Ciprofloxacin (Oral)

Ciprofloxacin is a potent antibiotic from the fluoroquinolone group which is used to treat stubborn bacterial infections.

Overview:

Ciprofloxacin is a potent antibiotic drug in the fluoroquinolone group. It is usually reserved for only the most serious of infections. As such, it can capture the imagination as the drug used to treat anthrax, or more antiquated disease such as typhoid fever, or even the plague which killed almost ? of Europe's population in the 14th century. A wide variety of different side effects and negative reactions come with the drug though, so while it can treat a broad spectrum of different infections, it is usually only used as a last resort.

Ciprofloxacin was developed in 1987 by Bayer, a derivative of the quinolones discovered in 1960. The drug has been recognized by the World Health Organization as one of the world's essential medicines. Ciprofloxacin is widely available in its generic form, produced by a variety of different manufacturers. In the USA, the average cost per dose of ciprofloxacin is around 40 cents.

Type of Medicine:

  • Antibiotic

Conditions Treated:

  • Bacterial infections
  • Anthrax
  • Syphilis
  • Plague (Black Death)
  • Typhoid fever
  • Urinary tract infections

Side Effects:

Ciprofloxacin can produce a wide variety of different side effects on the body. Some side effects may be cause for alarm, while others are simply caused by the body adapting to the new medication.

Patients taking ciprofloxacin have suffered tendon rupture, where a patient's tendons become swollen and torn, potentially causing permanent nerve damage and loss of functionality in the ruptured tendon. Patients should stop using ciprofloxacin and contact their doctor immediately if they begin to experience any of the following:

  • Sudden pain, swelling, tenderness, or bruising
  • Stiffness
  • Difficulty moving
  • Snapping or popping sounds coming from the patient's joints
  • Patients who experience any of the previous effects should rest the afflicted joint(s) until they can receive medical attention. By working the joint, the patient makes tendon rupture more likely.
  • Signs of nerve damage coming from tendon rupture can include:
  • Numbness
  • Tingling
  • Burning pain
  • Sudden increase in sensitivity to temperature
  • Sudden increase in sensitivity to the sense of touch
  • Sudden increase in awareness of body position

The following side effects may require medical attention. Patients who begin to experience any of the following side effects after beginning to take ciprofloxacin should contact their doctor immediately or otherwise seek medical attention:

  • Diarrhea
  • Bloody, blackened, or otherwise discolored stool
  • Tarry or otherwise texturally affected stool
  • Tingling, burning, or pins and needle like sensations
  • Altered skin color
  • Altered urinary habits
  • Pain or other discomfort in the chest
  • Tightness or heaviness in the chest
  • Chills
  • Fever
  • Clumsiness, unsteadiness, or a sudden lack of coordination
  • Confusion
  • Persistent ringing or buzzing in the ears
  • Loss of hearing
  • Sudden pounding in the ears
  • Spitting or coughing up blood
  • Lightheadedness or dizziness when rising from a seated or prone position
  • Temporary blindness (one to five seconds) or fuzzy vision when rising from a seated or prone position
  • Accelerated or otherwise affected heart rate
  • Arrhythmia
  • Severe, throbbing headaches
  • Hives
  • Welts
  • Rash
  • Hive-like swelling on the face, eyelids, ears, or genitals
  • Muscle pain
  • Muscle stiffness
  • Nausea
  • Vomiting
  • Nightmares
  • Numbness in the hands or other extremities
  • Joint pain
  • Discomfort or pain in the arms, jaw, back, or neck
  • Painful red lumps under the skin, especially on the legs
  • Redness on the face, arms, neck, and on the upper chest
  • Seizures
  • Severe abdominal or stomach pain
  • Cramping or burning sensations in the stomach or abdominal
  • Shakiness in the arms and legs
  • Shakiness in the hands and feet
  • Swelling of the hands, face and lower legs
  • Swollen and painful lymph nodes
  • Painful swelling of the neck or groin
  • Thick and white vaginal discharge. Mild to no odor
  • Muscle control and coordination problems
  • Unusual drowsiness, dullness, or lack of focus
  • White patches/sores in the mouth or on the tongue
  • Yellow discoloration of the eyes or skin

The incidence of the following side effects is not known. Nevertheless, patients have consistently reported experiencing the following effects. Patients who begin to experience any of the following effects should contact their doctor immediately or otherwise seek medical attention:

