Ciprofloxacin (Oral Route)
Original Article: http://www.mayoclinic.com/health/drug-information/DR602795
US Brand Names
Ciprofloxacin is used to treat bacterial infections in many different parts of the body. Ciprofloxacin oral liquid and tablets are also used to treat anthrax infection after inhalational exposure. Ciprofloxacin may mask or delay the symptoms of syphilis. It is not effective against syphilis infections.
Ciprofloxacin extended-release tablets are only used to treat urinary tract infections.
Proquin® XR tablets are only used to treat uncomplicated or simple urinary tract infections (acute cystitis).
Ciprofloxacin belongs to the class of drugs known as fluoroquinolone antibiotics. It works by killing bacteria or preventing their growth. However, this medicine will not work for colds, flu, or other virus infections.
This medicine is available only with your doctor's prescription.
This product is available in the following dosage forms:
- Powder for Suspension
In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For this medicine, the following should be considered:
Tell your doctor if you have ever had any unusual or allergic reaction to this medicine or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.
Appropriate studies performed to date have not demonstrated pediatric-specific problems that would limit the usefulness of ciprofloxacin in children. However, because of this medicine's toxicity, it should be used with caution, after other medicines have been considered and found ineffective. Ciprofloxacin oral liquid or tablets may be used in children to prevent anthrax infection after possible exposure, and to treat serious kidney infections.
Appropriate studies have not been performed on the relationship of age to the effects of ciprofloxacin extended-release tablets in the pediatric population. Safety and efficacy have not been established.
Appropriate studies performed to date have not demonstrated geriatric-specific problems that would limit the usefulness of ciprofloxacin in the elderly. However, elderly patients are more likely to have age-related kidney or heart problems, or develop severe tendon problems (including tendon rupture), which may require caution in patients receiving ciprofloxacin.
|All Trimesters||C||Animal studies have shown an adverse effect and there are no adequate studies in pregnant women OR no animal studies have been conducted and there are no adequate studies in pregnant women.|
Studies in women suggest that this medication poses minimal risk to the infant when used during breastfeeding.
Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking this medicine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.
Using this medicine with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.
Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
- Arsenic Trioxide
- Guar Gum
- Insulin Aspart, Recombinant
- Insulin Glulisine
- Insulin Lispro, Recombinant
- Perflutren Lipid Microsphere
- Sodium Phosphate
- Sodium Phosphate, Dibasic
- Sodium Phosphate, Monobasic
Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
- Aluminum Carbonate, Basic
- Aluminum Hydroxide
- Aluminum Phosphate
- Dihydroxyaluminum Aminoacetate
- Dihydroxyaluminum Sodium Carbonate
- Lanthanum Carbonate
- Magnesium Carbonate
- Magnesium Hydroxide
- Magnesium Oxide
- Magnesium Trisilicate
- Mycophenolate Mofetil
Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.
Using this medicine with any of the following may cause an increased risk of certain side effects but may be unavoidable in some cases. If used together, your doctor may change the dose or how often you use this medicine, or give you special instructions about the use of food, alcohol, or tobacco.
- Dairy Food
Other Medical Problems
The presence of other medical problems may affect the use of this medicine. Make sure you tell your doctor if you have any other medical problems, especially:
- Brain or spinal cord disease, including hardening of the arteries in the brain, epilepsy or seizures or
- Diabetes or
- Diarrhea or
- Heart rhythm problems (e.g., prolonged QT interval) or
- Hypokalemia (low potassium in the blood), uncorrected or
- Joint problems (e.g., rheumatoid arthritis), or history of—Use with caution. May make these conditions worse.
- Kidney disease—Use with caution. The effects may be increased because of slower removal of ciprofloxacin from the body.
- Myasthenia gravis (severe muscle weakness)—Should not be used in patients with this condition.
- Organ transplant (e.g., kidney, heart, or lung) or
- Tendon disorder (e.g., rheumatoid arthritis), history of—Use with caution. May increase the risk of tendon problems.
Take this medicine only as directed by your doctor. Do not take more of it, do not take it more often, and do not take it for a longer time than your doctor ordered.
This medicine comes with a Medication Guide. It is very important that you read and understand this information. Be sure to ask your doctor about anything you do not understand.
Use only the brand of this medicine that your doctor prescribed. Different brands may not work the same way.
This medicine works best when there is a constant amount in the blood or urine. To help keep the amount constant, do not miss any doses. Also, it is best to take the doses at evenly spaced times, day and night. For example, if you are to take one dose a day, try to take it at the same time each day.
