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Cipro - medtigo

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Cipro

Brand Name :

Cipro, Cipro XR, ProQuin XR, Ciprofloxacin,Ciloxan,cetraxal, Cipro HC, Ciprodex, Otiprio, Otixal, Otovel. Bacquinor, Baycip, Ciflox,Cifloxin, Ciprinol, Ciprobay, Ciprocinol, Ciprodar, Ciproxan, Ciproxin, Flociprin, Proquin

Synonyms :

Alcon Cilox, AuriPro, Bacquinor, Baflox , Bay o 9867, Bay q 3939, BAYQ3939 , Bernoflox, Bi-Cipro, BRN 3568352 , CCRIS 5241, Cetraxal , Cifloxin, Cilab, Ciplus, Ciprecu , Cipro Cipro IV, Cipro XR , Ciprobay, Ciprobay Uro, Ciprocinol Ciprodar, Ciproflox, Ciprofloxacin, Ciprofloxacina, Ciprofloxacine, Ciprofloxacine [INN-French], Ciprofloxacino, Ciprofloxacino [INN-Spanish], Ciprofloxacinum, Ciprofloxacinum [INN-Latin], Ciprogis , Ciprolin, Ciprolon, Cipromycin, Ciproquinol, Ciprowin, Ciproxan, Ciproxina, Ciproxine , Ciriax , Citopcin, Cixan, Corsacin , Cycin , Cyprobay, Eni, Fimoflox, HSDB 6987, Ipiflox, Italnik, Linhaliq, Linhaliq [Liposomal Formulation], Loxan, NSC 758467 , Otiprio, Probiox, Proflaxin, Proflox, Proksi 250 , Proksi 500, Quinolid , Quintor, Rancif, Roxytal , Septicide, Sophixin, Ofteno , Spitacin, Superocin, Unex, UNII-5E8K9I0O4U, Zumaflox, Ciprofloxacin, Ciprofloxacine, Ciprofloxacino, Ciprofloxacinum

Class :

Fluroquinolone; Bioterrorism





Spectrum of Activity

Ciprofloxacin shows activity on gram-positive aerobic bacteria, gram-negative aerobic bacteria, a few anaerobic bacteria, and other organisms like chlamydia, mycoplasma, mycobacterium, Rickettsia. Ciprofloxacin shows activity more in gram-negative bacteria than gram-positive bacteria. Ciprofloxacin is inactive against fungi and viruses.

Ciprofloxacin shows activity on Gram-positive aerobic cocci in infections against S.aureus( methicillin-susceptible ( oxacillin-susceptible), S.epidermidis( oxacillin-susceptible strains ), S.pneumoniae penicillin-susceptible strains, S. pyogenes (group A β-hemolytic streptococci, S. epidermidis oxacillin-susceptible strains, S.pyogenes group A beta-hemolytic streptococci, S. saprophyticus, Enterococcus faecalis, and active in vitro activity against other staphylococci like S.haemolyticus, S.hominis. some penicillin-resistant S.pneumoniae, Viridans streptococci and group C, F, G streptococci, and nonenterococcal group D streptococci.S. pyogenes (group A β-hemolytic streptococci), S. saprophyticus, and Enterococcus faecalis

Gram-positive aerobic bacilli: Listeria monocytogenes and resistance to Nocardia asteroides.Bacillus anthracis, corynebacterium.

 Gram-negative aerobes: Active against in vitro Campylobacter jejuni, H.influenzae, H.parainfluenzae, M. cataeehalis, Ps.aeruginosa, and Some Enterobacteriaceae like Yersinia enterocolitica, Shigella, Serratia, Providencia, Salmonella, Providencia, P.mirabilis, P.Vulgaris, E. coli, Klebsiella, M.morgani, Citrobacter, Edwardsiella, Enterobacter

Active in vitro against Aeromonas, Acinebacter, Brucella, Francisella tularensis, Legionella, Vibrio, Yersinia pestis & Burkholderia cepacia, and stenotrophomonas maltophilia are resistant.

Active in vitro and clinical infections against M. pneumoniae, M. tuberculosis, C. pneumoniae, N. gonorrhoeae with decreased susceptibility to ciprofloxacin. In the U.S, quinolone-resistant N.gonorrhea widely disseminated. Resistance to ciprofloxacin can occur due to mutation in the target DNA type II topoisomerase enzyme, which results in alterations in membrane permeability and efflux pumps. Few cross-resistance occurs between ciprofloxacin and other fluoroquinolones. Some cross-resistance occurs between ciprofloxacin and other fluoroquinolones.

 

