formylciprofloxacin.24 These 4 metabolites account for 15% of a total oral dose.22

There is a lack of available data on the enzymes and types of reactions involved in forming these metabolites.2,3,4,5

27% of an oral dose was recovered unmetabolized in urine compared to 46% of an intravenous dose.8 Collection of radiolabelled ciprofloxacin resulted in 45% recovery in urine and 62% recovery in feces.10

The average half life following a 250mg oral dose was 4.71 hours and 3.65 hours following a 100mg intravenous dose.8 Generally the half life is reported as 4 hours.Label,8

The average renal clearance after a 250mg oral dose is 5.08mL/min*kg.8 Following a 100mg intravenous dose, the average total clearance is 9.62mL/min*kg, average renal clearance is 4.42mL/min*kg, and average non renal clearance is 5.21mL/min*kg.8

Patients experiencing an overdose may present with nausea, vomiting, abdominal pain, crystalluria, nephrotoxicity, and oliguria.14,15,16 Ciprofloxacin overdose typically leads to acute renal failure.16 An overdose may progress over the next 6 days with rising serum creatinine and BUN, as well as anuria.15 Patients may require prednisone therapy, urgent hemodialysis, or supportive therapy.14,16 Depending on the degree of overdose, patients may recover normal kidney function or progress to chronic kidney failure.16

The oral LD50 in rats is >2000mg/kg.27

Ciprofloxacin for intratympanic injection or otic use has low systemic absorption and so it unlikely to be a risk in pregnancy or lactation.26 There is generally no harm to the fetus in animal studies, however high doses may lead to gastrointestinal disturbances in the mother which may increase the incidence of abortion.25,19,23,20 In human studies there was no increase in fetal malformations above background rates.21,22 The risk and benefit of ciprofloxacin should be weighed in pregnancy and breast feeding.25,19,23,21,22,24,20,18

2/8 in vitro tests and 0/3 in vivo tests of mutagenicity of ciprofloxacin have yielded a positive result.26,25,19,23,21,22,24,20,18

Oral doses of 200 and 300 times the maximum recommended clinical dose in rats and mice have shown no carcinogenicity or tumorigenicity.26,19,23,21,22,24,20,18

Oral doses above the maximum recommended clinical dose have shown no effects on fertility in rats.26,23,21,22,24,20,18

Extended description of the mechanism of action and particular properties of each drug interaction.

A severity rating for each drug interaction, from minor to major.

A rating for the strength of the evidence supporting each drug interaction.

An effect category for each drug interaction. Know how this interaction affects the subject drug.

The date on which a patent was filed with the relevant government.

There is additional data available for commercial users including Adverse Effects, Contraindications, and Blackbox Warnings. Contact us to learn more about these and other features.

Drug created on June 13, 2005 07:24 / Updated on August 14, 2019 10:48

Taking ciprofloxacin increases the risk that you will develop tendinitis (swelling of a fibrous tissue that connects a bone to a muscle) or have a tendon rupture (tearing of a fibrous tissue that connects a bone to a muscle) during your treatment or for up to several months afterward. These problems may affect tendons in your shoulder, your hand, the back of your ankle, or in other parts of your body. Tendinitis or tendon rupture may happen to people of any age, but the risk is highest in people over 60 years of age. Tell your doctor if you have or have ever had a kidney, heart, or lung transplant; kidney disease; a joint or tendon disorder such as rheumatoid arthritis (a condition in which the body attacks its own joints, causing pain, swelling, and loss of function); or if you participate in regular physical activity. Tell your doctor and pharmacist if you are taking oral or injectable steroids such as dexamethasone, methylprednisolone (Medrol), or prednisone (Rayos). If you experience any of the following symptoms of tendinitis, stop taking ciprofloxacin, rest, and call your doctor immediately: pain, swelling, tenderness, stiffness, or difficulty in moving a muscle. If you experience any of the following symptoms of tendon rupture, stop taking ciprofloxacin and get emergency medical treatment: hearing or feeling a snap or pop in a tendon area, bruising after an injury to a tendon area, or inability to move or to bear weight on an affected area.

