Ciprofloxacin

May be taken with or without food. May be taken w/ meals to minimise GI discomfort. Do not take w/ antacids, Fe or dairy products.

Hypersensitivity to ciprofloxacin or other quinolones. History or risk of QT prolongation; known history of myasthenia gravis. Concomitant use with tizanidine.

Patient with known or suspected CNS disorders, risk factors predisposing to seizures, or lower seizure threshold; history or risk factors for QT interval prolongation, torsades de pointes, uncorrected hypokalaemia/hypomagnesaemia, cardiac disease (e.g. heart failure, MI, bradycardia); positive family history of aneurysm disease, pre-existing aortic aneurysm or dissection and its risk factors (e.g. Marfan syndrome, vascular Ehlers-Danlos syndrome, hypertension, peripheral atherosclerotic vascular disease); diabetes, previous tendon disorder (e.g. rheumatoid arthritis), G6PD deficiency. Renal and hepatic impairment. Elderly, children. Pregnancy and lactation. Immunocompromised febrile neutropenic patients. Not recommended for the treatment of streptococcal infections or as treatment option for gonococcal infections in some countries due to increase in quinolones-resistant N. gonorrhoeae globally. Not effective in the treatment of syphilis. Reserve use for the treatment of acute exacerbation of chronic bronchitis, acute uncomplicated cystitis, or acute sinusitis in patients with no alternative treatment options. Patient Counselling This drug may cause dizziness and temporary loss of vision, if affected, do not drive or operate machinery. Avoid excessive exposure to sunlight or artificial UV light (e.g. tanning beds) and use protective measures (e.g. sunscreen, wear loose-fitting clothes) if staying outdoors during therapy. Remove contact lenses prior to administration and wait at least 15 minutes before reinsertion. Maintain adequate hydration during therapy. Monitoring Parameters Monitor transaminases, blood glucose levels, CBC, renal function, LFT periodically and during prolonged therapy. Monitor for signs and symptoms of hypersensitivity reactions, tendonitis, and altered mental status. Perform eye examinations regularly. Perform culture and susceptibility tests prior to treatment initiation; consult local institutional recommendations before treatment initiation due to antibiotic resistance risks. Test patients for syphilis at the time of gonorrhoeal diagnosis and 3 months thereafter.

Significant: Irreversible tendinitis, tendon rupture, peripheral neuropathy, CNS effects (e.g. seizures, increased intracranial pressure), QT interval prolongation, torsades de pointes, psychiatric reactions (e.g. depression, psychosis, suicidal ideation), aortic aneurysm ruptures or dissection (long-term use), photosensitivity reactions, haemolytic reactions (in G6PD deficiency patient), hyperglycaemia; delayed corneal healing (ophth). Rarely, crystalluria. Blood and lymphatic system disorders: Jaundice. Ear and labyrinth disorders: Ear pruritus, otitis media, pain at the application site. Eye disorders: Ophth: Corneal deposits, burning sensation, conjunctival hyperaemia, crusting of eyelid, eye pruritus. Gastrointestinal disorders: Nausea, vomiting, diarrhoea, abdominal pain, dyspepsia. General disorders and administration site conditions: Fever, irritability. Hepatobiliary disorders: Hepatitis. Injury, poisoning and procedural complications: Inj and infusion site reactions. Investigations: Increased transaminases. Musculoskeletal and connective tissue disorders: Myalgia, arthralgia. Nervous system disorders: Increased intracranial pressure, dizziness, headache, restlessness, tremor. Psychiatric disorders: Insomnia, nervousness, somnolence. Respiratory, thoracic and mediastinal disorders: Rhinitis, nasopharyngitis. Skin and subcutaneous tissue disorders: Rash.
Potentially Fatal: Hypoglycaemia, hepatic necrosis, severe hypersensitivity reactions [e.g. anaphylaxis, Stevens-Johnson syndrome, toxic epidermal necrolysis (TEN)], severe myasthenia gravis exacerbation, superinfection in prolonged use (e.g. C. difficile-associated diarrhoea, pseudomembranous colitis).

Increased risk of prolonged QT interval with Class IA (e.g. quinidine, procainamide) and Class III (e.g. amiodarone, sotalol) antiarrhythmics, TCA, macrolides (e.g. erythromycin), cisapride, antipsychotics. Increased serum concentration with probenecid. May increase serum concentration and toxicity of methotrexate; CYP1A2 substrates (e.g. clozapine, ropinirole, theophylline); xanthine derivatives (e.g. caffeine, pentoxifylline). Increased risk of tendon disorders with corticosteroids. Increased serum creatinine with cyclosporin. Increased risk of convulsions with NSAIDs. May alter serum concentrations of phenytoin. Reduced oral absorption with products containing multivalent cations (e.g. Al, Ca, Mg, Fe). May increase anticoagulant effect of vitamin K, warfarin.

Ear Anti-Infectives & Antiseptics / Eye Anti-Infectives & Antiseptics / Quinolones

J01MA02 - ciprofloxacin ; Belongs to the class of fluoroquinolones. Used in the systemic treatment of infections.
S01AE03 - ciprofloxacin ; Belongs to the class of quinolone antiinfectives. Used in the treatment of eye infections.
S03AA07 - ciprofloxacin ; Belongs to the class of antiinfectives used in ophthalmologic and otologic preparations.
S02AA15 - ciprofloxacin ; Belongs to the class of antiinfectives used in the treatment of ear infections.