If you need to take this medicine for anthrax infection, your doctor will want you to begin taking it as soon as possible after you are exposed to anthrax.
Swallow the extended-release tablet whole. Do not crush, split, or chew it.
Shake the oral liquid for at least 15 seconds just before each use. The oral liquid has small microcapsules floating in it. These microcapsules may look like bubbles or small beads. Do not chew the microcapsules when you take the oral liquid. Measure the oral liquid with the marked measuring spoon that comes with the bottle.
You may take this medicine with or without food. However, Proquin® XR tablets should be taken with a main meal, preferably the evening meal.
Drink plenty of fluids while you are taking this medicine. Drinking extra water will help prevent some unwanted effects of ciprofloxacin.
Do not take this medicine alone with milk, yogurt, or other dairy products. Do not drink any juice with calcium added when you take this medicine. It is okay to have dairy products or juice as part of a larger meal when you take this medicine.
If you are taking aluminum or magnesium-containing antacids, iron supplements, multivitamins, didanosine (Videx®), lanthanum carbonate (Fosrenol®), sevelamer (Renagel®), sucralfate (Carafate®), or any products containing calcium or zinc, do not take them at the same time that you take this medicine. It is best to take these medicines at least 2 hours before or 4 to 6 hours after taking ciprofloxacin. These medicines may keep ciprofloxacin from working properly.
Keep using this medicine for the full treatment time, even if you feel better after the first few doses. Your infection may not clear up if you stop using the medicine too soon.
The dose of this medicine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so.
The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.
- For oral dosage form (extended-release tablets):
- For uncomplicated urinary tract infections:
- Adults—500 milligrams (mg) once a day for 3 days.
- Children—Use and dose must be determined by your doctor.
- For urinary tract infections:
- Adults—500 to 1000 milligrams (mg) once a day.
- Children—Use and dose must be determined by your doctor.
- For uncomplicated urinary tract infections:
- For oral dosage forms (suspension or tablets):
- For infections:
- Adults—250 to 750 milligrams (mg) two times a day, taken every 12 hours.
- Children—Use and dose must be determined by your doctor.
- For urinary tract or serious kidney infections:
- Adults—250 to 500 milligrams (mg) two times a day, taken every 12 hours.
- Children—Dose is based on body weight and must be determined by your doctor. The dose is usually 10 to 20 milligrams (mg) per kilogram (kg) of body weight every 12 hours.
- For treatment of anthrax infection (post-exposure):
- Adults—500 milligrams (mg) two times a day, taken every 12 hours.
- Children—Dose is based on body weight and must be determined by your doctor. The dose is usually 15 milligram (mg) per kilogram (kg) of body weight every 12 hours.
- For infections:
If you miss a dose of this medicine, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses.
Do not take more than one extended-release tablet each day.
Keep out of the reach of children.
Do not keep outdated medicine or medicine no longer needed.
Ask your healthcare professional how you should dispose of any medicine you do not use.
Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Keep from freezing.
You may store the oral liquid at room temperature or in the refrigerator. Do not freeze the bottle. Do not keep the oral liquid for more than 14 days. Throw away any unused liquid after 14 days.
If your or your child's symptoms do not improve within a few days, or if they become worse, check with your doctor.
Do not use this medicine if you are also taking tizanidine (Zanaflex®). Tell your doctor if you or your child are also using theophylline (Theo-Dur®) or other products that contain caffeine (e.g., coffee, soda, chocolate). Using these medicines together may increase risks for more serious side effects.
This medicine may cause serious allergic reactions, including anaphylaxis, which can be life-threatening and require immediate medical attention. Call your doctor right away if you or your child have a rash; itching; hives; hoarseness; shortness of breath; trouble breathing; trouble swallowing; or any swelling of your hands, face, mouth, or throat after you take this medicine.
Serious side effects can occur during treatment with this medicine. Sometimes serious side effects can occur without warning. However, possible warning signs are including black, tarry stools; blistering, peeling, or loosening of the skin; bloody or cloudy urine; chills; decreased urination; diarrhea; fever; joint or muscle pain; red skin lesions, often with a purple center; sores, ulcers, or white spots in the mouth or on the lips; severe stomach pain; skin rash; swelling of the face, fingers, feet, and/or lower legs; unusual bleeding or bruising; unusual weight gain; or yellow skin or eyes. Stop taking this medicine and check with your doctor immediately if you or your child notice any of these warning signs.