DRUG INTERACTION

Cipro

&

  • psyllium
  • bifidobacterium
  • lactobacillus
  • Saccharomyces boulardii
  • lanreotide
  • cyproterone
  • ramucirumab (Rx)
  • fidaxomycin
  • tobramycin (systemic)
  • dacomitinib
  • pembrolizumab
  • amikacin (systemic)
  • panitumumab
  • blinatumomab
  • durvalumab
  • olaratumab
  • necitumumab
  • moxetumomab pasudotox
  • mogamulizumab
  • inotuzumab
  • dinutuximab
  • pentamycin
  • dibekacin
  • cemiplimab
  • gemtuzumab
  • demeclocycline
  • omadacycline
  • tobramycin (ophthalmic)
  • sarecycline
  • cefiderocol
  • valrubicin
  • plicamycin
  • denileukin diftitox
  • decitabine
  • niraparib
  • methacholine
  • carbachol
  • bethanechol
  • acetylcholine
  • atezolizumab
  • raloxifen
  • avelumab
  • leucovorin
  • cladabrine
  • Abocitinib
  • pralatrexate
  • meclofenamate
  • pemetrexed
  • ustekinumab
  • diroximel fumarate
  • daratumumab
  • coccidioidin skin test
  • candida albicans extract
  • brewer’s yeast
  • brewer’s yeast
  • poliovirus vaccine, live, trivalent
  • elotuzumab
  • trimetrexate
  • l-methyl folate
  • Methyclothiazide
  • Influenza virus vaccine
  • Acitretin
  • Tafamidis
  • Sapropterin
  • Pidotimod
  • Nitisinone
  • Mipomersen
  • Levetiracetam
  • Inebilizumab
  • Diethylamine salicylate
  • COVID-19 vaccine
  • Cephalothin
  • Alitretinoin
  • methotrexate
  • Verteporfin
  • Omacetaxine
  • methyl aminolevulinate topical
  • efgartigimod alfa
  • aminolevulinic acid
  • cetuximab
  • streptozocin
  • zoster vaccine recombinant
  • lyme disease vaccine
  • human papillomavirus vaccine
  • daclizumab
  • capecitabine  
  • lomustiine
  • amitriptyline
  • triptorelin
  • Tedizolid
  • rituximab
  • Darolutamide
  • Altretamine
  • Varicella-zoster vaccine
  • Deferiprone
  • topotecan
  • ajmaline
  • pneumococcal vaccine
  • poliovirus vaccine
  • adenovirus vaccine type 7
  • adenovirus vaccine type 4
  • brincidofovir
  • lenograstim
  • ofatumumab
  • doxorubicin
  • thioguanine
  • tetanus toxoid
  • primidone
  • lipegfilgrastim
  • pegaspargase
  • monomethyl fumarate
  • ibritumomab
  • dimethyl fumarate
  • varicella-zoster vaccine (recombinant)
  • influenza virus vaccine, h5n1, live
  • carmustine
  • influenza virus vaccine (h5n1), adjuvanted
  • influenza a (h5n1) vaccine
  • eluxadoline
  • influenza virus vaccine quadrivalent, adjuvanted
  • idecabtagene vicleucel
  • adenovirus types 4 and 7 live, oral
  • thiotepa
  • tocilizumab
  • levodopa
  • efalizumab
  • canakinumab
  • aminoglutethimide
  • ado-trastuzumab emtansine
  • adenovirus vaccine
  • zoster vaccine live
  • typhoid vaccine, live
  • influenza virus vaccine, live, trivalent
  • influenza virus vaccine, h1n1, live
  • delavirdine
  • paclitaxel
  • siltuximab
  • miconazole
  • fludarabine
  • epirubicin
  • vinblastine
  • lomustine
  • risankizumab
  • rilonacept
  • pacritinib
  • linezolid
  • griseofulvin
  • vincristine
  • rufinamide
  • phenobarbital
  • nelarabine
  • mitoxantrone
  • mitomycin
  • mitapivat
  • letermovir
  • lasmiditan
  • idarubicin
  • filgrastim
  • elagolix
  • daunorubicin
  • daclatasvir
  • carfilzomib
  • brentuximab
  • anakinra
  • alefacept
  • thalidomide
  • teriflunomide
  • rubella virus vaccine
  • ozanimod
  • mumps virus vaccine
  • measles virus vaccine
  • golimumab
  • etanercept
  • certolizumab
  • adalimumab
  • etoposide
  • mechlorethamine
  • adenovirus type 7 vaccine
  • melphalan
  • varicella virus vaccine
  • yellow fever vaccine
  • measles mumps and rubella vaccine
  • ocrelizumab
  • palifermin
  • pimecrolimus
  • ropeginterferon alfa 2b
  • tacrolimus
  • tisagenlecleucel
  • tofacitinib
  • amphotericin B cholesteryl sulfate
  • amphotericin B deoxycholate
  • amphotericin B liposomal
  • amphotericin B phospholipid complex
  • anthrax vaccine adsorbed
  • denosumab
  • diphtheria & tetanus toxoids
  • echinacea
  • haemophilus influenzae type b vaccine
  • hepatitis A vaccine inactivated
  • hepatitis a/b vaccine
  • hepatitis b vaccine
  • HIV vaccine
  • human papillomavirus vaccine, quadrivalent
  • hydroxyurea
  • influenza virus vaccine (H5N1)
  • influenza virus vaccine trivalent
  • influenza virus vaccine trivalent, adjuvanted
  • influenza virus vaccine trivalent, recombinant
  • meningococcal A C Y and W-135 diphtheria conjugate vaccine
  • meningococcal A C Y and W-135 polysaccharide vaccine combined
  • meningococcal group B vaccine
  • ofatumumab SC
  • pneumococcal vaccine 13-valent
  • pneumococcal vaccine heptavalent
  • pneumococcal vaccine polyvalent
  • poliovirus vaccine inactivated
  • rabies vaccine
  • roflumilast
  • sipuleucel-T
  • trastuzumab
  • trastuzumab deruxtecan
  • eslicarbazepine acetate
  • vitamin a
  • rifampin
  • belzutifan
  • belimumab
  • belatacept
  • armodafinil
  • amobarbital
  • alemtuzumab
  • pimecrolimus
  • ocrelizumab
  • nivolumab
  • natalizumab
  • fingolimod
  • desogestrel
  • butalbital
  • brexanolone
  • zoster vaccine
  • yellow fever vaccine
  • varicella virus vaccine
  • smallpox vaccine
  • rotavirus vaccine
  • rubella vaccine
  • measles vaccine
  • influenza virus vaccine quadrivalent
  • atracurium
  • dengue vaccine
  • tisagenlecleucel
  • palifermin
  • lisocabtagene maraleucel
  • ciltacabtagene autoleucel
  • brexucabtagene autoleucel
  • axicabtagene ciloleucel
  • chlorambucil
  • ethinyl estradiol
  • dicumarol
  • atenolol
  • anisindione
  • penicillin G benzathine
  • chloramphenicol
  • heparin
  • enoxaparin
  • dalteparin
  • bivalirudin
  • argatroban
  • willow bark
  • bazedoxifene/conjugated estrogens
  • aspirin rectal
  • aspirin/citric acid/sodium bicarbonate
  • Aspirin
  • ganaxolone
  • erythromycin stearate
  • erythromycin lactobionate
  • erythromycin ethylsuccinate
  • elbasvir/grazoprevir
  • daridorexant
  • cholera vaccine
  • lumacaftor/ivacaftor
  • dienogest/estradiol valerate
  • zafirlukast
  • urofollitropin
  • tralokinumab
  • torsemide
  • tazarotene
  • pseudoephedrine
  • propoxiphene napsylate
  • propoxiphene hydrochloride
  • oxyphencyclimine hydrochloride
  • oxymetazoline hydrochloride
  • naxitamab
  • nandrolone decanoate
  • methylphenidate
  • methocarbamol
  • idoxuridine
  • hyaluronidase
  • hyaluronic acid
  • gonadoreline hydrochloride
  • glycopyrrolate
  • ganirelix acetate
  • gallium citrate
  • gadobutarol
  • fulvestrant
  • fexofenadine hydrochloride
  • fenefluramine hydrochloride
  • febuxostat
  • famciclovir
  • ergocalciferol
  • divalproex sodium
  • diclorfenamide
  • dezocine
  • desmopressin acetate
  • demeclocycline hydrochloride
  • defibrotide sodium
  • deferiprone
  • deferasirox
  • daunorubicin hydrochloride
  • darunavir
  • darifenacin hydrobromide
  • daptomycin
  • dapsone
  • dantrolene sodium
  • danazol
  • dalafampridine
  • dalbavancin Hydrochloride
  • daclatasvir dihydrochloride
  • dactinomycin
  • dacitabine
  • cefiderocol sulfate tosylate
  • butoconazole nitrate
  • benralizumab
  • albuterol
  • acetylcysteine
  • acebutolol
  • acam2000
  • abrocitinib
  • abobotulinumtoxin A
  • abatacept
  • abametapir
  • abaloparatide
  • chloroquine
  • ferric maltol
  • lorlatinib
  • piracetam
  • timolol
  • chlorothiazide
  • ferric pyrophosphate citrate
  • lornoxicam
  • piretanide
  • tinidazole
  • chloroxylenol
  • ferric sulfate
  • lorpiprazole
  • pirfenidone
  • tiopronin
  • chlorpheniramine
  • ferrous bisglycinate
  • losartan
  • piroxicam
  • tiotropium
  • chlorpromazine
  • ferrous fumarate
  • lovastatin
  • pitavastatin
  • tipranavir
  • chlorpropamide
  • ferrous gluconate
  • loxoprofen
  • pitolisant
  • tirofiban
  • chlorprothixene
  • ferrous succinate
  • lubiprostone
  • pivampicillin
  • tisotumab vedotin
  • chlorthalidone
  • ferrous sulfate anhydrous
  • lumateperone
  • pivmecillinam
  • tixocortol
  • chlorzoxazone
  • ferumoxides
  • lumefantrine
  • plazomicin
  • tizanidine
  • abiraterone
  • cholecalciferol
  • ferumoxsil
  • lumiracoxib
  • plerixafor
  • tobramycin (oral inhalation)
  • acalabrutinib
  • choline c 11
  • ferumoxytol
  • lurasidone
  • polatuzumab vedotin
  • tocainide
  • acarbose
  • choline magnesium trisalicylate
  • fesoterodine
  • lurbinectedin
  • polythiazide
  • tocofersolan
  • aceclofenac
  • choline salicylate
  • fexinidazole
  • lynestrenol
  • pomalidomide
  • tocopherol
  • acemetacin
  • chondroitin sulfate
  • finasteride
  • macimorelin
  • ponatinib
  • tofacitinib
  • acenocoumarol
  • chromic chloride
  • finerenone
  • macitentan
  • ponesimod
  • tolazamide
  • acetaminophen
  • chromic nitrate
  • fish oil
  • magaldrate
  • posaconazole
  • tolbutamide
  • acetazolamide
  • chromium
  • flavoxate
  • magnesium
  • potassium
  • tolcapone
  • acetohexamide
  • chromium gluconate
  • flecainide
  • magnesium carbonate
  • potassium acetate
  • tolfenamic acid
  • acetylsalicylic acid
  • chromium nicotinate
  • flibanserin
  • magnesium chloride
  • potassium bicarbonate
  • tolmetin
  • acipimox
  • chromous sulfate
  • floctafenine
  • magnesium citrate
  • potassium cation
  • tolterodine
  • aclidinium
  • ciclesonide
  • florbetaben (18f)
  • magnesium gluconate
  • potassium chloride
  • tolvaptan
  • acrivastine
  • cidofovir
  • florbetapir (18f)
  • magnesium hydroxide
  • potassium citrate
  • topiramate
  • acyclovir
  • cilazapril
  • floxuridine
  • magnesium oxide
  • potassium nitrate
  • adefovir dipivoxil
  • cilostazol
  • flucloxacillin
  • magnesium silicate
  • potassium perchlorate
  • torasemide
  • adenosine
  • cimetidine
  • fluconazole
  • magnesium sulfate
  • potassium sulfate
  • toremifene
  • agomelatine
  • cinacalcet
  • flucytosine
  • magnesium trisilicate
  • tositumomab
  • albendazole
  • cinnarizine
  • fludeoxyglucose (18f)
  • mangafodipir
  • pralidoxime
  • trabectedin
  • albiglutide
  • cinoxacin
  • fludrocortisone
  • manidipine
  • pralsetinib
  • tramadol
  • albutrepenonacog alfa
  • ciprofibrate
  • fluindione
  • mannitol
  • pramipexole
  • trametinib
  • alclofenac
  • cisapride
  • flumazenil
  • maprotiline
  • pramlintide
  • trandolapril
  • aldesleukin
  • cisplatin
  • flumethasone
  • maraviroc
  • prasugrel
  • trastuzumab emtansine
