Cipro (Ciprofloxacin)

Cipro (ciprofloxacin) is an antibiotic in the fluoroquinolone group. It is used to treat a range of bacterial infections by stopping bacteria from growing. In Australian clinical practice, it may be prescribed for selected bacterial infections when a doctor decides it is appropriate.

What is Cipro?

Cipro is commonly prescribed for infections such as urinary tract infections (UTIs), respiratory tract infections (such as bronchitis or pneumonia), skin infections, bone and joint infections, gastrointestinal infections (such as infectious diarrhoea), and some sexually transmitted infections.

Cipro works by blocking bacterial DNA gyrase and topoisomerase IV, which are enzymes bacteria need for DNA replication, transcription, repair and recombination. This causes the bacteria to die.

It is important to take Cipro exactly as prescribed by your healthcare provider and to finish the full course, even if you start to feel better before the medicine is finished. Misuse or overuse of antibiotics can lead to antibiotic resistance, which can make infections harder to treat in the future.

Clinical Pharmacology

Ciprofloxacin is well absorbed from the gastrointestinal tract after oral use, with a bioavailability of about 70-80%. Peak plasma concentrations are usually reached 1-2 hours after an oral dose.

The medicine has a large volume of distribution, which means it spreads widely through body tissues and fluids. It penetrates well into tissues such as the lungs, kidneys, liver, gallbladder and reproductive organs. It also crosses the blood-brain barrier and the placenta, and passes into breast milk. It is metabolised in the liver into several metabolites, which have less antibacterial activity than the original drug.

The main route of elimination is through the kidneys, with about 40-50% of an oral dose excreted unchanged in the urine. The elimination half-life of ciprofloxacin is about 4-6 hours in patients with normal kidney function. It is also excreted in bile and faeces.

Ciprofloxacin has a broad spectrum of activity against both Gram-negative and Gram-positive bacteria. It is particularly effective against Gram-negative pathogens such as Escherichia coli, Pseudomonas aeruginosa, Neisseria gonorrhoeae, and Haemophilus influenzae. It has limited activity against anaerobic bacteria.

Ciprofloxacin shows concentration-dependent killing, which means its ability to kill bacteria increases at higher drug concentrations. The minimum inhibitory concentration (MIC) for ciprofloxacin varies depending on the bacterial species.

Cipro forms and ingredients

Cipro (ciprofloxacin) comes in a range of formulations, including tablets, extended-release tablets, oral suspension and intravenous solutions. The ingredients vary slightly depending on the formulation. Below are the typical ingredients in each form of Cipro.

Cipro tablets

The active ingredient is ciprofloxacin hydrochloride.

Inactive ingredients are microcrystalline cellulose, corn starch, silicon dioxide, crospovidone, magnesium stearate, hypromellose, titanium dioxide, polyethylene glycol and water.

Cipro XR (extended-release) tablets

The active ingredient is ciprofloxacin hydrochloride.

Inactive ingredients are microcrystalline cellulose, sodium alginate, sodium bicarbonate, magnesium stearate, colloidal silicon dioxide, hypromellose, titanium dioxide, polyethylene glycol and propylene glycol.

Cipro oral suspension

The active ingredient is ciprofloxacin hydrochloride.

Inactive ingredients are microcrystalline cellulose, carboxymethylcellulose sodium, citric acid, hydroxypropyl methylcellulose, polysorbate 20, simethicone emulsion, sodium benzoate, sorbic acid, sucrose, water and artificial flavouring (bubble gum flavour).

Cipro intravenous solution

The active ingredient is ciprofloxacin lactate.

Inactive ingredients are lactic acid, sodium chloride and water for injection.

The active ingredient (ciprofloxacin hydrochloride or ciprofloxacin lactate) provides the therapeutic effect, while the inactive ingredients act as fillers, binders, stabilisers, preservatives and flavouring agents.

What are the dosages of Cipro?

The dose of Cipro (ciprofloxacin) varies depending on the type and severity of the infection, the patient's age, kidney function and other individual factors. Here is the dosage information for Cipro presented in a table:

Complete the full course of treatment even if symptoms improve. Avoid too much sunlight or UV exposure. Report any signs of tendon pain, swelling or inflammation. Watch for signs of serious side effects, including allergic reactions, central nervous system effects and Clostridium difficile-associated diarrhoea.

Consult an Australian healthcare provider for dosage advice tailored to your individual health needs and condition.

