Cipro (Ciprofloxacin)

Cipro (ciprofloxacin) is an antibiotic from a group of medicines called fluoroquinolones. It is used to treat a range of bacterial infections by stopping bacteria from growing.

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 certain 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 leads to the bacteria dying.

It is important to take Cipro exactly as prescribed by a healthcare provider in the UK and to complete the full course of treatment, even if your symptoms improve before you finish the medicine. Misusing or overusing antibiotics can lead to antibiotic resistance, making 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 taking a dose by mouth.

The medicine has a large volume of distribution, which means it spreads widely into 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 to form several metabolites, which have less antibacterial activity than the parent 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 bacteria-killing effect 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 different forms, 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. The dosage information for Cipro is shown in the table below:

Complete the full course of treatment even if your 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.

Speak to a healthcare provider in the United Kingdom for dosage advice tailored to your individual health needs and condition.

Important Safety Information

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

• Ciprofloxacin is associated with an increased risk of tendinitis and tendon rupture, which can happen during or after treatment. The risk is higher in patients over 60, 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 straight away 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 using it in these patients.
• Serious and sometimes fatal allergic reactions can happen after the first dose. Stop taking it straight away if you develop a rash, hives or other signs of an allergic reaction.
• 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 problems (for example, torsades de pointes). Use with caution in patients with risk factors such as certain heart conditions or the use of other medicines that prolong the QT interval.
• Clostridium difficile-associated diarrhoea can happen during or after treatment. Symptoms include severe diarrhoea, abdominal pain and fever. Stop treatment if significant diarrhoea occurs and manage it appropriately.
• Cases of severe liver injury have been reported. Stop treatment if symptoms of liver disease occur, such as jaundice, dark urine or severe tiredness.
• It can affect blood sugar levels, including hyperglycaemia and hypoglycaemia. People with diabetes should monitor their blood glucose levels closely.
• It can cause muscle weakness in people with or without myasthenia gravis. Monitor 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 (for example, complicated urinary tract infections and post-exposure inhalational anthrax).

Prescription

You need a prescription to buy Cipro (ciprofloxacin). In the UK, it is a prescription-only medicine because of the risk of serious side effects, the need for proper diagnosis and medical supervision, and the importance of using antibiotics appropriately to help prevent antimicrobial resistance.

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

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 due to the risk of significant hypotension and sedation.

Patients with myasthenia gravis should avoid ciprofloxacin due to 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 (for example, epilepsy, severe cerebral arteriosclerosis) due to the risk of seizures and other CNS effects.

Use with caution in patients with known QT prolongation, uncorrected electrolyte disorders (for example, 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 problems: 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 tiredness and abdominal pain.
8. QT interval prolongation, which can lead to serious heart rhythm disturbances (for example, torsades de pointes).
9. Musculoskeletal problems: 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 alter its effects or increase the risk of serious side effects.

1. Tizanidine (Zanaflex): Co-administration is contraindicated due to the risk of significant hypotension and sedation.
2. Theophylline: Ciprofloxacin can increase the plasma concentration of theophylline, leading to possible theophylline toxicity (for example, 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 the absorption of ciprofloxacin. Take ciprofloxacin at least 2 hours before or 6 hours after these products.
5. Antiarrhythmics and other QT-prolonging drugs: Ciprofloxacin can prolong the QT interval, increasing the risk of serious heart rhythm disturbances. Use with caution in patients taking other QT-prolonging drugs (for example, amiodarone, sotalol).
6. Non-steroidal anti-inflammatory drugs (NSAIDs): Taking these at the same time may increase the risk of CNS stimulation and seizures.
7. Ciclosporin: Co-administration can lead to increased serum levels of ciclosporin and an increased 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. People with diabetes should monitor their blood glucose levels closely. Concurrent use can increase the risk of tendinitis and tendon rupture. Ciprofloxacin can increase caffeine levels and prolong its effects, leading to an increased risk of CNS stimulation (for example, nervousness, insomnia).

Overdose of Cipro

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

Managing ciprofloxacin overdose involves supportive care and treatment of symptoms. In the United Kingdom, seek emergency medical help or contact a poisons service immediately. In the case of a recent overdose, gastric lavage (stomach pumping) may be considered to remove unabsorbed drug from the stomach. Give activated charcoal to reduce drug absorption if the overdose is identified within an hour of ingestion. Ensure adequate hydration to prevent crystalluria and protect kidney function. Provide suitable treatment for nausea, vomiting, seizures and other symptoms. Monitor heart function and treat any cardiac arrhythmias. Monitor kidney function and manage any signs of renal impairment.

To help prevent an 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 essential to help maintain its effectiveness and safety.

Store at room temperature, between 20°C and 25°C (68°F to 77°F). Brief storage at temperatures between 15°C and 30°C (59°F to 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 the reach of children and pets to prevent accidental ingestion.

Benefits of Using Cipro