  • alectinib
  • citalopram
  • flunarizine
  • maribavir
  • pravastatin
  • trazodone
  • alendronic acid
  • cladribine
  • flunisolide
  • mebeverine
  • prazepam
  • treprostinil
  • alfentanil
  • clarithromycin
  • flunitrazepam
  • mecamylamine
  • praziquantel
  • tretinoin
  • alfuzosin
  • clemastine
  • fluocinolone acetonide
  • mecasermin
  • prednisolone
  • triamcinolone
  • alimemazine
  • clevidipine
  • fluocinonide
  • meclofenamic acid
  • prednisolone acetate
  • triamterene
  • aliskiren
  • clindamycin
  • fluocortolone
  • medrogestone
  • prednisolone phosphate
  • triazolam
  • allopurinol
  • clobazam
  • fluorouracil
  • medroxyprogesterone acetate
  • prednisone
  • trichlormethiazide
  • almasilate
  • clobetasol propionate
  • fluoxetine
  • mefenamic acid
  • prednisone acetate
  • triclabendazole
  • almotriptan
  • clofarabine
  • flupentixol
  • mefloquine
  • pregabalin
  • triethylenetetramine
  • alogliptin
  • clofazimine
  • fluprednisolone
  • megestrol acetate
  • pregnenolone
  • trifluoperazine
  • alosetron
  • clofibrate
  • flurazepam
  • melatonin
  • prenylamine
  • trifluridine
  • alpelisib
  • clomipramine
  • flurbiprofen
  • meloxicam
  • pretomanid
  • trilaciclib
  • alprazolam
  • clonazepam
  • fluspirilene
  • memantine
  • primaquine
  • trilostane
  • aluminium
  • clonidine
  • flutamide
  • menthyl salicylate
  • probenecid
  • trimebutine
  • aluminium phosphate
  • clopidogrel
  • fluticasone
  • meperidine
  • probucol
  • trimethadione
  • aluminum hydroxide
  • clorazepic acid
  • fluticasone furoate
  • mephenytoin
  • procainamide
  • trimethoprim
  • amantadine
  • clotiazepam
  • fluticasone propionate
  • mepivacaine
  • procaine benzylpenicillin
  • ambrisentan
  • clove oil
  • fluvastatin
  • meprednisone
  • procarbazine
  • trimipramine
  • ambroxol
  • cloxacillin
  • fluvoxamine
  • mepyramine
  • prochlorperazine
  • triprolidine
  • amifampridine
  • clofazimine
  • folic acid
  • mercaptopurine
  • progesterone
  • amikacin (oral inhalation)
  • clofibrate
  • fomepizole
  • meropenem
  • promazine
  • troglitazone
  • amiloride
  • clomipramine
  • fondaparinux
  • mesalazine
  • promethazine
  • troleandomycin
  • aminophenazone
  • clonazepam
  • formestane
  • mesoridazine
  • propafenone
  • tropisetron
  • aminophylline
  • clonidine
  • formoterol
  • mestranol
  • propantheline
  • trovafloxacin
  • amiodarone
  • fosamprenavir
  • metamfetamine
  • propiverine
  • tucatinib
  • amisulpride
  • fosaprepitant
  • metamizole
  • propofol
  • typhoid vaccine
  • amitriptyline
  • foscarnet
  • metaxalone
  • propranolol
  • ubidecarenone
  • amlodipine
  • fosfomycin
  • metformin
  • propylthiouracil
  • ubrogepant
  • ammonium chloride
  • fosinopril
  • methadone
  • protriptyline
  • udenafil
  • amodiaquine
  • clozapine
  • fosnetupitant
  • methazolamide
  • prucalopride
  • ulipristal
  • amoxapine
  • cobicistat
  • fosphenytoin
  • methimazole
  • prussian blue
  • upadacitinib
  • amoxicillin
  • cobimetinib
  • fostamatinib
  • pyrantel
  • vaborbactam
  • amphetamine
  • cocaine
  • fostemsavir
  • methotrimeprazine
  • pyrazinamide
  • valaciclovir
  • amphotericin b
  • codeine
  • framycetin
  • methoxsalen
  • pyridoxine
  • valbenazine
  • ampicillin
  • colchicine
  • frovatriptan
  • methsuximide
  • pyrimethamine
  • valdecoxib
  • amprenavir
  • colistimethate
  • furosemide
  • methyldopa
  • pyrithione
  • valganciclovir
  • amrinone
  • colistin
  • fusidic acid
  • methylene blue
  • quazepam
  • valproic acid
  • anagrelide
  • conivaptan
  • gabapentin enacarbil
  • methylergometrine
  • quetiapine
  • valsartan
  • ancestim
  • conjugated estrogens
  • gadobenic acid
  • methylnaltrexone
  • quinapril
  • vancomycin
  • antazoline
  • copanlisib
  • gadodiamide
  • methylprednisolone
  • quinapril
  • vandetanib
  • antihemophilic factor (recombinant), pegylated
  • corifollitropin alfa
  • gadofosveset trisodium
  • methylprednisolone aceponate
  • quinethazone
  • vardenafil
  • antipyrine
  • corticotropin
  • gadopentetic acid
  • methylprednisolone hemisuccinate
  • quinidine
  • varenicline
  • antithrombin iii human
  • cortisone acetate
  • gadoteric acid
  • methylprednisone
  • quinine
  • velpatasvir
  • antrafenine
  • crizotinib
  • gadoteridol
  • methyltestosterone
  • rabeprazole
  • vemurafenib
  • apalutamide
  • cyanocobalamin
  • galantamine
  • methysergide
  • raltegravir
  • venetoclax
  • apixaban
  • cyclacillin
  • ganciclovir
  • meticillin
  • ramelteon
  • venlafaxine
  • apomorphine
  • cyclandelate
  • gatifloxacin
  • meticrane
  • ramipril
  • verapamil
  • apremilast
  • cyclizine
  • gefitinib
  • metoclopramide
  • ranitidine
  • vernakalant
  • aprepitant
  • cyclobenzaprine
  • gemcitabine
  • metolazone
  • ranolazine
  • vibrio cholerae cvd 103-hgr strain live antigen
  • arformoterol
  • cyclopenthiazide
  • gemfibrozil
  • metoprolol
  • rasagiline
  • vilanterol
  • aripiprazole
  • cyclophosphamide
  • gemifloxacin
  • metronidazole
  • reboxetine
  • vilazodone
  • aripiprazole lauroxil
  • cyclosporine
  • gentamicin
  • metyrapone
  • regorafenib
  • vildagliptin
  • arsenic trioxide
  • cyclothiazide
  • gestrinone
  • mexiletine
  • relebactam
  • viloxazine
  • artemether
  • cyproheptadine
  • gilteritinib
  • mezlocillin
  • relugolix
  • asciminib
  • cyproterone acetate
  • gimeracil
  • mianserin
  • remdesivir
  • asenapine
  • cytarabine
  • givosiran
  • midazolam
  • repaglinide
  • vindesine
  • astemizole
  • dabrafenib
  • glasdegib
  • midostaurin
  • rescinnamine
  • vinflunine
  • asunaprevir
  • dacarbazine
  • gliclazide
  • mifepristone
  • reserpine
  • vinorelbine
  • atazanavir
  • dapagliflozin
  • glimepiride
  • migalastat
  • resorcinol
  • vismodegib
  • atogepant
  • dasatinib
  • glipizide
  • miglitol
  • retapamulin
  • vitamin d
  • atomoxetine
  • deflazacort
  • gliquidone
  • milnacipran
  • ribavirin
  • vitamin e
  • atorvastatin
  • degarelix
  • glyburide
  • milrinone
  • ribociclib
  • voclosporin
  • atovaquone
  • delafloxacin
  • glycerol phenylbutyrate
  • minocycline
  • ribostamycin
  • vorapaxar
  • auranofin
  • delamanid
  • glycol salicylate
  • mirabegron
  • rifabutin
  • voriconazole
  • aurothioglucose
  • desflurane
  • glymidine
  • mirtazapine
  • rifamycin
  • vorinostat
  • avacopan
  • desipramine
  • golodirsen
  • modafinil
  • rifapentine
  • vortioxetine
  • avanafil
  • desloratadine
  • goserelin
  • mobocertinib
  • rilpivirine
  • voxelotor
  • avapritinib
  • desoximetasone
  • granisetron
  • modafinil
  • riluzole
  • voxilaprevir
  • axitinib
  • deutetrabenazine
  • grazoprevir
  • moexipril
  • rimegepant
  • warfarin
  • azacitidine
  • dexamethasone
  • grepafloxacin
  • mometasone furoate
  • rimonabant
  • yohimbine
  • azatadine
  • dexamethasone acetate
  • guanabenz
  • montelukast
  • riociguat
  • zaleplon
  • azathioprine
  • dexbrompheniramine
  • guanethidine
  • moricizine
  • ripretinib
  • zanamivir
  • azelaic acid
  • dexchlorpheniramine maleate
  • guanfacine
  • morphine
  • risdiplam
  • zanubrutinib
  • azelastine
  • dexfenfluramine
  • guanidine
  • moxifloxacin
  • risedronic acid
  • zidovudine
  • azilsartan medoxomil
  • dexibuprofen
  • halofantrine
  • moxisylyte
  • risperidone
  • zileuton
  • azithromycin
  • dexketoprofen
  • haloperidol
  • muzolimine
  • ritonavir
  • zinc
  • azlocillin
  • dexlansoprazole
  • hetacillin
  • mycophenolate mofetil
  • rivaroxaban
  • zinc acetate
  • aztreonam
  • dexmedetomidine
  • histrelin
  • mycophenolic acid
  • rizatriptan
  • zinc ascorbate
  • bacampicillin
  • dexpanthenol
  • hydralazine
  • n-acetyltyrosine
  • rofecoxib
  • zinc chloride
  • bacitracin
  • dexrazoxane
  • hydrochlorothiazide
  • nabumetone
  • roflumilast
  • zinc gluconate
  • baclofen
  • dextran
  • hydrocodone
  • nadolol
  • rolapitant
  • zinc oxide
  • balsalazide
  • dextromethorphan
  • hydrocortisone
  • nafarelin
  • romidepsin
  • zinc sulfate
  • baricitinib
  • dextropropoxyphene
  • hydrocortisone acetate
  • nafcillin
  • ropinirole
  • zinc sulfate, unspecified form
  • bcg vaccine
  • diatrizoate
  • hydrocortisone butyrate
  • naldemedine
  • ropivacaine
  • ziprasidone
  • beclomethasone dipropionate
  • diazepam
  • hydrocortisone cypionate
  • nalidixic acid
  • rosiglitazone
  • zofenopril
  • bedaquiline
  • dichlorobenzyl alcohol
  • hydrocortisone phosphate
  • nalmefene
  • rosoxacin
  • zolmitriptan
  • belumosudil
  • diclofenac
  • hydrocortisone succinate
  • naloxegol
  • rosuvastatin
  • zolpidem
  • benazepril
  • diclofenamide
  • hydroflumethiazide
  • naloxone
  • rotigotine
  • zonisamide
  • bendamustine
  • dicloxacillin
  • hydromorphone
  • naltrexone
  • roxithromycin
  • zopiclone
  • bendroflumethiazide
  • dicoumarol
  • hydrotalcite
  • naproxen
  • rucaparib
  • zotepine
  • benorilate
  • dicyclomine
  • hydroxocobalamin
  • nateglinide
  • rupatadine
  • zuclopenthixol
  • benoxaprofen
  • didanosine
  • hydroxychloroquine
  • nebivolol
  • ruxolitinib
  • abacavir
  • benserazide
  • dienogest
  • hydroxyethyl starch
  • nedaplatin
  • sacubitril
  • abemaciclib
  • benzatropine
  • diethylstilbestrol
  • hydroxyprogesterone caproate
  • nedocromil
  • safinamide
  • benznidazole
  • diflunisal
  • hydroxyzine
  • nefazodone
  • salbutamol
  • benzocaine
  • difluocortolone
  • hyoscyamine
  • nelfinavir
  • salicylamide
  • benzphetamine
  • digitoxin
  • ibandronate
  • neomycin
  • salicylic acid
  • benzthiazide
  • digoxin
  • ibrexafungerp
  • neratinib
  • salmeterol
  • benzydamine
  • dihydralazine
  • ibrutinib
  • netilmicin
  • salmon calcitonin
  • benzyl alcohol
  • ibuprofen
  • netupitant
  • salsalate
  • benzylpenicillin
  • dihydro-alpha-ergocryptine
  • ibutilide
  • nevirapine
  • samidorphan
  • benzylpenicilloyl polylysine
  • dihydrocodeine
  • icatibant
  • niacin
  • saquinavir
  • bepotastine
  • dihydroergocornine
  • icosapent
  • nicardipine
  • saxagliptin
  • bepridil
  • dihydroergocristine
  • idarucizumab
  • nicorandil
  • scopolamine
  • berotralstat
  • dihydroergotamine
  • idebenone
  • nifedipine
