Cipro

What is Cipro (ciprofloxacin)?

Ciprofloxacin is a type of fluoroquinolone antibiotic used to treat different types of infections. It is sold under the brand name Cipro.

As a fluoroquinolone antibiotic, Cipro has a black box warning¹ for the risk of serious adverse reactions, including tendon rupture or tendinitis, peripheral neuropathy, and central nervous system effects.

Cipro is available in the following immediate-release dosage forms:

• Cipro tablet: 250mg and 500mg

• Cipro oral suspension: 250mg/5ml and 500mg/5ml

Cipro XR

An extended-release version of Cipro (Cipro XR) is available in some countries as a 500mg or 1,000mg tablet. Doctors may prescribe it to treat uncomplicated urinary tract infections only.

This article will focus only on immediate-release Cipro. Please ask your doctor for more information about Cipro XR or generic extended-release ciprofloxacin.

Note that it may not be available in your country.

What is Cipro used to treat?

The US Food and Drug Administration (FDA) has approved Cipro to treat some infections in adults, including:

• Sinus infection

• Respiratory tract infections, like pneumonia and bronchitis

• Food poisoning

• Diverticulitis

• Gallbladder infection

• Gastroenteritis

• Bone and joint infections

• Cellulitis

• Sexually transmitted diseases (STDs), like gonorrhea

• Urinary tract infections (UTIs), like prostate, kidney, or bladder infections

The FDA has also approved Cipro for the following health conditions, although they are less common:

• Typhoid fever

• Anthrax

• Plague

Cipro is not always the first choice of treatment to treat uncomplicated bronchitis, sinus infections, or UTIs. However, your doctor may prescribe Cipro if these conditions can’t be treated with other medications or if the benefits outweigh the risks.

How do you take Cipro?

Cipro is an oral medication. Your doctor may prescribe Cipro as an oral suspension or tablet.

You can take Cipro with or without food. Depending on the type and severity of your health condition, your doctor will usually recommend taking regular Cipro twice daily – once in the morning and once in the evening.

Swallow Cipro tablets whole. Do not crush, break, or chew the tablets. Breaking the tablets up can cause a bitter taste and affect how the drug is absorbed.

Do not split the medication in half unless otherwise instructed by your doctor.

The oral suspension comes in the form of granules that you need to dissolve using the special liquid provided. Shake the bottle for around 15 seconds before you pour it into your measuring cup to ensure the granules are properly dissolved.

Only use the medical measuring cup or syringe provided with the package. If the package does not include a measuring cup, ask your pharmacist for one. Do not use a kitchen spoon or household measuring device as you may not get the correct dose.

Your dose will depend on your condition. The usual dose for adults is 250mg, 500mg, or 750mg taken orally every twelve hours¹.

Your treatment duration will vary based on your condition and its severity. For example, treatment could last five days for a gastrointestinal infection, 28 days for a bacterial infection of the prostate, and up to 60 days for some bone and joint infections.

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Remember to follow your doctor’s instructions carefully.

Seeing results

Cipro starts working a few hours after you take it, but you may not notice your symptoms improving for two to three days, or longer in the case of deep tissue, bone, and joint infections.

Speak to your doctor if you don’t notice any improvements.

Remember to keep taking your medication for the entire course of your prescription, even if you start to feel better.

Potential side effects of Cipro

Cipro can cause unwanted side effects¹.

Mild side effects of Cipro are mostly gastrointestinal disruptions like diarrhea and nausea.