  • Acid or sour stomach
  • Blistered, peeling, or loose skin
  • Blue discoloration of the lips, fingernails, or palms of the hand
  • Bone pain
  • Watery or loose diarrhea
  • Bloody stool or diarrhea
  • Difficulty chewing, breathing or talking
  • Loss of function of jaw or throat muscles
  • Double vision
  • Sudden and rogue increases in muscle tone
  • Feelings of generalized discomfort
  • Auditory, visual, or physical hallucinations
  • Increased sensations or sensitivity to pain
  • Increased sensitivity or sensations of touch
  • Slow or irregular heart rate
  • Sudden increases in heart rate
  • Sudden fluctuations in mood
  • Nosebleeds
  • Skin lesions - typically red with a purple center
  • Sores or ulcers, usually white, in the mouth
  • Unusual or rogue bleeding or bruising
  • Sudden burst of nervous/anxious energy
  • Vaginal yeast infections

Not all side effects of ciprofloxacin necessarily require medical attention. Some side effects are simply the result of the patient's body adapting to the sudden influx of new drugs into the body. The following side effects do not necessarily require medical attention. Patients who begin to experience any of the following side effects should consult with their doctor to determine how best to mitigate or otherwise lessen the adverse effects.

  • Runny nose
  • Sneezing
  • Stuffy nose

This is not necessarily a complete list of side effects. Patients who begin to experience new, unexpected, or unwanted effects after beginning to take any drug, ciprofloxacin included, should contact their doctor immediately. Patients can report new side effects to the FDA at 1 800 FDA 1088 or www.fda.gov/medwatch.

Dosage:

The proper dosage amount the patient takes is going to vary considerably depending on the condition being treated, the severity of the condition, and any other mitigating factors. Patients should rely on their doctor to prescribe to them the best effective dose to treat their condition. Patients should ensure that they follow their doctor's directions completely to ensure they are safely and effectively treating their condition.

Patients should also read the medication guide which comes with their ciprofloxacin to ensure they completely understand how the medication works and how to take it correctly.

Ciprofloxacin is most effective when the amount of ciprofloxacin in the blood is relatively constant. To support this, patients should do their best to ensure that they take ciprofloxacin at the same time(s) every day.

Patients should take all of the medicine prescribed to them by their doctor. Patients who begin to feel better after a certain number of treatments should complete the treatments prescribed to them by their doctor.

Patients who are prescribed the extended release tablet form of ciprofloxacin should take the tablet whole. Under no circumstances should the patient crush, split, or otherwise mangle the tablet. By doing so the patient will accelerate the release of ciprofloxacin into the bloodstream, amplifying the risk of side effects.

An oral suspension form of ciprofloxacin is available. Patients who have been described this form of ciprofloxacin should shake the oral suspension for fifteen seconds just before measuring their dose. Patients should use a specialized dose-measuring spoon or medicine cup to measure their dose and be absolutely sure that the dose they have measured is correct.

Patients who are taking ciprofloxacin should always take their medication with water, as well as try to drink a great deal of water throughout the day. By drinking enough water, patients will ensure that their kidneys are able to handle the ciprofloxacin without incident.

Interactions:

Different drugs can interact in a patient's body in a variety of unique ways. Patients should disclose a complete list of all drugs, medications, and supplements they are taking to their doctor prior to deciding to take ciprofloxacin. Patients should rely on their doctor to identify any potential interactions between ciprofloxacin and any drug, medication, or supplement they are presently taking.

Dairy products, such as milk or yogurt, and foods fortified with calcium, such as juices, can make ciprofloxacin less effective. Patients who are taking ciprofloxacin should avoid consuming any dairy products or calcium-fortified foods on their own. Patients are, however, able to consume these products as part of a larger meal. By diluting the concentration of the dairy product or calcium fortification, it allows the ciprofloxacin to act as it normally would on the body. Patients should consult with their doctor to determine what dairy type foods are safe for them to eat, and which are not.

Supplements which contain calcium, iron, or zinc should never be taken while a patient is taking ciprofloxacin. By taking supplements with these ingredients in them, patients are putting themselves at increased risk of complications, and potentially weakening the effects of ciprofloxacin on the body. Patients should consult with their doctor to determine how best to get an adequate amount of zinc, iron, and calcium from their diet without interfering with ciprofloxacin. Patients should disclose a full list of all drugs, medications, and supplements to their doctor prior to deciding to take ciprofloxacin.