  • secobarbital
  • betamethasone
  • dihydrostreptomycin
  • idelalisib
  • nilotinib
  • selegiline
  • betamethasone phosphate
  • diltiazem
  • ifosfamide
  • nilutamide
  • selenious acid
  • betaxolol
  • dimenhydrinate
  • iloperidone
  • nilvadipine
  • selenium
  • bexarotene
  • dimercaprol
  • iloprost
  • nimesulide
  • selexipag
  • bezafibrate
  • dimethyl sulfoxide
  • imatinib
  • nimodipine
  • selinexor
  • bicalutamide
  • diphenhydramine
  • imipramine
  • nintedanib
  • selpercatinib
  • bicisate
  • disopyramide
  • indacaterol
  • nirmatrelvir
  • selumetinib
  • bictegravir
  • disulfiram
  • indapamide
  • nisoldipine
  • semaglutide
  • bilastine
  • dl-methylephedrine
  • indigotindisulfonic acid
  • nitrazepam
  • sertindole
  • binimetinib
  • dobutamine
  • indinavir
  • nitrendipine
  • sertraline
  • bismuth subgallate
  • docetaxel
  • indomethacin
  • nitric oxide
  • sevelamer
  • bismuth subnitrate
  • dofetilide
  • infigratinib
  • nitrofurantoin
  • sevoflurane
  • bisoprolol
  • dolasetron
  • infliximab
  • nitroprusside
  • sibutramine
  • bisoxatin
  • domperidone
  • inosine pranobex
  • nizatidine
  • sildenafil
  • bleomycin
  • donepezil
  • inositol
  • nomegestrol
  • silodosin
  • boceprevir
  • dopamine
  • inotersen
  • nomegestrol acetate
  • simeprevir
  • bortezomib
  • doravirine
  • insulin aspart
  • norelgestromin
  • simvastatin
  • bosentan
  • doripenem
  • insulin beef
  • norethisterone
  • siponimod
  • bosutinib
  • dosulepin
  • insulin degludec
  • norethynodrel
  • sirolimus
  • brentuximab vedotin
  • doxacurium
  • insulin detemir
  • norfloxacin
  • sitagliptin
  • bretylium
  • doxazosin
  • insulin glargine
  • norgestimate
  • sodium acetate
  • brexpiprazole
  • doxepin
  • insulin glulisine
  • norgestrel
  • sodium aurothiomalate
  • brigatinib
  • insulin human
  • nortriptyline
  • sodium bicarbonate
  • brivaracetam
  • doxycycline
  • insulin lispro
  • nylidrin
  • sodium feredetate
  • bromazepam
  • doxylamine
  • insulin pork
  • octinoxate
  • sodium ferric gluconate complex
  • bromocriptine
  • dronabinol
  • iobenguane sulfate i-123
  • octreotide
  • sodium fluoride
  • bromotheophylline
  • dronedarone
  • iodixanol
  • ofloxacin
  • sodium sulfate
  • brompheniramine
  • droperidol
  • ioflupane i-123
  • olanzapine
  • sofosbuvir
  • buclizine
  • drospirenone
  • iopromide
  • olaparib
  • solifenacin
  • budesonide
  • droxidopa
  • iothalamic acid
  • oliceridine
  • solriamfetol
  • bumadizone
  • dulaglutide
  • ioversol
  • olmesartan
  • somatotropin
  • bumetanide
  • duloxetine
  • ioxilan
  • olodaterol
  • sonidegib
  • bupivacaine
  • dutasteride
  • ipecac
  • olsalazine
  • sorafenib
  • bupropion
  • duvelisib
  • ipilimumab
  • omeprazole
  • sorbitol
  • buprenorphine
  • dydrogesterone
  • irbesartan
  • ondansetron
  • sotagliflozin
  • bupropion
  • dyphylline
  • irinotecan
  • opium
  • sotalol
  • buserelin
  • ebastine
  • iron
  • orphenadrine
  • sparfloxacin
  • buspirone
  • edoxaban
  • iron dextran
  • oseltamivir
  • spirapril
  • busulfan
  • edrophonium
  • iron isomaltoside 1000
  • osilodrostat
  • spironolactone
  • butabarbital
  • efavirenz
  • iron sucrose
  • osimertinib
  • stavudine
  • butriptyline
  • elbasvir
  • isavuconazole
  • ospemifene
  • stiripentol
  • cabazitaxel
  • eletriptan
  • isavuconazonium
  • oxacillin
  • streptomycin
  • cabergoline
  • eliglustat
  • isoflurane
  • oxaliplatin
  • strontium chloride
  • cabozantinib
  • eltrombopag
  • isoniazid
  • oxaprozin
  • stavudine
  • caffeine
  • elvitegravir
  • isosorbide
  • oxatomide
  • stiripentol
  • calcitriol
  • emedastine
  • isosorbide mononitrate
  • oxazepam
  • streptomycin
  • calcium acetate
  • empagliflozin
  • isosulfan blue
  • oxtriphylline
  • strontium chloride
  • calcium carbonate
  • emtricitabine
  • isotretinoin
  • oxybenzone
  • strontium ranelate
  • calcium chloride
  • enalapril
  • isoxicam
  • oxybutynin
  • sucralfate
  • calcium citrate
  • enalaprilat
  • isradipine
  • oxycodone
  • sufentanil
  • calcium glucoheptonate
  • enasidenib
  • istradefylline
  • oxymorphone
  • sulbactam
  • calcium gluconate
  • encainide
  • itraconazole
  • oxyphenbutazone
  • sulfadiazine
  • calcium lactate
  • encorafenib
  • ivabradine
  • oxyquinoline
  • sulfamethoxazole
  • calcium phosphate
  • enfortumab vedotin
  • ivacaftor
  • oxytocin
  • sulfasalazine
  • calcium polycarbophil
  • enoxacin
  • ivermectin
  • sulfinpyrazone
  • canagliflozin
  • entecavir
  • ivosidenib
  • palbociclib
  • sulfisoxazole
  • candesartan cilexetil
  • entrectinib
  • ixabepilone
  • paliperidone
  • sulindac
  • cannabidiol
  • enzalutamide
  • ixazomib
  • palonosetron
  • sulpiride
  • canrenoic acid
  • epinastine
  • kanamycin
  • palovarotene
  • sultamicillin
  • capecitabine
  • eplerenone
  • ketamine
  • pamidronic acid
  • sultopride
  • capmatinib
  • epoprostenol
  • ketazolam
  • panobinostat
  • sumatriptan
  • capreomycin
  • eprosartan
  • ketoconazole
  • pantoprazole
  • sunitinib
  • capsaicin
  • eravacycline
  • ketoprofen
  • papaverine
  • suvorexant
  • captopril
  • erdafitinib
  • ketorolac
  • paramethadione
  • synthetic conjugated estrogens, a
  • carbamazepine
  • ergoloid mesylate
  • labetalol
  • parecoxib
  • synthetic conjugated estrogens, b
  • carbenicillin
  • ergometrine
  • lacidipine
  • paricalcitol
  • tacrine
  • carbidopa
  • ergotamine
  • lacosamide
  • paritaprevir
  • tacrolimus
  • carbimazole
  • eribulin
  • lactulose
  • paromomycin
  • tadalafil
  • carbinoxamine
  • erlotinib
  • lamivudine
  • paroxetine
  • tafenoquine
  • carboplatin
  • ertapenem
  • lamotrigine
  • pasireotide
  • talc
  • carindacillin
  • ertugliflozin
  • lansoprazole
  • patent blue
  • tamoxifen
  • cariprazine
  • erythromycin
  • lanthanum carbonate
  • patiromer
  • tamsulosin
  • escitalopram
  • lapatinib
  • pazopanib
  • tasimelteon
  • carprofen
  • esketamine
  • larotrectinib
  • pefloxacin
  • tazemetostat
  • carvedilol
  • esmolol
  • latamoxef
  • pegaptanib
  • technetium tc-99m exametazime
  • cefaclor
  • esomeprazole
  • ledipasvir
  • peginesatide
  • technetium tc-99m mebrofenin
  • cefadroxil
  • estazolam
  • lefamulin
  • technetium tc-99m oxidronate
  • cefalotin
  • esterified estrogens
  • leflunomide
  • pemigatinib
  • teduglutide
  • cefamandole
  • estetrol
  • lemborexant
  • penbutolol
  • tegafur
  • cefapirin
  • estradiol
  • lenalidomide
  • penciclovir
  • telaprevir
  • cefazolin
  • estradiol acetate
  • lenvatinib
  • penicillamine
  • telavancin
  • cefdinir
  • estradiol benzoate
  • lercanidipine
  • pentaerythritol tetranitrate
  • telithromycin
  • cefditoren
  • estradiol cypionate
  • lesinurad
  • pentamidine
  • telmisartan
  • cefepime
  • estradiol dienanthate
  • letrozole
  • pentastarch
  • temazepam
  • cefmenoxime
  • estradiol valerate
  • leuprolide
  • pentetic acid
  • temocillin
  • cefmetazole
  • estramustine
  • levacetylmethadol
  • pentobarbital
  • temozolomide
  • cefonicid
  • estrone sulfate
  • levamlodipine
  • pentostatin
  • temsirolimus
  • cefoperazone
  • eszopiclone
  • levobupivacaine
  • pentoxifylline
  • teniposide
  • ceforanide
  • etacrynic acid
  • levocabastine
  • perampanel
  • tenofovir alafenamide
  • ceforanide
  • etafedrine
  • levocarnitine
  • perflubutane
  • tenofovir disoproxil
  • cefotaxime
  • ethambutol
  • levocetirizine
  • perflutren
  • tenoxicam
  • cefotetan
  • ethanol
  • levofloxacin
  • perhexiline
  • tepotinib
  • cefotiam
  • ethinylestradiol
  • levoketoconazole
  • perindopril
  • terbinafine
  • cefoxitin
  • ethosuximide
  • levomenthol
  • permethrin
  • terbutaline
  • cefpiramide
  • ethynodiol diacetate
  • levomilnacipran
  • perphenazine
  • terfenadine
  • cefpirome
  • etodolac
  • levonorgestrel
  • pexidartinib
  • terlipressin
  • cefpodoxime
  • etomidate
  • levosalbutamol
  • phenazopyridine
  • testolactone
  • cefprozil
  • etonogestrel
  • levosimendan
  • phenelzine
  • testosterone
  • cefradine
  • levothyroxine
  • pheneticillin
  • testosterone cypionate
  • ceftaroline fosamil
  • etoricoxib
  • lidocaine
  • phenformin
  • testosterone enanthate
  • ceftazidime
  • etravirine
  • lidoflazine
  • phenindione
  • testosterone propionate
  • ceftibuten
  • eucalyptus oil
  • linagliptin
  • pheniramine
  • testosterone undecanoate
  • ceftizoxime
  • everolimus
  • liothyronine
  • penicillin v
  • tetrabenazine
  • ceftobiprole
  • exemestane
  • liotrix
  • phenprocoumon
  • tetracycline
  • ceftolozane
  • exenatide
  • liraglutide
  • phentermine
  • tetradecyl hydrogen sulfate (ester)
  • ceftriaxone
  • ezogabine
  • lisinopril
  • phentolamine
  • tetraferric tricitrate decahydrate
  • cefuroxime
  • famotidine
  • lisuride
  • phenylbutazone
  • tezacaftor
  • celecoxib
  • fedratinib
  • lithium carbonate
  • phenytoin
  • theophylline
  • celiprolol
  • felbamate
  • lithium citrate
  • pholcodine
  • thiabendazole
  • cenobamate
  • felodipine
  • lixisenatide
  • phosphoric acid
  • thiamylal
  • cephalexin
  • fenbufen
  • lofexidine
  • phylloquinone
  • thiethylperazine
  • cephaloglycin
  • fenfluramine
  • lomefloxacin
  • picosulfuric acid
  • thioridazine
  • ceritinib
  • fenofibrate
  • lomitapide
  • pimavanserin
  • cerivastatin
  • fenofibric acid
  • lonafarnib
  • pimozide
  • thiothixene
  • certolizumab pegol
  • fenoldopam
  • loperamide
  • pinacidil
  • tiagabine
  • cetirizine
  • fenoprofen
  • lopinavir
  • pinaverium
  • tiaprofenic acid
  • cevimeline
  • fentanyl
  • loracarbef
  • pindolol
  • ticagrelor
  • chenodeoxycholic acid
  • ferric ammonium citrate
  • loratadine
  • piperacillin
  • ticarcillin
  • chloral hydrate
  • ferric carboxymaltose
  • lorazepam
  • piperaquine
  • ticlopidine
  • chlorcyclizine
  • ferric cation
  • lorcaserin
  • pipotiazine
  • tiludronic acid
  • acebutolol
  • albuterol
  • bcg vaccine live
  • aminolevulinic acid topical
  • aminolevulinic acid oral
  • ProQuin XR
  • ofloxacin
  • Moxifloxacin Systemic
  • moxifloxacin
  • Floxin
  • Cipro
  • Cipro XR
  • delafloxacin
  • Avelox
  • ciprofloxacin
Cipro + 