Taking ciprofloxacin may cause changes in sensation and nerve damage that may not go away even after you stop taking ciprofloxacin. This damage may occur soon after you begin taking ciprofloxacin. Tell your doctor if you have ever had peripheral neuropathy (a type of nerve damage that causes tingling, numbness, and pain in the hands and feet). If you experience any of the following symptoms, stop taking ciprofloxacin and call your doctor immediately: numbness, tingling, pain, burning, or weakness in the arms or legs; or a change in your ability to feel light touch, vibrations, pain, heat, or cold.

Taking ciprofloxacin may affect your brain or nervous system and cause serious side effects. This can occur after the first dose of ciprofloxacin. Tell your doctor if you have or have ever had seizures, epilepsy, cerebral arteriosclerosis (narrowing of blood vessels in or near the brain that can lead to stroke or ministroke), stroke, changed brain structure, or kidney disease. If you experience any of the following symptoms, stop taking ciprofloxacin and call your doctor immediately: seizures; tremors; dizziness; lightheadedness; headaches that won’t go away (with or without blurred vision); difficulty falling asleep or staying asleep; nightmares; not trusting others or feeling that others want to hurt you; hallucinations (seeing things or hearing voices that do not exist); thoughts or actions towards hurting or killing yourself; feeling restless, anxious, nervous, depressed, memory changes, or confused, or other changes in your mood or behavior.

Taking ciprofloxacin may worsen muscle weakness in people with myasthenia gravis (a disorder of the nervous system that causes muscle weakness) and cause severe difficulty breathing or death. Tell your doctor if you have myasthenia gravis. Your doctor may tell you not to take ciprofloxacin. If you have myasthenia gravis and your doctor tells you that you should take ciprofloxacin, call your doctor immediately if you experience muscle weakness or difficulty breathing during your treatment.

Talk to your doctor about the risks of taking ciprofloxacin.

ciprofloxacin 500 mg drug study

Your doctor or pharmacist will give you the manufacturer’s patient information sheet (Medication Guide) when you begin treatment with ciprofloxacin. Read the information carefully and ask your doctor or pharmacist if you have any questions. You can also visit the Food and Drug Administration (FDA) website (http://www.fda.gov/Drugs) or the manufacturer’s website to obtain the Medication Guide.

Ciprofloxacin is used to treat or prevent certain infections caused by bacteria such as pneumonia; gonorrhea (a sexually transmitted disease); typhoid fever (a serious infection that is common in developing countries); infectious diarrhea (infections that cause severe diarrhea); and infections of the skin, bone, joint, abdomen (stomach area), and prostate (male reproductive gland), Ciprofloxacin is also used to treat or prevent plague (a serious infection that may be spread on purpose as part of a bioterror attack) and inhalation anthrax (a serious infection that may be spread by anthrax germs in the air on purpose as part of a bioterror attack). Ciprofloxacin may also be used to treat bronchitis, sinus infections, or urinary tract infections but should not be used for bronchitis and sinus infections, or certain types of urinary tract infections if there are other treatment options. Ciprofloxacin extended-release (long-acting) tablets are used to treat kidney and urinary tract infections; however, some types of urinary tract infections should only be treated with ciprofloxacin extended release tablets if no other treatment options are available. Ciprofloxacin is in a class of antibiotics called fluoroquinolones. It works by killing bacteria that cause infections.

Antibiotics such as ciprofloxacin will not work for colds, flu, or other viral infections. Using antibiotics when they are not needed increases your risk of getting an infection later that resists antibiotic treatment.

Ciprofloxacin comes as a tablet, a suspension (liquid), and an extended-release tablet to take by mouth with or without food. The tablets and suspension are usually taken twice a day, and the extended-release tablets are usually taken once a day. When used to treat gonorrhea, the tablets and suspension may be given as a single dose. Take ciprofloxacin at around the same time(s) every day. The length of your treatment depends on the type of infection you have. Your doctor will tell you how long to take ciprofloxacin. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take ciprofloxacin exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor.