Patients should not take didanosine (an HIV antiviral) in any form while they are taking ciprofloxacin. By taking didanosine concurrently with ciprofloxacin,. The patient is putting themselves at increased risk of complications and potentially impeding the function of both didanosine and ciprofloxacin on their bodies. Patients who must take both didanosine and ciprofloxacin concurrently should consult with their doctor to determine adequate, noninteractive alternatives. Patients should disclose a full list of all drugs, medications, and supplements to their doctor prior to deciding to take ciprofloxacin.

Patients should avoid taking any form of phosphate binder (such as lanthanum carbonate or sevelamer) while they are taking ciprofloxacin. Patients who must take any form of phosphate binder while they are waking ciprofloxacin should consult with their doctor to determine the best course of action and potential alternative drugs or treatments. Patients should disclose a full list of all drugs, medications, and supplements to their doctor prior to deciding to take ciprofloxacin.

Patients who are taking medications to treat depression or mental illness, such as SSRIs (selective serotonin re-uptake inhibitors), should exercise extreme caution when deciding whether or not to take ciprofloxacin. When taken together, medications such as SSRIs and ciprofloxacin can have dangerous effects on the patient's heart rate, including a dangerous depression of the patient's heart rate and erratic fits of intense heart rate. Patients with a history of arrhythmia should never combine SSRIs and ciprofloxacin. Patients who must take ciprofloxacin and any kind of mental health drug together should consult with their doctor to determine potential alternatives and establish the best way to move forward. Patients should disclose a complete list of all drugs, medications, and supplements they are taking to their doctor prior to deciding whether or not take take ciprofloxacin.

Diuretics (“water pills”) interact negatively with ciprofloxacin. Diuretics draw water out of the body, while patients are directed to increase water consumption to help their kidneys deal with the sudden influx of ciprofloxacin. By taking diuretics, patients will decrease the excretion of ciprofloxacin, putting themselves at risk of increased side effects and overdose. Patients should disclose a full list of all drugs, medications, and supplements to their doctor prior to deciding to take ciprofloxacin.

Patients should be aware that coffee is a diuretic. While patients are already cautioned against caffeine while taking ciprofloxacin, the diuretic nature of coffee is also a concern. Patients should avoid coffee while they are taking ciprofloxacin.

Patients who are taking ciprofloxacin should be careful when taking antacids. Many antacids, such as Maalox contain aluminum or magnesium, both of which will interfere with the absorption of ciprofloxacin in the bloodstream. If possible, patients should avoid taking any medicine containing aluminum or magnesium concurrently with ciprofloxacin. If the medicine must be taken, it should be taken after more than six hours have passed since the last dose of ciprofloxacin taken and with more than six hours until the patient next needs to take ciprofloxacin. Patients should consult with their doctor to determine an effective alternative to medications which contain aluminum or magnesium, or how best to mitigate the interaction between magnesium/aluminum and ciprofloxacin. Patients should disclose a complete list of all drugs, medications, and supplements they are taking to their doctor prior to deciding to take ciprofloxacin.

Patients who are taking steroids such as prednisone such as prednisone should avoid taking ciprofloxacin. Ciprofloxacin can cause tendon rupture, a risk that is greatly increased when it interacts in a patient's body with a steroid such as prednisone. Patients who must take a steroid and ciprofloxacin concurrently should consult with their doctor immediately to determine possible non reactive alternatives and alternative treatment strategies. Patients should disclose a complete list of all drugs, medications, and supplements they are taking to their doctor prior to deciding to take ciprofloxacin.

Patients who are taking an NSAID (nonsteroidal anti-inflammatory drug) should avoid taking ciprofloxacin. By taking an NSAID concurrently with ciprofloxacin the patient puts him/herself at increased risk of adverse side effects, including anxiety, tremors, muscle spasms, and hallucinations. Patients who must take ciprofloxacin concurrently with an NSAID should consult with their doctor to determine nonreactive alternatives, dosage adjustments, or strategies to mitigate interactions. Patients should disclose a complete list of all drugs, medications, and supplements they are taking to their doctor prior to deciding to take ciprofloxacin.

Patients who are taking any kind of blood thinner (such as warfarin) should avoid taking ciprofloxacin. By taking a blood thinner concurrently with ciprofloxacin patients make themselves dangerously at risk of bleeding. Patients who take a blood thinner concurrently with ciprofloxacin report massive increases in unexplained bleeding, bruising, and massive increases in time it takes to stop bleeding. Patients who are taking a blood thinner and need to take ciprofloxacin should consult with their doctor to determine adequate alternatives and the best way to proceed. Patients may need to adjust dosage to ensure their clotting isn't too adversely affected. Patients should be vigilant for signs of excessive bleeding, including spitting up blood and blood in stool and urine. Patients should also disclose a complete list of all drugs, medications, and supplements they are taking to their doctor prior to deciding to take ciprofloxacin.