Doses Form and Uses

Dizziness

Restlessness

Lightheadedness

Vaginitis

Insomnia

Photosensitivity

Pruritus

Rash

Anxiety

Agitation

Confusion

Tendinitis

Arthralgia

Lfts Elevated

Myalgia

Disorientation

Attention Disturbance

Nervousness

Impaired Memory

Delirium

Paranoia

Hallucinations

Nightmares

Tremor

Hyperglycemia

SERIOUS ADVERSE REACTION

 

Permanent disabled adverse reaction found while using fluoroquinolones with tendinitis and tendon rupture, peripheral neuropathy, and CNS effects.

Tendinitis/tendon rupture may occur during treatment or months after discontinued treatment and risk all ages.

Risk increased in older patients aged more than 60 years.

Strictly Avoided in the patient on Corticosteroids and Kidney/Heart/Lung transplant patients.

Avoid in Myasthenia Gravis patients leads to exacerbating muscle weakness.

 

RESERVE USE FOR PATIENTS WITH NO ALTERNATIVE OPTIONS

ACUTE BACTERIAL SINUSITIS

ACUTE BACTERIAL EXACERBATION OF CHRONIC BRONCHITIS UNCOMPLICATED UTI

Aortic Aneurysm Risk (Unless No Other Options)

Marfan Syndrome (Unless No Other Options)

Ehlers-Danlos Syndrome (Unless No Other Options)

Caution If Qt Prolongation

Caution If Congenital Long Qt Syndrome

Caution If Qt Prolongation Family Hx

Caution If Torsades De Pointes Hx

Caution If Ventricular Arrhythmias

Caution If Bradycardia

Caution If Recent Mi

Caution If CHF

Caution If Electrolyte Abnormalities

Caution If G6pd Deficiency

Caution If Tendon Disorder History

Caution If Kidney, Heart Or Lung Transplant

Caution If Peripheral Neuropathy Or History

Caution If Renal Impairment

Caution If Hepatic Impairment

Caution If Seizure Disorder

Caution If Seizure Threshold Lowered

Caution If Cns Disorder

Caution If Dehydration

Caution If Diabetes Mellitus

Caution If Recent Abx-Assoc. Colitis History

Caution If Depression Or History

 

 

 

Pregnancy Warning 

According to data no evidence of the risk of a teratogenic effect on humans and animals. Risk of abortion in human data and bone cartilage damage in animal data.

 

Breastfeeding Warnings

After a dose of anthrax, avoid breastfeeding for 3 to 4 hrs. Avoid breastfeeding during treatment or 2 days after discontinuation.No data is available for infant C.Difficile assoc. Diarrhea as well as effects on milk production.

 

 

Mechanism Of Action.            

Fluoroquinolones inhibit the enzyme bacterial DNA gyrase ( Primarily active in gram-negative bacteria), which nicks double-stranded DNA, introduces negative supercoils, and then reseals the neaked ends, needed to prevent supercoiling of strands. At the same time, they separate to permit replication or transcription. The DNA gyrase consists of Two A and Two B subunits: The A subunits carry nicking DNA, the B subunit introduces negative supercoils & then the A subunit reseals the strands. Fluoroquinolones bind to A subunits with high affinity and interfere with its strand cutting and resealing function.

In gram-positive bacteria, the primary target of   Fluoroquinolones action is a similar enzyme topoisomerase IV which nicks and DNA replicates & separates daughter DNA strands from it. Higher the topoisomerase IV affinity confer higher potency against gram-positive bacteria. The bactericidal action probably results from the digestion of DNA by exonucleases whose production is signaled by the damaged DNA.                            

Mechanism of Resistance  

Resistance was noted due to chromosomal mutation producing DNA gyrase or Topoisomerase IV with reduced affinity for Fluoroquinolones or reduced permeability /increased efflux of this drug across the bacterial membrane. Opposite to nalidixic acid, which selects single-step resistance mutants at high frequency, Fluoroquinolones resistance mutants are not easily selected; therefore, resistance to fluoroquinolones is slow to develop. However, reported increasing resistance among Salmonella, Pseudomonas, Staphylococci, Gonococci, and Pneumococci.                                                                                     

Absorption

Bioavailability (PO): ~50-85%

Peak plasma time (PO): Immediate-release, 0.5-2 hr; extended-release, 1-2.5 hr

Distribution

Distributed widely throughout the body; tissue concentrations often exceed serum concentrations, especially in kidneys, gallbladder, liver, lungs, gynecologic tissue, and prostatic tissue; cerebrospinal fluid (CSF) concentration is 10% in noninflamed meninges and 14-37% in inflamed meninges; crosses placenta; enters breast milk.

Protein-bound: 20-40%

Vd: 2.1-2.7 L/kg

Metabolism

Metabolized in liver

Enzyme inhibitor: CYP1A2

Elimination

Half-life: 2-5 hr (children); 3-5 hr (adults)

Excretion: Urine (30-50%), feces 

IV compatibilities 

 

Infuse 1-2 mg/mL in Dextrose or normal saline into large vein for 60 min.

When administering intermittently through Y-site, temorarily discontinue primary solution.

 

IV Incompatibilities

Additive: Aminophylline, amoxicillin, amoxicillin-clavulanate, amphotericin, ampicillin-sulbactam, ceftazidime, cefuroxime, clindamycin, floxacillin, heparin, piperacillin, sodium bicarbonate, ticarcillin

Y-site: Aminophylline, ampicillin-sulbactam, azithromycin, cefepime, dexamethasone sodium phosphate, furosemide, heparin, hydrocortisone sodium succinate, magnesium sulfate, methylprednisolone sodium succinate, phenytoin, potassium phosphates, propofol, sodium bicarbonate, sodium phosphates, total parenteral nutrition formulations, warfarin

 

IV Compatibilities

Solution: Compatible with most IV fluids

Additive: Amikacin, aztreonam, dobutamine, dopamine, fluconazole, gentamicin, lidocaine, linezolid, metronidazole (ready-to-use form is compatible; hydrochloride form in vial is incompatible), midazolam, potassium chloride, tobramycin

Y-site: Amiodarone, calcium gluconate, clarithromycin, digoxin, diphenhydramine, dobutamine, dopamine, linezolid, lorazepam, midazolam, promethazine, quinupristin/dalfopristin, tacrolimus

 

Storage 

Stable at 0.5-2mg/mL in dextrose five or normal saline for 14 days at room temprature or in freeze.

Generic Name: Ciprofloxacin( Oral) 

Pronounced: SIP roe FLOX a sin 

Why do we use Ciprofloxacin?

This drug is from fluoroquinolone category used for different types of bacterial infection, e.g., Skin Infection, Lung or airway infection like T.B., pneumonic and septicemic plague, chronic bronchitis, lower respiratory tract infection, bone infection, Urinary tract infection, infectious diarrheas caused by E.Coli Campylobacter jejuni & shigella bacteria. Anthrax, Typhoid fever, cervical and urethral gonorrhea, cystitis 

WARNING  

Ciprofloxacin may cause a severe permanent effect on tendon-like tendon rupture, tendonitis, nerve problem in the leg & arm ( peripheral neuropathy), and nervous system problem like depression seizures. Contact your physician if you are on Ciprofloxacin and observe the following symptoms: Pain/numbness/burning/tingling/weakness in arms/hands/legs/feet, changes in senses touch, pain, temperature, vibration, body position, severe or lasting headache, vision changes, shaking ( tremors), mental/mood changes like agitation, anxiety, confusion, hallucination, depression, rare thoughts of suicide. If you observe any sign like pain or swelling in joints/muscles, stop exercising, take a rest and seek medical help.

Avoid patients with age more than 60yr and patients taking prednisolone ( Corticosteroids), patients with transplant (kidney, heart, lung), which leads to increased tendon problems. Ciprofloxacin worsens Myasthenia gravis condition. Consult your doctor if you have new or worsening muscle weakness such as drooping eyelids, unsteady walk, or trouble breathing. Talk to the doctor before using this medicine. 

HOW TO USE  

Before starting Ciprofloxacin, read the medication guide or patient information leaflet, which the Pharmacist provides. If doubts or questions related to medication, consult your doctor. This medicine is either taken with or without food as directed by a doctor, usually twice a day every 12, in the morning and evening. Shake the container for 15 seconds (apply for Liquid forms )before pouring each dose. Carefully measure the amount using a measuring device/spoon, which is given along with medication. Don’t use the kitchen spoon, which may not get the correct dose. Don’t chew the contents of the suspension. Do not use a feeding tube for rest, which may clog the pipe.

The dosage and duration of treatment depend upon the patient’s condition and the response to treatment. Drink plenty of water while on medication. To avoid drug-drug interaction, patients need to tell the doctor about their medical history (for Allergies). Administer this medicine 2 hours before or 6 hours after taking other products that may bind to it, decreasing the medication effect. Avoid Dairy products & calcium-containing juices to reduce the absorption of Ciprofloxacin. Take with or without food; absorption is not affected by food. Limit caffeine intake. Take this medicine at least 2 hr before or 6hr after eating calcium-rich foods. Ask your doctor/Pharmacist about using nutritional supplement/replacement with this medicine. For the best result, take the dose of medicine simultaneously to avoid missed doses. Complete the course, even if symptoms disappear after a few days. If patients do not complete the period of antibiotics, it increases the chance of the return of the infection. If patients continuously skip the medication without completing the course leads to produce resistance (drugs do not show the effect on the microorganism responsible for infection)of that medicine. If your condition persists or worsens, tell your doctor. 

SIDE EFFECT 

If you observe nausea, diarrhea, dizziness, lightheadedness, headache, or trouble sleeping, talk to your Doctor/Pharmacist. The selection of medication for patients by a doctor mostly depends on factors like patients’ history, treatment history, allergic condition, age, etc. Consult your doctor if there are any side effects like unusual bruising or bleeding, signs of new or persistent fever, sore throat. Also, don’t ignore if change in the urine volume, red/pink color urine, dark urine seek medical help immediately because that are the signs of kidney problems. Contact your doctor/Pharmacist directly if you have severe dizziness, fainting, fast/irregular heartbeat, sudden pain in the Chest/stomach/shortness of breath/back/cough. This medicine rarely produces an intestinal condition due to a bacterial called C.difficile; this condition may occur during or after weeks of treatment stopped. If you have developed: diarrhea that doesn’t stop, abdominal or stomach pain/cramping, blood/mucus in your stool, tell your doctor. Suppose you have these symptoms, don’t use anti-diarrhea or opioid products because they may worsen symptoms. This medication’s prolonged use leads to white patches in your mouth, a change in vaginal discharge, or any other new symptoms. Severe allergic reaction is infrequent in this medication, but still, you find out rash/itching/swelling to the face, tongue, throat—trouble breathing severe dizziness. If you find other side effects that are not mentioned, contact your doctor/pharmacist or directly report the side effects to the manufacturing company or FDA official website.