One type of ciprofloxacin cannot be substituted for another. Be sure that you receive only the type of ciprofloxacin that was prescribed by your doctor. Ask your pharmacist if you have any questions about the type of ciprofloxacin you were given.

Do not take ciprofloxacin with dairy products or calcium-fortified juices alone. However, you may take ciprofloxacin with a meal that includes these foods or drinks.

Swallow the tablets and extended-release tablets whole; do not split, crush, or chew them. If you cannot swallow tablets whole, tell your doctor.

If you are taking the suspension, shake the bottle very well for 15 seconds before each use to mix the medication evenly. Swallow the correct dose without chewing the granules in the suspension. Close the bottle completely after each use. Do not give the suspension to a patient through a feeding tube.

You should begin feeling better during the first few days of your treatment with ciprofloxacin. If your symptoms do not improve or if they get worse, call your doctor. If you are being treated for a urinary tract infection, call your doctor if you develop fever or back pain during or after your treatment. These symptoms may be signs that your infection is worsening.

Take ciprofloxacin until you finish the prescription, even if you feel better. Do not stop taking ciprofloxacin without talking to your doctor unless you experience certain serious side effects listed in the IMPORTANT WARNING and SIDE EFFECTS sections If you stop taking ciprofloxacin too soon or if you skip doses, your infection may not be completely treated and the bacteria may become resistant to antibiotics.

In the event of biological warfare, ciprofloxacin may be used to treat and prevent dangerous illnesses that are deliberately spread such as tularemia and anthrax of the skin or mouth. Ciprofloxacin is also sometimes used to treat cat scratch disease (an infection that may develop after a person is bitten or scratched by a cat), Legionnaires’ disease (type of lung infection), chancroid (genital sores caused by bacteria), granuloma inguinale (donovanosis; a sexually transmitted disease), and infections of the outer ear that spread to the bones of the face. Ciprofloxacin may also be used to help treat tuberculosis and Crohn’s disease (condition in which the immune system attacks the lining of the digestive tract causing pain, diarrhea, weight loss, and fever). Ciprofloxacin is also sometimes used to prevent traveler’s diarrhea in certain patients and to prevent infections in patients who have fever and are at high risk for infection because they have very few white blood cells, people who are having certain types of surgery, and those people in close contact with someone who is sick with meningitis. Talk to your doctor about the risks of using this medication for your condition.

This medication may be prescribed for other uses; ask your doctor or pharmacist for more information.

Do not drink or eat a lot of caffeine-containing products such as coffee, tea, energy drinks, cola, or chocolate. Ciprofloxacin may increase nervousness, sleeplessness, heart pounding, and anxiety caused by caffeine.

Make sure you drink plenty of water or other fluids every day while you are taking ciprofloxacin.

If you miss a dose of ciprofloxacin, take the missed dose as soon as you remember it. However, if it is almost time for the next dose, skip the missed dose and continue your regular dosing schedule. Do not take a double dose to make up for a missed one. Do not take more than two doses of the tablets or suspension or more than one dose of the extended-release tablets in one day.

Ciprofloxacin may cause problems with bones, joints, and tissues around joints in children. Ciprofloxacin should not normally be given to children younger than 18 years of age unless they have certain serious infections that cannot be treated with other antibiotics or they have been exposed to plague or anthrax in the air. If your doctor prescribes ciprofloxacin for your child, be sure to tell the doctor if your child has or has ever had joint-related problems. Call your doctor if your child develops joint problems such as pain or swelling while taking ciprofloxacin or after treatment with ciprofloxacin.

Talk to your doctor about the risks of taking ciprofloxacin or giving ciprofloxacin to your child.

Ciprofloxacin may cause other side effects. Call your doctor if you have any unusual problems while taking this medication.

If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration’s (FDA) MedWatch Adverse Event Reporting program online (http://www.fda.gov/Safety/MedWatch) or by phone (1-800-332-1088).

Keep this medication in the container it came in, tightly closed, and out of reach of children. Store the tablets and extended-release tablets at room temperature and away from excess heat and moisture (not in the bathroom). Store the suspension in the refrigerator or at room temperature, closed tightly, for up to 14 days. Do not freeze ciprofloxacin suspension. Discard any suspension that is left over after 14 days.

