Ciprofloxacin: Uses, Dosage, Side Effects, and More
1. Drug Name
Generic Name: Ciprofloxacin
Brand Name(s):
- Pakistan: Ciprox, Ciprol
- India: Ciplox, Ciprova
- United States: Cipro, Proquin XR
- United Kingdom: Ciproxin
2. Pharmacological Class
Class: Antibiotic
Subclass: Fluoroquinolone
3. Mechanism of Action
Ciprofloxacin inhibits bacterial DNA gyrase and topoisomerase IV, enzymes essential for DNA replication, transcription, repair, and recombination. This inhibition results in bacterial cell death.
4. Indications
Primary Indications:
- Treatment of various bacterial infections such as urinary tract infections, respiratory tract infections, skin infections, and gastrointestinal infections.
Off-label Uses:
- Prophylaxis of anthrax exposure.
5. Dosage and Administration
Standard Dosage:
- Adults: 250-750 mg every 12 hours depending on the severity and type of infection.
Route of Administration: Oral (tablets, suspension) and intravenous.
Special Populations:
- Pediatric: Use with caution, typically for severe infections; dosage is weight-based.
- Geriatric: No specific dose adjustment required, but caution advised in renal impairment.
6. Pharmacokinetics
Absorption: Ciprofloxacin is well absorbed from the gastrointestinal tract.
Distribution: It is widely distributed in body tissues and fluids.
Metabolism: Partially metabolized in the liver.
Excretion: Primarily excreted unchanged in the urine.
Half-life: Approximately 4-6 hours.
7. Contraindications
Ciprofloxacin is contraindicated in patients with a history of allergic reactions to ciprofloxacin, other quinolones, or any component of the formulation. It is also contraindicated in patients taking tizanidine.
8. Warnings and Precautions
Use with caution in patients with a history of tendon disorders, as fluoroquinolones have been associated with an increased risk of tendinitis and tendon rupture. Also, use caution in patients with a history of QT prolongation, seizures, or severe renal impairment.
9. Side Effects
Common Side Effects: Nausea, diarrhea, dizziness, and headache.
Serious Side Effects: Tendon rupture, peripheral neuropathy, CNS effects (e.g., seizures, hallucinations), and Clostridium difficile-associated diarrhea.
10. Drug Interactions
Major Interactions: Tizanidine (increased risk of severe hypotension and sedation), theophylline (increased risk of theophylline toxicity).
Moderate Interactions: Antacids containing aluminum or magnesium, iron supplements, and multivitamins (reduced absorption of ciprofloxacin).
Minor Interactions: Caffeine (increased effects of caffeine).
11. Pregnancy and Lactation
Pregnancy Category: Category C - Risk cannot be ruled out.
Breastfeeding Considerations: Ciprofloxacin is excreted in breast milk. Use with caution and only if clearly needed.
12. Patient Counseling Information
Key Points for Patients:
- Take ciprofloxacin exactly as prescribed, even if you feel better before completing the course.
- Avoid taking ciprofloxacin with dairy products or calcium-fortified juices alone, but it can be taken with meals that include these products.
- Report any signs of tendon pain, swelling, or inflammation to your doctor immediately.
Administration Tips:
- Take with a full glass of water. Drink plenty of fluids while taking ciprofloxacin.
- Do not take antacids, iron supplements, or multivitamins containing zinc within 2 hours before or 6 hours after taking ciprofloxacin.