 

PRECAUTIONS

 

During a doctor visit, tell your doctor/pharmacist about any medical history like diabetes, heart problem like heart attack, joint or tendon pain, kidney disease, liver disease, mental/mood disorder, myasthenia gravis, peripheral neuropathy, seizures, blood vessels related disease or condition, B.P., genetic condition, allergic condition or history of allergy with other quinolones antibiotics like norfloxacin,gemifloxacin, levofloxacin, moxifloxacin or ofloxacin. Tell your doctor if you have problems related to heart problems like prolonged. Q.T. intervals rarely cause fast severe/irregular heartbeat and other symptoms such as severe dizziness, fainting which need medical attention. Tell all the information about ongoing treatment and past treatment to the doctor. This medication rarely causes elevated blood sugar levels; check your blood glucose level and share report with doctors. Monitor increased urination or thirst and consult your doctor. Glyburide with Ciprofloxacin shows an increase in the glucose-lowering effect. Also, observe the symptoms of blood sugar lowering like sudden sweating, shaking, fast heartbeat, hunger, blurred vision, dizziness, or tingling hands/feet. Carry glucose tablets if a diabetic patient with Ciprofloxacin sees the above symptoms. If you don’t carry the glucose tablet, eat sugar content products to elevate the sugar level. Maintain a good sugar level with a proper diet and small meals. Do not skip a meal. Your doctor needs to switch to another diabetes medication if any reaction occurs. Avoid alcohol or marijuana; Ciprofloxacin already makes dizzy, and intake of alcohol or marijuana makes dizzier, lifting heavy things, driving, or any other things which require alertness. This drug is photosensitive so try to avoid tanning booths and sunlamps. Wear sunscreen and wear protective wear when outside; if you get sunburned or have any skin-related problem, talk to the doctor.

Avoid typhoid vaccine when you are on Ciprofloxacin. Tell the physician/doctor that you are on ciprofloxacin treatment before immunizations. This medicine contains sucrose so before surgery, tell your doctor or dentist you are taking Ciprofloxacin. This drug is not recommended if you suffer from a hereditary metabolic condition such as fructose intolerance,sucrase-isomaltase deficiency,glucose-galactose malabsorption. Children are more sensitive to the side effect of this drug, especially in joint/tendon problems. An older patient may suffer more if they have tendon problems on corticosteroids, prolonged QTc interval, and sudden break or tear main blood vessel. Suppose your nursing infant consult a doctor about treatment. 

DRUG INTERACTIONS

Drug-drug interaction may change how your medications work, increase your risk for a severe side effect, or require patient monitoring. This document does not claim all possible drug-drug interactions. Before visiting the doctor, keep a list of all products you use, including prescribed drugs, OTC, and herbal products; share this with your doctor or Pharmacist. Without your doctor’s approval, don’t stop, change, or start the medicine. Some products like acenocoumarol, warfarin, strontium may interact with Ciprofloxacin.Many drugs like amiodarone,dofetilide,quinidine,procainamidesotalol prolonged QTc interval besides ciprofloxacin . Drugs like duloxetine, flibanserin, lomitapide, pirfenidone, tasimelteon, tizanidine removal of this drug slow down by Ciprofloxacin. Avoid caffeine intake, OTC product that contains caffeine; this medicine increases the effect of caffeine. 

OVERDOSE 

The patient overdosed and has severe symptoms of passing out or breathing; in the U.S., call 911 and call a poison control center immediately. Other countries call an ambulance and are admitted to the hospita 

NOTES 

Don’t share your medicines with anyone. You depend upon microorganisms that cause infection in the body medicines selected by doctors. This medicine is prescribed for your current condition, and don’t use it without consulting your doctor for the subsequent infection. Treatment or selection of proper medication depending upon lab test or medical test such as kidney function, blood counts, cultures. This should be monitored closely for progress or to check the side effects. Consult your doctor for more details about the medication. Don’t change the brand of medicine without consulting the doctor; not all brands have the same effect   

MISSED DOSE 

If you miss a dose, If it’s less than 6 hours before the next dose, skip the missed dose. Do not double the dose to level up the missed dose. Take the next dose at the regular tim  

STORAGE 

Store the dry powder in an upright position at room temperature. Do not keep in freeze. Once mixed with water for injection, please keep it in the refrigerator or room temperature. Discard the suspension after 14 days. Keep away from children and pets. Before discarding, consult the doctor/physician if you have any doubts or queries.

 

 

 

 

 

 

 

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Cipro

Brand Name :

Cipro, Cipro XR, ProQuin XR, Ciprofloxacin,Ciloxan,cetraxal, Cipro HC, Ciprodex, Otiprio, Otixal, Otovel. Bacquinor, Baycip, Ciflox,Cifloxin, Ciprinol, Ciprobay, Ciprocinol, Ciprodar, Ciproxan, Ciproxin, Flociprin, Proquin

Synonyms :

Alcon Cilox, AuriPro, Bacquinor, Baflox , Bay o 9867, Bay q 3939, BAYQ3939 , Bernoflox, Bi-Cipro, BRN 3568352 , CCRIS 5241, Cetraxal , Cifloxin, Cilab, Ciplus, Ciprecu , Cipro Cipro IV, Cipro XR , Ciprobay, Ciprobay Uro, Ciprocinol Ciprodar, Ciproflox, Ciprofloxacin, Ciprofloxacina, Ciprofloxacine, Ciprofloxacine [INN-French], Ciprofloxacino, Ciprofloxacino [INN-Spanish], Ciprofloxacinum, Ciprofloxacinum [INN-Latin], Ciprogis , Ciprolin, Ciprolon, Cipromycin, Ciproquinol, Ciprowin, Ciproxan, Ciproxina, Ciproxine , Ciriax , Citopcin, Cixan, Corsacin , Cycin , Cyprobay, Eni, Fimoflox, HSDB 6987, Ipiflox, Italnik, Linhaliq, Linhaliq [Liposomal Formulation], Loxan, NSC 758467 , Otiprio, Probiox, Proflaxin, Proflox, Proksi 250 , Proksi 500, Quinolid , Quintor, Rancif, Roxytal , Septicide, Sophixin, Ofteno , Spitacin, Superocin, Unex, UNII-5E8K9I0O4U, Zumaflox, Ciprofloxacin, Ciprofloxacine, Ciprofloxacino, Ciprofloxacinum

Class :

Fluroquinolone; Bioterrorism




Spectrum of Activity

Ciprofloxacin shows activity on gram-positive aerobic bacteria, gram-negative aerobic bacteria, a few anaerobic bacteria, and other organisms like chlamydia, mycoplasma, mycobacterium, Rickettsia. Ciprofloxacin shows activity more in gram-negative bacteria than gram-positive bacteria. Ciprofloxacin is inactive against fungi and viruses.

Ciprofloxacin shows activity on Gram-positive aerobic cocci in infections against S.aureus( methicillin-susceptible ( oxacillin-susceptible), S.epidermidis( oxacillin-susceptible strains ), S.pneumoniae penicillin-susceptible strains, S. pyogenes (group A β-hemolytic streptococci, S. epidermidis oxacillin-susceptible strains, S.pyogenes group A beta-hemolytic streptococci, S. saprophyticus, Enterococcus faecalis, and active in vitro activity against other staphylococci like S.haemolyticus, S.hominis. some penicillin-resistant S.pneumoniae, Viridans streptococci and group C, F, G streptococci, and nonenterococcal group D streptococci.S. pyogenes (group A β-hemolytic streptococci), S. saprophyticus, and Enterococcus faecalis

Gram-positive aerobic bacilli: Listeria monocytogenes and resistance to Nocardia asteroides.Bacillus anthracis, corynebacterium.

 Gram-negative aerobes: Active against in vitro Campylobacter jejuni, H.influenzae, H.parainfluenzae, M. cataeehalis, Ps.aeruginosa, and Some Enterobacteriaceae like Yersinia enterocolitica, Shigella, Serratia, Providencia, Salmonella, Providencia, P.mirabilis, P.Vulgaris, E. coli, Klebsiella, M.morgani, Citrobacter, Edwardsiella, Enterobacter

Active in vitro against Aeromonas, Acinebacter, Brucella, Francisella tularensis, Legionella, Vibrio, Yersinia pestis & Burkholderia cepacia, and stenotrophomonas maltophilia are resistant.

Active in vitro and clinical infections against M. pneumoniae, M. tuberculosis, C. pneumoniae, N. gonorrhoeae with decreased susceptibility to ciprofloxacin. In the U.S, quinolone-resistant N.gonorrhea widely disseminated. Resistance to ciprofloxacin can occur due to mutation in the target DNA type II topoisomerase enzyme, which results in alterations in membrane permeability and efflux pumps. Few cross-resistance occurs between ciprofloxacin and other fluoroquinolones. Some cross-resistance occurs between ciprofloxacin and other fluoroquinolones.

 

Dosage forms 

Tab  

100mg

250mg

500mg

750mg

 

ER TAB

500mg

1000mg

Suspension 

250mg per 5ml

500mg per 5ml 

Injection 

200mg/100 mL

200mg/20 mL

400mg/40mL

400mg/200mL

Bacterial Infection

Oral route 

Dose 250-750mg per orally every 12 hour

Info: duration varies with infection type, severity 

Intravenous 

Dose 200-400mg IV every 12 hour

Severe/Complicated: 400mg IV every 8 hour

Info: duration varies with infection type, severity

 

Urinary Tract Infection 

Uncomplicated cystitis

Dose: 500mg ER PO every 24 hr for three days

Alt: 250mg per orally every 12 hr for three days

Patients with no alternative treatment options; refer to IDSA guidelines; do not cut/crush/chew ER tab. 

 

Uncomplicated pyelonephritis

Dose:1000mg per orally ER every 24 hr for seven days 

Alt:500 mg Per orally every 12 hr for seven days; 400mg IVx1, then 500mg Per orally every 12 hr for seven days totals; 400mg IV every

 

Complicated 

Dose: 1000mg ER per orally every 24 hr for 7 to 14 days

Alt:500 mg Per orally every 12 hr for 7 to 14 days; 400mg IV 12hr for 7-14 day

Info: do not cut/crush/chew ER tab 

 

Intra-abdominal infections, complicated

Dose:500 mg Per Orally every 12hr for 7-14 days

Alt: 400 mg IV every 12h for 7-14 days

Info: Part of a multi-drug regimen

 

Bone/joint infections

Dose:500-750 mg Per Orally every 12 hr for 4-8wk

Alt: 400 mg IV every 8-12hr for 4-8wk

 

Prostatitis, Chronic Bacterial

500 mg PO q12h x28 days

 

Pneumonia, hospital-acquired or ventilator-assoc.