It is important to keep all medication out of sight and reach of children as many containers (such as weekly pill minders and those for eye drops, creams, patches, and inhalers) are not child-resistant and young children can open them easily. To protect young children from poisoning, always lock safety caps and immediately place the medication in a safe location – one that is up and away and out of their sight and reach. http://www.upandaway.org

Unneeded medications should be disposed of in special ways to ensure that pets, children, and other people cannot consume them. However, you should not flush this medication down the toilet. Instead, the best way to dispose of your medication is through a medicine take-back program. Talk to your pharmacist or contact your local garbage/recycling department to learn about take-back programs in your community. See the FDA’s Safe Disposal of Medicines website (http://goo.gl/c4Rm4p) for more information if you do not have access to a take-back program.

In case of overdose, call the poison control helpline at 1-800-222-1222. Information is also available online at https://www.poisonhelp.org/help. If the victim has collapsed, had a seizure, has trouble breathing, or can’t be awakened, immediately call emergency services at 911.

Keep all appointments with your doctor and the laboratory. Your doctor may order certain lab tests to check your body’s response to ciprofloxacin. If you have diabetes, your doctor may ask you to check your blood sugar more often while taking ciprofloxacin.

Do not let anyone else take your medication. Your prescription is probably not refillable. If you still have symptoms of infection after you finish taking ciprofloxacin, call your doctor.

It is important for you to keep a written list of all of the prescription and nonprescription (over-the-counter) medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies.

¶ This branded product is no longer on the market. Generic alternatives may be available.

AHFS® Patient Medication Information™. © Copyright, 2019. The American Society of Health-System Pharmacists®, 4500 East-West Highway, Suite 900, Bethesda, Maryland. All Rights Reserved. Duplication for commercial use must be authorized by ASHP.

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ciprofloxacin 500 mg drug study

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For many people, Cipro is a safe treatment for a urinary tract infection or UTI. But it is not the only option.

The United States Foods and Drug Administration (FDA) warn doctors about prescribing Cipro to certain people, as there is a potential for serious side effects.

Understanding how Cipro works and its possible side effects can help a person make an informed choice about their UTI treatment.

Cipro is the brand name for ciprofloxacin, which is a type of antibiotic known as a fluoroquinolone.

Doctors use fluoroquinolones to treat a range of different bacterial infections. Which fluoroquinolone they prescribe depends on the underlying infection, and if the bacteria are resistant to a specific drug.

Fluoroquinolones work by interfering with the bacteria’s ability to replicate and grow, and so it kills the infection.

Doctors often prescribe Cipro for people with UTIs, as these infections are usually bacterial and respond well to this drug.

However, the FDA advises that the serious side effects may outweigh the benefits for patients with uncomplicated UTIs who have other treatment options.

When taking Cipro for a UTI, it is essential to follow the doctor or pharmacist’s instructions exactly. The drug is likely to come in the form of a take-home oral tablet or solution, and the treatment course typically lasts no longer than 7 days.

For an antibiotic to be most effective, a person should always complete the full course. Even if symptoms start to clear up, it is essential for people to finish all the medication to ensure they kill the infection completely.

People should never stop treatment early unless a doctor tells them to do so. Doing so may allow the infection to return and potentially be worse.

When taking Cipro or any other antibiotic for a UTI, drinking extra fluids and often urinating can help flush out the infection and speed up recovery.

Side effects are common with antibiotic, drugs such as Cipro. The most common side effects while taking Cipro include:

These common symptoms tend to be mild and clear up without treatment once a person stops taking Cipro.

Less common side effects, occurring in less than 1 percent of people, may include:

Rarely, Cipro can also cause a severe allergic reaction. Anyone who experiences any of the following symptoms should seek immediate medical care:

Fluoroquinolone antibiotics also have what is known as a boxed warning. This is the most serious warning from the FDA, and it means that the FDA consider the drug to be potentially dangerous in some capacity.

The boxed warning for Cipro is for two separate risks.