Important safety information

Cipro (ciprofloxacin) is an antibiotic used to treat various bacterial infections, but it has important safety considerations.

• Ciprofloxacin is associated with an increased risk of tendinitis and tendon rupture, which can happen during treatment or after treatment has finished. The risk is higher in patients over 60 years, those taking corticosteroids, and those with kidney, heart or lung transplants.
• It can cause permanent peripheral neuropathy (nerve damage). Symptoms include pain, burning, tingling, numbness or weakness. Stop taking it immediately if these symptoms occur.
• It can cause central nervous system (CNS) effects, including seizures, increased intracranial pressure, tremors, restlessness, anxiety, confusion, hallucinations and depression. Use with caution in patients with a history of seizures or other CNS disorders.
• It may worsen muscle weakness in people with myasthenia gravis. Avoid use in these patients.
• Serious and sometimes fatal allergic reactions can occur after the first dose. Stop taking it immediately if a rash, hives or other signs of an allergic reaction occur.
• It can cause moderate to severe sunburn-like reactions. Avoid too much sunlight and UV exposure, and use sunscreen and protective clothing.
• It can prolong the QT interval on an ECG, which may increase the risk of serious heart rhythm disturbances (e.g. torsades de pointes). Use with caution in patients with risk factors such as certain heart conditions or concurrent use of medicines that prolong the QT interval.
• Clostridium difficile-associated diarrhoea can occur during treatment or afterwards. Symptoms include severe diarrhoea, abdominal pain and fever. Stop taking it if significant diarrhoea occurs and manage it appropriately.
• Cases of severe liver injury have been reported. Stop taking it if symptoms of liver disease (e.g. jaundice, dark urine, severe fatigue) occur.
• It can affect blood sugar levels, including hyperglycaemia and hypoglycaemia. Patients with diabetes should monitor blood glucose levels closely.
• It can cause muscle weakness in people with or without myasthenia gravis. Monitor patients for signs of muscle weakness.
• It is contraindicated in patients with a history of hypersensitivity to ciprofloxacin, other quinolones, or any component of the formulation.

Special precautions

Pregnancy: Use only if the potential benefit justifies the potential risk to the fetus.

Breastfeeding: Ciprofloxacin is excreted in human milk. Consider stopping breastfeeding or stopping the medicine, taking into account how important the medicine is to the mother.

Paediatric use: Safety and effectiveness in patients under 18 years old are limited to certain infections (e.g. complicated urinary tract infections and post-exposure inhalational anthrax).

Prescription

You need a prescription to buy Cipro (ciprofloxacin). In Australia, it is a prescription-only medicine, reflecting the potential for serious side effects, the need for proper diagnosis and medical supervision, and the importance of appropriate antibiotic use to help limit resistance.

If you think you may need Cipro, speak with a healthcare provider who can assess your symptoms and decide whether this antibiotic is suitable for your condition. They can then provide a prescription if it is considered necessary in Australia.

Contraindications to Cipro

Ciprofloxacin (Cipro) has several contraindications where its use is not recommended.

Patients with a history of hypersensitivity or allergic reactions to ciprofloxacin, other fluoroquinolones, or any components of the formulation.

Co-administration with tizanidine (Zanaflex) is contraindicated because of the risk of significant hypotension and sedation.

Patients with myasthenia gravis should avoid ciprofloxacin because of the risk of worsening muscle weakness.

Patients with a history of tendon disorders related to quinolone use should avoid ciprofloxacin.

Use with caution in patients with known or suspected CNS disorders (e.g. epilepsy, severe cerebral arteriosclerosis) because of the risk of seizures and other CNS effects.

Use with caution in patients with known QT prolongation, uncorrected electrolyte disorders (e.g. hypokalaemia, hypomagnesaemia), or those taking other medicines that prolong the QT interval.

Side effects

Ciprofloxacin (Cipro) can cause a range of side effects, some of which can be serious.

Common side effects

1. Gastrointestinal issues: nausea, diarrhoea, vomiting, abdominal pain.
2. Central nervous system effects: dizziness, headache, drowsiness.
3. Skin reactions: rash, itching.