Patients should avoid taking ciprofloxacin concurrently with any medication designed to modify their heart rhythm. Ciprofloxacin can alter heart rhythm, throwing off the treatment and putting the patient at increased risk of negative side effects. Patients who must take a heart rhythm modifying medication concurrently with v should consult with their doctor to determine an adequate alternative or adjustment to ensure the patient's safety. Patients should disclose a complete list of all drugs, medications, and supplements they are taking to their doctor prior to deciding to take ciprofloxacin.

Any of the following medications can interact negatively with ciprofloxacin. Patients should avoid taking any of the following drugs and Methotrexate concurrently. Patients who are taking any of the following drugs and need to begin taking ciprofloxacin should consult with their doctor to determine possible alternatives or alternative treatments.

  • Zolpidem (Ambien)
  • Theophylline (asthma medication)
  • Sildenafil (Viagra)
  • Ropinirole (used to treat Parkinson's Disease)
  • Probenecid (used to treat gout)
  • Phenytoin (used to prevent seizures)
  • Methotrexate (immunosuppressive and chemotherapy drug)
  • Cyclosporine (immunosuppressive drug)

This is not necessarily a complete list of interactions. Patients should disclose a complete list of all drugs, medications, and supplements they are taking to their doctor prior to deciding to take ciprofloxacin. Patients should rely on their doctor to identify any potential interactions between ciprofloxacin and any drug, medication, or supplement the patient is taking.

Warnings:

Ciprofloxacin is notable among antibiotics for causing serious adverse side effects. Ciprofloxacin should not be used as the first choice treatment. Patients should usually avoid taking ciprofloxacin unless it is the only drug capable of treating their condition.

Ciprofloxacin can impair a patient's reaction time. Patients who are taking ciprofloxacin should avoid driving, operating heavy machinery, or engage in any other high-risk activities until they fully understand how ciprofloxacin affects them and what risks it may cause.

Ciprofloxacin is considered a class C drug in terms of pregnancy. This means that insufficient research has been done to determine whether or not it has an adverse effect on human fetuses. Patients who are pregnant, are trying to become pregnant, or who may become pregnant should consult with their doctor to determine whether or not ciprofloxacin is right for them.

Additionally, ciprofloxacin can pass through breastfeeding to a breastfeeding baby. Ciprofloxacin has been identified as having adverse effects on a breastfeeding baby. Patients who are breastfeeding or who may begin breastfeeding should consult with their doctor to determine an adequate alternative to ciprofloxacin to ensure the baby remains safe.

Patients who are taking tizanidine should never take ciprofloxacin. Ciprofloxacin will impede the excretion of tizanidine, putting the patient at a severely increased risk of negative side effects, including coma and death. When taken concurrently, the risk of an overdose of tizanidine is increased dramatically.

Patients have been known to suffer serious allergic reactions to ciprofloxacin. Patients should be vigilant for signs of an allergic reaction, especially when they first begin taking ciprofloxacin or after raising their dosage. Signs of an allergic reaction can include:

  • Hives
  • Rashes
  • Swelling of the throat or neck
  • Anaphylaxis
  • Patients who have previously had an allergic reaction to ciprofloxacin should not take ciprofloxacin.
  • Patients who are allergic to other fluoroquinolones (gemifloxacin, moxifloxacin, and more) should never take ciprofloxacin.

In patients who are taking antibiotics (such as ciprofloxacin), diarrhea, especially diarrhea which is especially watery or bloody, can be a sign of a new or worsening infection. Patients who begin to suffer from diarrhea, suffer from more intense diarrhea, or suddenly find blood in their diarrhea after beginning to take ciprofloxacin should contact their doctor immediately.

Ciprofloxacin may cause negative complication in patients with muscle or nerve disorders. Patients with muscle or nerve disorders should consult with their doctor to determine whether or not it is safe for them to take ciprofloxacin.

Patients with tendon problems, joint problems, or arthritis may have their condition exacerbated by ciprofloxacin Patients with tendon problems, joint problems, or arthritis should consult with their doctor to determine whether or not it is safe for them to take ciprofloxacin.

Ciprofloxacin is excreted through the kidney. Patients with renal impairment are it increased risk of negative side effects and overdose on ciprofloxacin, as decreased clearance may cause adverse effects. Patients with kidney disease or renal impairment should not take ciprofloxacin. Patients with renal impairment who must take ciprofloxacin should consult with their doctor to find a suitable alternative.