Firstly, Cipro may increase the risk of tendinitis and tendon rupture in people of all ages, which can lead to serious side effects, such as:

These symptoms may come on after just one or two doses and may last for years. It is unknown yet whether some of the symptoms and changes, especially nerve changes, are permanent.

The risk of tendinitis and tendon rupture is greater for people who are:

Secondly, fluoroquinolones may worsen muscle weakness in people who have myasthenia gravis.

People from these high-risk groups should not take Cipro.

It is also important to understand that several other antibiotics have similar side effects, though they may affect a person in slightly different ways.

A 2015 systematic review concluded that Cipro is a safe and effective drug for treating UTIs most of the time and that adverse events were lower than with other antimicrobial treatments.ciprofloxacin 500 mg drug study

However, adverse events are still possible and occur often enough for the FDA to release a warning that doctors should only use fluoroquinolones, such as Cipro, when no other treatment options are available.

Cipro may not be right when someone is pregnant. Anyone who is pregnant should discuss all their treatment options with a doctor before making a decision.

A person can pass Cipro on to a child through their breast milk. Women should either not take Cipro while breastfeeding or should stop breastfeeding while taking the drug.

People should always talk to a doctor to help find the best option in these situations.

It is possible for Cipro to interact with other drugs. These drugs may change the way Cipro works, which could be harmful or cause serious side effects.

There are many drugs that may interact with fluoroquinolones, such as Cipro, including:

Again, people must always discuss any current medications, vitamins, and supplements with a doctor before taking Cipro or another antibiotic.

The bacteria Escherichia coli cause most cases of UTIs.

A 2015 systematic review concluded that E. coli resistance to ciprofloxacin is increasing, and that the medical community should consider restricting the use of this antibiotic.

In other words, doctors may need to start looking at other methods for treating UTIs.

Other drugs that doctors may recommend for UTIs include:

However, some of these drugs may also have issues with bacterial resistance. Researchers are currently investigating new treatment options for UTIs and other bacterial infections, including combination drug therapy, vaccines, and small molecules that attack specific functions in the bacteria.

If a person suspects they have a UTI, they should see a doctor. While Cipro may be effective for many people with uncomplicated UTIs, some doctors may recommend other treatment options first.

Anyone who has concerns about taking Cipro, or any of its possible side effects, should discuss them with a doctor. By working directly with a doctor, most people can find the right solution for their UTI.

Article last reviewed by Fri 7 September 2018.Visit our Urinary Tract Infection category page for the latest news on this subject, or sign up to our newsletter to receive the latest updates on Urinary Tract Infection.All references are available in the References tab.

Anger, J., et al. (2019). Recurrent uncomplicated urinary tract infections in women: AUA/CUA/SUFU guideline (2019). https://www.auanet.org/guidelines/recurrent-uti

Fasugba, O., et al. (2015). Ciprofloxacin resistance in community-and hospital-acquired Escherichia coli urinary tract infections: A systematic review and meta-analysis of observational studies. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4660780/

FDA Drug Safety Communication: FDA advises restricting fluoroquinolone antibiotic use for certain uncomplicated infections; warns about disabling side effects that can occur together. (2016). https://www.fda.gov/Drugs/DrugSafety/ucm500143.htm

FDA drug safety communication: FDA updates warnings for oral and injectable fluoroquinolone antibiotics due to disabling side effects. (2018). https://www.fda.gov/Drugs/DrugSafety/ucm511530.htm

Flores-Mireles, A. L., et al. (2016). Urinary tract infections: Epidemiology, mechanisms of infection and treatment options. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4457377/

Gutiérrez-Castrellón, P., et al. (2015). Efficacy and safety of ciprofloxacin treatment in urinary tract infections (UTIs) in adults: A systematic review with meta-analysis. https://www.anmm.org.mx/GMM/2015/n2_english/2331AX152_151_2015_UK2_210-228.pdf

Kang, C.-I., et al. (2018). Clinical practice guidelines for the antibiotic treatment of community-acquired urinary tract infections. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5895837/

Label: Ciprofloxacin — ciprofloxacin tablet, film coated. (2012). https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=d54a97d5-3664-4ca5-bffd-8366c7255b73

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