Serious side effects

1. Increased risk of tendinitis and tendon rupture, especially in the Achilles tendon. This can happen during treatment or even months after treatment has stopped.
2. Peripheral neuropathy: severe nerve pain, tingling, numbness or weakness, which can be permanent.
3. Central nervous system effects: seizures, tremors, restlessness, confusion, hallucinations, depression, anxiety.
4. Serious skin reactions: Stevens-Johnson syndrome, toxic epidermal necrolysis.
5. Hypersensitivity reactions: severe allergic reactions, including anaphylaxis, which can be life-threatening. Symptoms include rash, itching, swelling, severe dizziness and difficulty breathing.
6. Severe, persistent diarrhoea that can lead to serious bowel conditions.
7. Severe liver damage, which may present as jaundice, dark urine, severe fatigue and abdominal pain.
8. QT interval prolongation, which can lead to serious heart rhythm disturbances (e.g. torsades de pointes).
9. Musculoskeletal issues: joint pain, muscle pain.
10. Psychiatric effects: psychosis, suicidal thoughts or actions.

Always report any new or worsening symptoms to a healthcare provider promptly.

Interactions of Cipro with other medicines

Ciprofloxacin (Cipro) can interact with various other medicines, which may change its effects or increase the risk of serious side effects.

1. Tizanidine (Zanaflex): Co-administration is contraindicated because of the risk of significant hypotension and sedation.
2. Theophylline: Ciprofloxacin can increase the plasma concentration of theophylline, leading to possible theophylline toxicity (e.g. seizures, arrhythmias). Monitor theophylline levels closely.
3. Warfarin (Coumadin): Ciprofloxacin may increase the anticoagulant effects of warfarin, raising the risk of bleeding. Monitor INR/PT levels frequently.
4. Antacids, sucralfate and mineral supplements: These can interfere with absorption of ciprofloxacin. Take ciprofloxacin at least 2 hours before or 6 hours after these products.
5. Antiarrhythmics and other QT-prolonging medicines: Ciprofloxacin can prolong the QT interval, increasing the risk of serious heart rhythm disturbances. Use with caution in patients taking other QT-prolonging medicines (e.g. amiodarone, sotalol).
6. Non-steroidal anti-inflammatory drugs (NSAIDs): Concurrent use may increase the risk of CNS stimulation and seizures.
7. Cyclosporine: Co-administration can lead to increased serum levels of cyclosporine and a higher risk of nephrotoxicity. Monitor kidney function closely.
8. Phenytoin (Dilantin): Ciprofloxacin can alter phenytoin levels, leading to either an increase or decrease in its effect. Monitor phenytoin levels closely.
9. Methotrexate: Ciprofloxacin can inhibit the renal tubular transport of methotrexate, potentially increasing the risk of methotrexate toxicity.
10. Glyburide: Co-administration can increase the risk of hypoglycaemia. Monitor blood glucose levels closely.

Ciprofloxacin can cause both hyperglycaemia and hypoglycaemia, so patients with diabetes should monitor their blood glucose levels closely. Concurrent use may increase the risk of tendinitis and tendon rupture. Ciprofloxacin can also increase caffeine levels and prolong its effects, which may raise the risk of CNS stimulation, such as nervousness and insomnia.

Overdose of Cipro

An overdose of Cipro (ciprofloxacin) can be serious and needs immediate medical attention.

Management of ciprofloxacin overdose involves supportive care and treatment of symptoms. Seek emergency medical help or contact an Australian poisons information centre immediately. In the case of a recent overdose, gastric lavage (stomach pumping) may be considered to remove unabsorbed drug from the stomach. Activated charcoal may be given to reduce drug absorption if the overdose is identified within an hour of ingestion. Ensure adequate hydration to help prevent crystalluria and protect kidney function. Provide appropriate symptomatic treatment for nausea, vomiting, seizures and other symptoms. Monitor heart function and treat any cardiac arrhythmias. Monitor kidney function and manage any signs of kidney impairment.

To help prevent overdose, take ciprofloxacin exactly as prescribed by your healthcare provider. Do not take more than the recommended dose. Do not self-medicate or change the dose without speaking to a healthcare professional.

Storage

Proper storage of Cipro (ciprofloxacin) is important to help maintain its effectiveness and safety.

Store at room temperature, between 20°C (68°F) and 25°C (77°F). Brief storage at temperatures between 15°C (59°F) and 30°C (86°F) is acceptable.

Keep the medicine in its original container to protect it from light. Store in a dry place, away from moisture and humidity.

Keep out of reach of children and pets to prevent accidental ingestion.

Benefits of using Cipro