400 mg IV q8h x7 days

Info: may extend duration based on clinical response; refer to IDSA guidelines

 

Anthrax

systemic

Dose: 400 mg IV every 8hr for at least 2wk; 

Info: 1st-line agent; part of multi-drug regimen; may use as a 1st-line agent in pregnant women; switch to PO Abx for post-exposure prophylaxis if inhalational exposure

 

cutaneous

Dose: 500 mg PO q12h x7-10 days; Info: for non-systemic infection; 1st-line agent; may use as 1st-line agent in pregnant women; use extended duration for post-exposure prophylaxis if bioterrorism suspected.

 

Post-exposure prophylaxis

Dose: 500 mg PO q12h x60 days; 

Info: 1st-line agent; give in combo w/ anthrax vaccine; may use as a 1st-line agent in pregnant women; may give x42 days or x14 days after last vaccine dose in immunocompetent pts 18-65 year; if anthrax vaccine regimen completed.

 

Typhoid fever

500 mg Per Orally every12h x2wk

 

Plague

500-750 mg Per Orally every 12h x2wk

Info: for prophylaxis and treatment

 

Chancroid

500 mg Per Orally every 12h x3 days

 

Salmonellosis, acute

500-750 mg Per Orally every 12h x3-7 days

Info: may extend treatment x1wk if immunocompromised

 

Salmonella, chronic carrier

750 mg PO every 12hr x1mo

 

Shigellosis, severe

500-750 mg PO every12h

Info: duration varies w/ infection severity; refer to CDC guidance

Febrile neutropenia, chemo-induced

 

PEDIATRIC DOSING 

Dosage Forms

Tab

250mg

500mg

750mg

ER Tab 

500mg

1000mg

Suspension

250mg per 5 mL

5oomg per 5mL

Injection

200mg/100 mL

200mg/20 mL

400mg/40mL

400mg/200mL

Urinary Tract Infection 

1-17 year

Dose: 18-30 mg/kg/day divided every 8 hr x 10-21 days

Max:400mg/dose IV; 750mg/dose PO

Alt: 20-40mg /kg/day PO divided every 12 hr

Info: for complicated UTI or pyelonephritis; not a first-line agent

Systemic anthrax

Neonates more than 32wk gestation

Dose:20-30mg/kg/day IV divided every 12 hr for at least 2wk

Info: 1st line agent; part of multi-drug regimen; dose depends on gestational and postnatal age; switch to Po abx*60 days total if inhalational exposure 

1 month and older 

Dose: 30 mg/kg/day IV divided q8h for at least 2wk; Max: 400 mg/dose; Info: 1st-line agent; part of multi-drug regimen; switch to PO abx x60 days total if inhalational exposure

Anthrax

cutaneous

neonates more than 32 wk gestation

Dose: 20-30 mg/kg/day PO divided q12h x7-10 days; Info: for non-systemic infection; 1st-line agent; dose depends on gestational and post-natal age; give abx x60 days total if bioterrorism suspected

1 month and older

Dose: 30 mg/kg/day PO divided q12h x7-10 days; Max: 500 mg/dose; Info: for non-systemic infection; 1st-line agent; give abx x60 days total if bioterrorism suspected

Anthrax

Post-exposure prophylaxis

neonates more than 32 wk gestation

Dose: 20-30 mg/kg/day PO divided q12h x60 days; Info: 1st-line agent; dose depends on gestational and postnatal age

1 month and older

Dose: 30 mg/kg/day PO divided q12h x60 days; Max: 500 mg/dose; Info: 1st-line agent

Plague

15 mg/kg/dose PO q8-12h x10-21 days

Max: 500 mg/dose; Info: for prophylaxis and tx

Infections, bacterial

20-30 mg/kg/day PO divided q12h

Alt: 15-30 mg/kg/day IV divided q8-12h; Max: 750 mg/dose PO; 400 mg/dose IV

Resp. infections, cystic fibrosis pts

40 mg/kg/day PO divided q12h

Alt: 30 mg/kg/day IV divided q8h; Max: 750 mg/dose PO; 400 mg/dose IV

Community-acquired pneumonia, mod-severe bacterial

More than 3 month

Dose: 30 mg/kg/day IV divided q12h x10 days; Info: may switch to PO regimen when possible to complete course

Salmonellosis, acute

20-30 mg/kg/day PO divided q12h x3-7 days

Max: 750 mg/dose; Info: may extend tx x1wk if immunocompromised

Salmonella, chronic carrier

20-30 mg/kg/day PO divided q12h x1mo

Max: 750 mg/dose

Shigellosis, severe

1 mo and older

Dose: 30 mg/kg/day PO divided q12h; Max: 500 mg/dose; Info: duration varies w/ infection severity; refer to CDC guidance

Typhoid fever

30 mg/kg/day PO/IV divided q12h x1-2wk

Max: 500 mg/dose

Chancroid

preadolescents >45 kg and adolescents

Dose: 500 mg PO q12h x3 days

Febrile neutropenia, chemo-induced

20-40 mg/kg/day PO divided q12h

Max: 750 mg/dose; Info: for empiric tx in low-risk pts not on fluoroquinolone prophylaxis; give w/ amoxicillin/clavulanate

Meningococcal prophylaxis

1 mo and older

Dose: 20 mg/kg/dose PO x1; Info: for asymptomatic meningococcal carriers

Infection prophylaxis, surgical

1 yo and older

Dose: 10 mg/kg/dose IV x1; Start: 120min preop; Info: refer to ASHP/IDSA guidelines

DOSING IN RENAL IMPAIRMENT

Adjust dose frequency

CrCl 10-29: give usual divided dose q18h; CrCl <10: give usually divided dose q24h

HD: give usually divided dose q24h, on dialysis days admin. after dialysis; no supplement; PD: give usually divided dose q24h; no supplement

DOSING IN HEPATIC IMPAIRMENT

Hepatic impairment: Use caution

Dizziness

Restlessness

Lightheadedness

Vaginitis

Insomnia

Photosensitivity

Pruritus

Rash

Anxiety

Agitation

Confusion

Tendinitis

Arthralgia

Lfts Elevated

Myalgia

Disorientation

Attention Disturbance

Nervousness

Impaired Memory

Delirium

Paranoia

Hallucinations

Nightmares

Tremor

Hyperglycemia

SERIOUS ADVERSE REACTION

 

Permanent disabled adverse reaction found while using fluoroquinolones with tendinitis and tendon rupture, peripheral neuropathy, and CNS effects.

Tendinitis/tendon rupture may occur during treatment or months after discontinued treatment and risk all ages.

Risk increased in older patients aged more than 60 years.

Strictly Avoided in the patient on Corticosteroids and Kidney/Heart/Lung transplant patients.

Avoid in Myasthenia Gravis patients leads to exacerbating muscle weakness.

 

RESERVE USE FOR PATIENTS WITH NO ALTERNATIVE OPTIONS

ACUTE BACTERIAL SINUSITIS

ACUTE BACTERIAL EXACERBATION OF CHRONIC BRONCHITIS UNCOMPLICATED UTI

Aortic Aneurysm Risk (Unless No Other Options)

Marfan Syndrome (Unless No Other Options)

Ehlers-Danlos Syndrome (Unless No Other Options)

Caution If Qt Prolongation

Caution If Congenital Long Qt Syndrome

Caution If Qt Prolongation Family Hx

Caution If Torsades De Pointes Hx

Caution If Ventricular Arrhythmias

Caution If Bradycardia

Caution If Recent Mi

Caution If CHF

Caution If Electrolyte Abnormalities

Caution If G6pd Deficiency

Caution If Tendon Disorder History

Caution If Kidney, Heart Or Lung Transplant

Caution If Peripheral Neuropathy Or History

Caution If Renal Impairment

Caution If Hepatic Impairment

Caution If Seizure Disorder

Caution If Seizure Threshold Lowered

Caution If Cns Disorder

Caution If Dehydration

Caution If Diabetes Mellitus

Caution If Recent Abx-Assoc. Colitis History

Caution If Depression Or History

 

 

 

Pregnancy Warning 

According to data no evidence of the risk of a teratogenic effect on humans and animals. Risk of abortion in human data and bone cartilage damage in animal data.

 

Breastfeeding Warnings

After a dose of anthrax, avoid breastfeeding for 3 to 4 hrs. Avoid breastfeeding during treatment or 2 days after discontinuation.No data is available for infant C.Difficile assoc. Diarrhea as well as effects on milk production.

 

 

Mechanism Of Action.            

Fluoroquinolones inhibit the enzyme bacterial DNA gyrase ( Primarily active in gram-negative bacteria), which nicks double-stranded DNA, introduces negative supercoils, and then reseals the neaked ends, needed to prevent supercoiling of strands. At the same time, they separate to permit replication or transcription. The DNA gyrase consists of Two A and Two B subunits: The A subunits carry nicking DNA, the B subunit introduces negative supercoils & then the A subunit reseals the strands. Fluoroquinolones bind to A subunits with high affinity and interfere with its strand cutting and resealing function.

In gram-positive bacteria, the primary target of   Fluoroquinolones action is a similar enzyme topoisomerase IV which nicks and DNA replicates & separates daughter DNA strands from it. Higher the topoisomerase IV affinity confer higher potency against gram-positive bacteria. The bactericidal action probably results from the digestion of DNA by exonucleases whose production is signaled by the damaged DNA.                            

Mechanism of Resistance  

Resistance was noted due to chromosomal mutation producing DNA gyrase or Topoisomerase IV with reduced affinity for Fluoroquinolones or reduced permeability /increased efflux of this drug across the bacterial membrane. Opposite to nalidixic acid, which selects single-step resistance mutants at high frequency, Fluoroquinolones resistance mutants are not easily selected; therefore, resistance to fluoroquinolones is slow to develop. However, reported increasing resistance among Salmonella, Pseudomonas, Staphylococci, Gonococci, and Pneumococci.                                                                                     

Absorption

Bioavailability (PO): ~50-85%

Peak plasma time (PO): Immediate-release, 0.5-2 hr; extended-release, 1-2.5 hr

Distribution

Distributed widely throughout the body; tissue concentrations often exceed serum concentrations, especially in kidneys, gallbladder, liver, lungs, gynecologic tissue, and prostatic tissue; cerebrospinal fluid (CSF) concentration is 10% in noninflamed meninges and 14-37% in inflamed meninges; crosses placenta; enters breast milk.

