Ciprofloxacin: Uses, dosage & interactions!

Ciprofloxacin is a quinolone antibiotic of the fluoroquinolone class, of bacteria destroying antibiotics.

It is classified as a second generation fluoroquinolone antibiotic. Some other fluoroquinolone drugs are; levofloxacin, ofloxacin, gatifloxacin, etc.

USAGE

  • Skin infections
  • Joint infections
  • Bone infections
  • Lung/airway infection like Tuberculosis, pneumonia, low respiratory tract infections, bronchitis, severe sinusitis.
  • Bacterial sepsis
  • STI like gonorrhea in men & women
  • Bacterial inflammation & infection of the prostate
  • Typhoid fever
  • Anthrax
  • Infectious diarrhea from shigella or salmonella.
  • Intra-abdominal infections
  • Urinary tract infections (UTI)
  • Cystitis

DOSAGE FOR CIPROFLOXACIN

Types of dosage forms & strengths:

  • 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.

Dosage:

  • Oral dose for immediate release tablets: 250-750 mg every 12 hours
  • XR tablets: 500-1000 mg every 24 hours.
  • IV dose: 200-400 mg every 8-12 hours.
  • Other doses depend on factors like the type & location of infection, bacteria, age, sex, presence of underlying diseases, immunity & doctor’s guidance.

Missed Dose: If a dose is missed & it is way past the time to take the particular dose, skip the dose & do not take it close to or along with the following dose.

In Overdose:
a) In case of overdose of ciprofloxacin, reversible renal toxicity can occurs.
b) 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.
c) Monitoring of renal function, urinary Ph & adequate hydration is recommended.

SIDE EFFECTS

  • Nausea
  • Vomiting
  • Headache
  • Rash
  • Diarrhea
  • Runny nose
  • Abdominal pain
  • Restlessness
  • Anxiety
  • Allergic reaction

ADVERSE EFFECTS ARISING FROM CIPROFLOXACIN

  • Damage to the peripheral nerves
  • CNS effects like paranoia, delusions, insomnia, etc
  • Seizures
  • Abnormal heart rhythm/beats
  • Change/Improper function of the liver
  • Stroke
  • Inflammation of the vessels lining the abdomen
  • Inflammation of the urine filtering cells in the kidney
  • Kidney failure
  • Hepatitis
  • Jaundice
  • Anemia
  • Chest tightness & pain
  • Respiratory failure

PRECAUTIONS & CONTRAINDICATIONS

This drug is contraindicated & precaution is advised in patients that have following conditions:

  • Allergic to fluoroquinolones
  • Ciprofloxacin can cause swelling or tearing of a tendon.
  • Arthritis or joint problems
  • Narrowing or hardening of arteries
  • High blood pressure
  • Genetic/hereditary disease
  • Muscle or nerve disorder like myasthenia gravis
  • Epilepsy
  • Brain tumor
  • QT prolongation
  • Low levels of potassium in the body
  • Avoiding sunlight & using sunscreen, as ciprofloxacin can increase the chances of sunburn.

INTERACTIONS OF CIPROFLOXACIN

Drugs whose blood level is increased/or effectiveness is increased (unwanted) when given in presence of ciprofloxacin:

  • Theophylline given in asthma
  • Tizanidine given in muscle spasticity
  • Warfarin – blood thinning drug
  • Glyburide – leads to very low blood sugar
  • Sulfonylureas – leads to very low blood sugar
  • Sildenafil
  • Sucralfate

Drugs that reduce the effectiveness of ciprofloxacin when given in combination:

  • Iron salts
  • Antacids
  • Calcium containing salts
  • Sevelamer

Drug-Food interaction

  • Milk and other dairy products reduce the effectiveness of the drug.
  • Orange juice reduces the effectiveness of the drug.
  • Caffeine concentration is increased when given in addition with the drug.
  • Multivitamins can interfere with the absorption of the drug.
  • Alcohol should not be taken along with the drug.

IN PREGNANCY, BREASTFEEDING & CHILDREN

  • Pregnancy: Ciprofloxacin is categorized as a category C drug, which includes drugs that have no adequate information or controlled studies on it. Although harm to fetus is speculated.
  • Breastfeeding: Fluoroquinolones are present in the breast milk of the mother, and therefore can pass on to infants causing serious adverse effects, therefore are not encouraged in breastfeeding mothers.
  • Children: Oral & IV drug are approved for children in two indications: Anthrax & complicated UTI.