Ciprofloxacin is metabolized in the liver. Patients with hepatic impairment or liver disease will see increased concentrations of ciprofloxacin in the blood, putting them at higher risk for negative side effects and putting themselves at risk of overdose. Patients with acute hepatic impairment should not take ciprofloxacin. Patients with hepatic impairment who must take ciprofloxacin should consult with their doctor to determine what the best course of action is.

Patients who have suffered severe head injuries or who have brain tumors should exercise caution when considering taking ciprofloxacin. Patients who have suffered severe brain injuries or who have brain tumors may see additional adverse effects, and ciprofloxacin may complicate or exacerbate their condition. Patients who have brain tumors or who have suffered severe head injuries should consult with their doctor to determine whether or not it is safe for them to take ciprofloxacin.

Patients who are epileptic or who suffer from seizures should exercise extreme caution when deciding whether or not they should take ciprofloxacin. Ciprofloxacin can interact negatively with epilepsy and raise the likelihood of seizures, exacerbating the condition. Patients who suffer from seizures or who are epileptic should consult with their doctor to determine whether or not ciprofloxacin is safe for them to take.

Patients who have suffered from Long QT Syndrome or who have a family history of Long QT Syndrome should exercise extreme caution when considering taking ciprofloxacin. Ciprofloxacin can compound the effects of Long QT Syndrome, putting the patient at risk of dangerous effects to their heart rate. Patients who have or are at greater risk of Long QT Syndrome should consult with their doctor to determine whether or not it is safe for them to take ciprofloxacin.

Patients with diabetes, especially patients who are taking diabetes medication, should exercise extreme caution when considering whether or not to take ciprofloxacin. Patients who have diabetes should consult with their doctor to determine whether or not it is safe for them to take ciprofloxacin.

Patients who have abnormally low blood levels of potassium (hypokalemia) should exercise extreme caution when considering whether or not to take ciprofloxacin. Ciprofloxacin can interact negatively with depleted levels of potassium in a patient's body. Patients should consult with their doctor to determine whether or not it is safe for them to take ciprofloxacin.

Patients should avoid consuming caffeine while they are taking ciprofloxacin. Ciprofloxacin will amplify the effects of caffeine on the body, which can have negative effects on a person's health. Patients who regularly consume caffeine should consult with their doctor to determine adequate alternatives to caffeine that they can consume while they are taking ciprofloxacin.

Patients who are taking ciprofloxacin are at increased risk of tearing their tendon or other tendon damage. Typically the tendon which is most affected is the Achilles tendon. Swelling of the the affected tendons is also common. These effects may persist up to several months after the cessation of treatment. This effect is most prevalent in patients over 60.

Children should never be given ciprofloxacin except at the direction of their doctor or other trained medical professional. Children may be at greater risk of suffering swollen or brittle tendons.

Patients who are taking ciprofloxacin are more prone to suffering from sunburns. Patients who are taking ciprofloxacin should take pains to protect themselves from the sun, including employing sunscreen (SPF 30 or higher) and protective clothing to shield themselves from the sun's rays. Patients who are taking ciprofloxacin should, under no circumstances, find themselves in a tanning bed.

Patients who begin to experience symptoms such as severe burns, itching, redness, or a rash after being in the sun should contact their doctor immediately.

This is not necessarily a complete list of warnings or risk. Patients should ensure their doctor is completely aware of any and all medical conditions the patient has. Patients should rely on their doctor to identify all of the risks associated with ciprofloxacin and provide them with sufficient instruction to take the medicine safely.

Storage:

Ciprofloxacin should be stored at room temperature, away from light, extreme temperatures, or moisture.

Patients who have been prescribed a liquid form of ciprofloxacin should store it at room temperature. The liquid form of ciprofloxacin should never be frozen. Once shaken (activated) the oral form of ciprofloxacin will be safe for approximately 14 days.

  • Ciprofloxacin should be stored out of the reach of children.
  • Patients should discard any old or unused medication.
  • Patients should follow the storage directions given to them by their doctor and the directions described in the medication guide.

Summary:

Ciprofloxacin is a potent antibiotic. As a powerful medicine, it is understandable that it comes with a wide variety of painful side effects. With these side effects in mind, medical professionals around the world have sought alternatives to the medication whenever possible. Sometimes, though, there is no alternative to ciprofloxacin treatment. Patients in those situations can at least take comfort in the fact that the side effects will be just as temporary as the bacterial infection the ciprofloxacin will target.