Protein-bound: 20-40%

Vd: 2.1-2.7 L/kg

Metabolism

Metabolized in liver

Enzyme inhibitor: CYP1A2

Elimination

Half-life: 2-5 hr (children); 3-5 hr (adults)

Excretion: Urine (30-50%), feces 

IV compatibilities 

 

Infuse 1-2 mg/mL in Dextrose or normal saline into large vein for 60 min.

When administering intermittently through Y-site, temorarily discontinue primary solution.

 

IV Incompatibilities

Additive: Aminophylline, amoxicillin, amoxicillin-clavulanate, amphotericin, ampicillin-sulbactam, ceftazidime, cefuroxime, clindamycin, floxacillin, heparin, piperacillin, sodium bicarbonate, ticarcillin

Y-site: Aminophylline, ampicillin-sulbactam, azithromycin, cefepime, dexamethasone sodium phosphate, furosemide, heparin, hydrocortisone sodium succinate, magnesium sulfate, methylprednisolone sodium succinate, phenytoin, potassium phosphates, propofol, sodium bicarbonate, sodium phosphates, total parenteral nutrition formulations, warfarin

 

IV Compatibilities

Solution: Compatible with most IV fluids

Additive: Amikacin, aztreonam, dobutamine, dopamine, fluconazole, gentamicin, lidocaine, linezolid, metronidazole (ready-to-use form is compatible; hydrochloride form in vial is incompatible), midazolam, potassium chloride, tobramycin

Y-site: Amiodarone, calcium gluconate, clarithromycin, digoxin, diphenhydramine, dobutamine, dopamine, linezolid, lorazepam, midazolam, promethazine, quinupristin/dalfopristin, tacrolimus

 

Storage 

Stable at 0.5-2mg/mL in dextrose five or normal saline for 14 days at room temprature or in freeze.

Generic Name: Ciprofloxacin( Oral) 

Pronounced: SIP roe FLOX a sin 

Why do we use Ciprofloxacin?

This drug is from fluoroquinolone category used for different types of bacterial infection, e.g., Skin Infection, Lung or airway infection like T.B., pneumonic and septicemic plague, chronic bronchitis, lower respiratory tract infection, bone infection, Urinary tract infection, infectious diarrheas caused by E.Coli Campylobacter jejuni & shigella bacteria. Anthrax, Typhoid fever, cervical and urethral gonorrhea, cystitis 

WARNING  

Ciprofloxacin may cause a severe permanent effect on tendon-like tendon rupture, tendonitis, nerve problem in the leg & arm ( peripheral neuropathy), and nervous system problem like depression seizures. Contact your physician if you are on Ciprofloxacin and observe the following symptoms: Pain/numbness/burning/tingling/weakness in arms/hands/legs/feet, changes in senses touch, pain, temperature, vibration, body position, severe or lasting headache, vision changes, shaking ( tremors), mental/mood changes like agitation, anxiety, confusion, hallucination, depression, rare thoughts of suicide. If you observe any sign like pain or swelling in joints/muscles, stop exercising, take a rest and seek medical help.

Avoid patients with age more than 60yr and patients taking prednisolone ( Corticosteroids), patients with transplant (kidney, heart, lung), which leads to increased tendon problems. Ciprofloxacin worsens Myasthenia gravis condition. Consult your doctor if you have new or worsening muscle weakness such as drooping eyelids, unsteady walk, or trouble breathing. Talk to the doctor before using this medicine. 

HOW TO USE  

Before starting Ciprofloxacin, read the medication guide or patient information leaflet, which the Pharmacist provides. If doubts or questions related to medication, consult your doctor. This medicine is either taken with or without food as directed by a doctor, usually twice a day every 12, in the morning and evening. Shake the container for 15 seconds (apply for Liquid forms )before pouring each dose. Carefully measure the amount using a measuring device/spoon, which is given along with medication. Don’t use the kitchen spoon, which may not get the correct dose. Don’t chew the contents of the suspension. Do not use a feeding tube for rest, which may clog the pipe.

The dosage and duration of treatment depend upon the patient’s condition and the response to treatment. Drink plenty of water while on medication. To avoid drug-drug interaction, patients need to tell the doctor about their medical history (for Allergies). Administer this medicine 2 hours before or 6 hours after taking other products that may bind to it, decreasing the medication effect. Avoid Dairy products & calcium-containing juices to reduce the absorption of Ciprofloxacin. Take with or without food; absorption is not affected by food. Limit caffeine intake. Take this medicine at least 2 hr before or 6hr after eating calcium-rich foods. Ask your doctor/Pharmacist about using nutritional supplement/replacement with this medicine. For the best result, take the dose of medicine simultaneously to avoid missed doses. Complete the course, even if symptoms disappear after a few days. If patients do not complete the period of antibiotics, it increases the chance of the return of the infection. If patients continuously skip the medication without completing the course leads to produce resistance (drugs do not show the effect on the microorganism responsible for infection)of that medicine. If your condition persists or worsens, tell your doctor. 

SIDE EFFECT 

If you observe nausea, diarrhea, dizziness, lightheadedness, headache, or trouble sleeping, talk to your Doctor/Pharmacist. The selection of medication for patients by a doctor mostly depends on factors like patients’ history, treatment history, allergic condition, age, etc. Consult your doctor if there are any side effects like unusual bruising or bleeding, signs of new or persistent fever, sore throat. Also, don’t ignore if change in the urine volume, red/pink color urine, dark urine seek medical help immediately because that are the signs of kidney problems. Contact your doctor/Pharmacist directly if you have severe dizziness, fainting, fast/irregular heartbeat, sudden pain in the Chest/stomach/shortness of breath/back/cough. This medicine rarely produces an intestinal condition due to a bacterial called C.difficile; this condition may occur during or after weeks of treatment stopped. If you have developed: diarrhea that doesn’t stop, abdominal or stomach pain/cramping, blood/mucus in your stool, tell your doctor. Suppose you have these symptoms, don’t use anti-diarrhea or opioid products because they may worsen symptoms. This medication’s prolonged use leads to white patches in your mouth, a change in vaginal discharge, or any other new symptoms. Severe allergic reaction is infrequent in this medication, but still, you find out rash/itching/swelling to the face, tongue, throat—trouble breathing severe dizziness. If you find other side effects that are not mentioned, contact your doctor/pharmacist or directly report the side effects to the manufacturing company or FDA official website.

 

PRECAUTIONS

 

During a doctor visit, tell your doctor/pharmacist about any medical history like diabetes, heart problem like heart attack, joint or tendon pain, kidney disease, liver disease, mental/mood disorder, myasthenia gravis, peripheral neuropathy, seizures, blood vessels related disease or condition, B.P., genetic condition, allergic condition or history of allergy with other quinolones antibiotics like norfloxacin,gemifloxacin, levofloxacin, moxifloxacin or ofloxacin. Tell your doctor if you have problems related to heart problems like prolonged. Q.T. intervals rarely cause fast severe/irregular heartbeat and other symptoms such as severe dizziness, fainting which need medical attention. Tell all the information about ongoing treatment and past treatment to the doctor. This medication rarely causes elevated blood sugar levels; check your blood glucose level and share report with doctors. Monitor increased urination or thirst and consult your doctor. Glyburide with Ciprofloxacin shows an increase in the glucose-lowering effect. Also, observe the symptoms of blood sugar lowering like sudden sweating, shaking, fast heartbeat, hunger, blurred vision, dizziness, or tingling hands/feet. Carry glucose tablets if a diabetic patient with Ciprofloxacin sees the above symptoms. If you don’t carry the glucose tablet, eat sugar content products to elevate the sugar level. Maintain a good sugar level with a proper diet and small meals. Do not skip a meal. Your doctor needs to switch to another diabetes medication if any reaction occurs. Avoid alcohol or marijuana; Ciprofloxacin already makes dizzy, and intake of alcohol or marijuana makes dizzier, lifting heavy things, driving, or any other things which require alertness. This drug is photosensitive so try to avoid tanning booths and sunlamps. Wear sunscreen and wear protective wear when outside; if you get sunburned or have any skin-related problem, talk to the doctor.

Avoid typhoid vaccine when you are on Ciprofloxacin. Tell the physician/doctor that you are on ciprofloxacin treatment before immunizations. This medicine contains sucrose so before surgery, tell your doctor or dentist you are taking Ciprofloxacin. This drug is not recommended if you suffer from a hereditary metabolic condition such as fructose intolerance,sucrase-isomaltase deficiency,glucose-galactose malabsorption. Children are more sensitive to the side effect of this drug, especially in joint/tendon problems. An older patient may suffer more if they have tendon problems on corticosteroids, prolonged QTc interval, and sudden break or tear main blood vessel. Suppose your nursing infant consult a doctor about treatment. 

DRUG INTERACTIONS

Drug-drug interaction may change how your medications work, increase your risk for a severe side effect, or require patient monitoring. This document does not claim all possible drug-drug interactions. Before visiting the doctor, keep a list of all products you use, including prescribed drugs, OTC, and herbal products; share this with your doctor or Pharmacist. Without your doctor’s approval, don’t stop, change, or start the medicine. Some products like acenocoumarol, warfarin, strontium may interact with Ciprofloxacin.Many drugs like amiodarone,dofetilide,quinidine,procainamidesotalol prolonged QTc interval besides ciprofloxacin . Drugs like duloxetine, flibanserin, lomitapide, pirfenidone, tasimelteon, tizanidine removal of this drug slow down by Ciprofloxacin. Avoid caffeine intake, OTC product that contains caffeine; this medicine increases the effect of caffeine. 

OVERDOSE 

The patient overdosed and has severe symptoms of passing out or breathing; in the U.S., call 911 and call a poison control center immediately. Other countries call an ambulance and are admitted to the hospita 

NOTES 

Don’t share your medicines with anyone. You depend upon microorganisms that cause infection in the body medicines selected by doctors. This medicine is prescribed for your current condition, and don’t use it without consulting your doctor for the subsequent infection. Treatment or selection of proper medication depending upon lab test or medical test such as kidney function, blood counts, cultures. This should be monitored closely for progress or to check the side effects. Consult your doctor for more details about the medication. Don’t change the brand of medicine without consulting the doctor; not all brands have the same effect   

MISSED DOSE 

If you miss a dose, If it’s less than 6 hours before the next dose, skip the missed dose. Do not double the dose to level up the missed dose. Take the next dose at the regular tim  

STORAGE 

Store the dry powder in an upright position at room temperature. Do not keep in freeze. Once mixed with water for injection, please keep it in the refrigerator or room temperature. Discard the suspension after 14 days. Keep away from children and pets. Before discarding, consult the doctor/physician if you have any doubts or queries.

 

 

 

 

 

 

 

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