This medicine can cause changes in heart rhythms, such as a condition called QT prolongation. It may change the way your heart beats and cause fainting or serious side effects in some patients. Contact your doctor right away if you or your child have any symptoms of heart rhythm problems, such as fast, pounding, or irregular heartbeats.
Ciprofloxacin may cause diarrhea, and in some cases it can be severe. It may occur 2 months or more after you or your child stop taking this medicine. Do not take any medicine to treat diarrhea without first checking with your doctor. Diarrhea medicines may make the diarrhea worse or make it last longer. If you have any questions about this or if mild diarrhea continues or gets worse, check with your doctor.
Stop using this medicine and check with your doctor right away if you or your child start having numbness, tingling, or burning pain in your hands, arms, legs, or feet. These may be symptoms of a condition called peripheral neuropathy.
Ciprofloxacin may rarely cause inflammation or tearing of a tendon (the cord that attaches muscles to bones). This can occur while you are taking the medicine or after you finish taking it. The risk of having tendon problems may be increased if you are over 60 years of age, are using steroid medicines (e.g., dexamethasone, prednisolone, prednisone, or Medrol®), have severe kidney problems, have a history of tendon problems (e.g., rheumatoid arthritis), or if you have received an organ transplant (e.g., heart, kidney, or lung). Stop using this medicine and check with your doctor right away if you have sudden pain or swelling in a tendon after exercise (e.g., ankle, back of the knee or leg, shoulder, elbow, or wrist), bruise more easily after an injury, or are unable to bear weight or move the affected area. Refrain from exercise until your doctor says otherwise.
Some people who take ciprofloxacin may become more sensitive to sunlight than they are normally. Exposure to sunlight, even for brief periods of time, may cause severe sunburn, skin rash, redness, itching, or discoloration. When you begin using this medicine:
- Stay out of direct sunlight, especially between the hours of 10:00 a.m. and 3:00 p.m., if possible.
- Wear protective clothing, including a hat and sunglasses.
- Apply a sun block product that has a skin protection factor (SPF) of at least 15. Some people may require a product with a higher SPF number, especially if they have a fair complexion. If you have any questions about this, check with your doctor.
- Do not use a sun lamp or tanning bed or booth.
If you have a severe reaction from the sun, check with your doctor.
Ciprofloxacin may cause some people to become dizzy, lightheaded, drowsy, or less alert than they are normally. Make sure you know how you react to this medicine before you drive, use machines, or do anything else that could be dangerous if you are dizzy or are not alert. If these reactions are especially bothersome, check with your doctor.
For diabetic patients taking diabetes medicine by mouth: Ciprofloxacin may cause hypoglycemia (low blood sugar) in some patients. Symptoms of low blood sugar must be treated before they lead to unconsciousness (passing out). Different people may feel different symptoms of low blood sugar. If you experience symptoms of low blood sugar, stop taking ciprofloxacin and check with your doctor right away:
- Symptoms of low blood sugar can include: Anxious feeling, behavior change similar to being drunk, blurred vision, cold sweats, confusion, cool pale skin, difficulty with concentrating, drowsiness, excessive hunger, headache, nausea, nervousness, rapid heartbeat, shakiness, or unusual tiredness or weakness.
Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal or vitamin supplements.
Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor immediately if any of the following side effects occur:More common
- Abdominal or stomach pain
- Actions that are out of control
- Arm, back, or jaw pain
- Bloody nose
- Bloody or black, tarry stools
- Bloody or cloudy urine
- Bluish color
- Blurred vision
- Burning, crawling, itching, numbness, prickling, "pins and needles", or tingling feelings
- Change in walking and balance
- Changes in skin color
- Chest pain or discomfort
- Chest tightness or heaviness
- Clumsiness or unsteadiness
- Continuing ringing or buzzing or other unexplained noise in the ears
- Coughing or spitting up blood
- Dark urine
- Darkening of the skin
- Decreased frequency or amount of urine
- Difficult or labored breathing
- Difficulty with moving
- Difficulty with passing urine (dribbling)
- Difficulty with swallowing
- Dizziness, faintness, or lightheadedness when getting up suddenly from a lying or sitting position
- Fast, irregular, pounding, or racing heartbeat or pulse
- Feeling of unreality
- Feeling of warmth
- Feeling sad or empty
- Frequent urination
- General feeling of discomfort or illness
- Greatly decreased frequency of urination or amount of urine
- Headache, severe and throbbing
- Hearing loss
- Heart stops
- Hives or welts
- Increased blood pressure
- Increased thirst
- Increased volume of pale or dilute urine
- Itching of the vagina or genital area
- Joint stiffness
- Lack of appetite
- Large, hive-like swelling on the face, eyelids, lips, tongue, throat, hands, legs, feet, or sex organs
- Light-colored stools
- Loss of appetite
- Loss of interest or pleasure
- Lower back or side pain
- Muscle pain or stiffness
- Nausea and vomiting
- No breathing
- No pulse or blood pressure
- Noisy breathing
- Numbness of the hands
- Pain during sexual intercourse
- Pain in the ankles or knees
- Pain in the joints
- Pain or discomfort in the arms, jaw, back, or neck
- Painful urination
- Painful, red lumps under the skin, mostly on the legs
- Pounding in the ears
- Puffiness or swelling of the eyelids or around the eyes, face, lips, or tongue
- Redness of the face, neck, arms, and occasionally, upper chest
- Redness of the skin
- Sensation of skin burning
- Sense of detachment from self or body
- Severe abdominal or stomach pain, cramping, or burning
- Shakiness and unsteady walk
- Shakiness in the legs, arms, hands, or feet
- Shortness of breath
- Skin rash
- Slow or fast heartbeat
- Slow or irregular breathing
- Small red or purple spots on the skin
- Sore mouth or tongue
- Swelling of the face, feet, or lower legs
- Swollen, painful, or tender lymph glands in the neck, armpit, or groin
- Talking, feeling, and acting with excitement
- Thick, white vaginal discharge with no odor or with a mild odor
- Tightness in the chest
- Trembling or shaking of the hands or feet
- Trouble concentrating
- Trouble sleeping
- Unable to sleep
- Unpleasant breath odor
- Unsteadiness, trembling, or other problems with muscle control or coordination
- Unusual drowsiness, dullness, tiredness, weakness, or feeling of sluggishness
- Unusual weight gain
- Upper right abdominal or stomach pain
- Vomiting of blood or material that looks like coffee grounds
- Weight loss
- White patches in the mouth and/or on the tongue
- Yellow eyes or skin
- Abdominal or stomach cramps or tenderness
- Acid or sour stomach
- Back, leg, or stomach pains
- Bleeding gums
- Blistering, peeling, or loosening of the skin
- Bluish-colored lips, fingernails, or palms
- Bone pain
- Cloudy urine
- Confusion as to time, place, or person
- Cough or hoarseness
- Cracks in the skin
- Diarrhea, watery and severe, which may also be bloody
- Difficult urination
- Difficulty with breathing, chewing, swallowing, or talking
- Double vision
- Drooping eyelids
- Dry mouth
- Excess air or gas in the stomach or intestines
- Excessive muscle tone
- Feeling of discomfort
- Feeling, seeing, or hearing things that are not there
- Feeling that others are watching you or controlling your behavior
- Feeling that others can hear your thoughts
- Flushed or dry skin
- Fruit-like breath odor
- Full feeling
- General body swelling
- High fever
- Holding false beliefs that cannot be changed by fact
- Increased hunger
- Increased sensitivity to pain
- Increased sensitivity to touch
- Increased urination
- Inflammation of the joints
- Irregular heartbeats
- Irregular or slow heart rate
- Joint or muscle pain
- Loss of heat from the body
- Loss of sense of smell
- Lower back or side pain
- Muscle aches
- Muscle tension or tightness
- Muscle twitching or jerking
- Muscle weakness
- Pain, inflammation, or swelling in the calves, shoulders, or hands
- Pains in the stomach, side, or abdomen, possibly radiating to the back
- Pale skin
- Passing gas
- Rapid heart rate
- Red skin lesions, often with a purple center
- Red, irritated eyes
- Redness, soreness, or itching skin
- Rhythmic movement of the muscles
- Scaly skin
- Severe mood or mental changes
- Severe tiredness
- Sore throat
- Sores, ulcers, or white spots on the lips or in the mouth
- Stomach discomfort, upset, or pain
- Stomach pain, continuing
- Sudden decrease in the amount of urine
- Tingling in the hands and feet
- Uncontrolled eye movements
- Unsteadiness or awkwardness
- Unusual behavior
- Unusual bleeding or bruising
- Unusual excitement, nervousness, or restlessness
- Unusual weight loss
- Vaginal yeast infection
- Weakness in the arms, hands, legs, or feet
Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:Less common
- Runny nose
- Stuffy nose
Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.
Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.