Ciproxin (Ciprofloxacin) 500mg
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.
• Tablets: 250, 500, and 750 mg.
• Tablets extended release (XR): 500 and 1000 mg.
• Microcapsules for suspension: 250 mg/5 ml, 500 mg/5 ml.
• Injection or Injection concentrate: 200 mg/100 ml, 200 mg/20 mg, 400 mg/200 ml, 400 mg/40 ml.
Tablets should be stored below 30 C (86 F). Extended release tablets should be stored between 15 C to 30 C (59 F to 86 F). Microcapsules should be stored below 25 C (77 F) and protected from freezing. Injections should be stored between 5 C to 30 C (41 F to 86 F) and prevented from freezing.
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. Anthrax, patients with fever and low white blood cell counts, and intraabdominal infections are also treated with ciprofloxacin.
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.
Ciprofloxacin administered together with
theophylline (Respbid, Slo-Bid, Theo-24, Theolair) can lead to
elevated, toxic blood levels of theophylline. Theophylline is used to
open airways in the treatment of asthma. Toxic levels of theophylline
can lead to seizures, and disturbances in heart rhythm. If concurrent
use of ciprofloxacin and theophylline cannot be avoided, frequent blood
tests to monitor theophylline blood levels are recommended.
Ciprofloxacin increases the effect of tizanidine (Zanaflex) that is used to treat muscle spasticity. Therefore, the two drugs should not be combined.
Iron salts (for example, ferrous sulfate) may reduce the absorption of ciprofloxacin because of formation of a ciprofloxacin-iron complex that is not absorbable. Antacids also may reduce the absorption of ciprofloxacin. If patients are receiving iron salts or antacids and ciprofloxacin, the ciprofloxacin should be given two hours before or six hours after the iron salt or antacid.
Ciprofloxacin may increase the blood thinning effect of warfarin (Coumadin). The reason for this is unknown. Anticoagulant activity should be monitored after starting or stopping ciprofloxacin.
Sevelamer (Renagel) may reduce the absorption of ciprofloxacin and possibly reduce the effectiveness of ciprofloxacin. Milk and orange juice also may reduce the absorption of ciprofloxacin. Ciprofloxacin, as with iron and antacids, should be given two hours before or six hours after milk or orange juice.
Administration of ciprofloxacin with diabetic medications (for example glyburide [Micronase, Diabeta, Glynase, Prestab]) may lead to severe low blood glucose.
Ciprofloxacin may increase blood concentrations of sildenafil (Viagra) that is used for treating erectile dysfunction. This combination should be avoided if possible.
Ciprofloxacin should be avoided during pregnancy, as safe use in pregnant women has not been established.
Ciprofloxacin should be avoided in nursing mothers, as safe use in pregnant women has not been established.
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.
Fluoroquinolones have neuromuscular blocking activity and can worsen muscle weakness in individuals with myasthenia gravis. Ciprofloxacin may worsen low blood glucose when combined with sulfonylureas (for example, glyburide).