Severe side effects include the following:

Peripheral neuropathy

Peripheral neuropathy, a type of nerve damage, mainly in the extremities, affects some people taking Cipro. Seek urgent medical attention if you develop symptoms, including:

• Numbness

• Weakness

• Pain

• A burning sensation

• A tingling sensation

• Increased sensitivity to heat, cold, pain, or light touch

Central nervous system effects

Cipro has been reported to cause central nervous system effects, including:

• Toxic psychosis

• Convulsions

• Increased intracranial pressure

Other symptoms may include:

• Agitation

• Nervousness

• Insomnia

• Nightmares

• Anxiety

• Dizziness

• Paranoia

• Tremors

• Confusion

• Hallucinations

• Psychotic reactions

• Depression

• Suicidal thoughts or behavior

Tendinitis and tendon rupture

The tendon usually affected by Cipro is the Achilles tendon. Cipro has also been reported to affect tendons in the biceps, hands, rotator cuffs, and other parts of the body.

This can occur while you are taking Cipro or up to several months after you have completed your treatment.

Worsening of myasthenia gravis

Myasthenia gravis is a rare neuromuscular condition that usually causes muscle weakness and fatigue. Cipro has neuromuscular blocking activities, so there is a risk of exacerbating muscle weakness in people with the condition.

You should not take Cipro if you have myasthenia gravis. Risks include respiratory muscle failure leading to ventilation or even death.

Other severe adverse reactions

Cipro may cause other severe reactions, most often reported after the administration of multiple doses of the drug. These include:

• Vasculitis

• Cardiac issues, such as prolonged QT interval

• Fever

• Acute renal failure

• Allergic pneumonitis

• Hepatitis

• Anemia

If you experience any of these severe side effects, stop taking Cipro and seek immediate medical attention.

Long-term use of Cipro

Long-term treatment with Cipro may increase your risk of developing some serious side effects, including liver damage, tendon damage, infections in the intestine, and nerve problems.

Missed doses

Take a missed dose as soon as you remember. If it’s less than six hours until your next scheduled dose, skip the dose you missed and resume your regular schedule. Never take two doses at once.

Overdoses

Taking too much Cipro can increase your risk of harmful adverse effects. You may develop damage in your central nervous system, liver, kidney, peripheral nerve, or tendons.

Other common symptoms of overdose include:

• Nausea

• Vomiting

• Diarrhea

• Drowsiness

• Stomach pain

• Seizures

• Difficulty urinating

• Weakness

• Blue lips and pale skin

If you think you or someone else has taken too much Cipro, seek emergency medical help immediately.

Allergy information

Cipro can cause allergic reactions in some people.

Symptoms of an allergic reaction include:

• Rash

• Flushing

• Itchiness

Cipro can also cause severe allergic reactions. Symptoms include:

• Swelling under the skin

• Swelling of the mouth, tongue, or throat

• Difficulty breathing

• Fast heartbeat

If you experience an allergic reaction when using Cipro, stop taking the drug and seek immediate medical attention.

Do not take Cipro again if you have already experienced an allergic reaction to it in the past.

What to discuss with your doctor before taking Cipro

Before you start taking Cipro, discuss the following things with your doctor if they apply to you:

• Allergies: Tell your doctor about all your allergies, especially if you are allergic to Cipro and/or any of its ingredients. You can ask your pharmacist about Cipro’s ingredients.

• Other medications: Tell your doctor about any other medications you are currently taking (prescription drugs and over-the-counter drugs). Tell them if you have ever taken steroids, oral or injectable. They should also know if you are taking herbal medicines or supplements.

• Other medical conditions: Tell your doctor about other medical conditions you have (past and present). Your doctor must know if you have:

• Diabetes

• Arthritis

• Nerve problems

• Heart problems

• Kidney or liver disease

• Muscle weakness

• Seizures

• Low blood potassium levels

• Any neuromuscular condition

• Any issues with your tendons

• Tell your doctor if you have trouble swallowing tablets.

• Tell your doctor if you are pregnant, planning to become pregnant, or you are currently breastfeeding.

Stopping Cipro

Do not stop taking Cipro suddenly or without your doctor’s advice. You should only stop taking Cipro if you experience an adverse effect or a reaction, and you should do so under medical guidance.

Suddenly stopping the use of Cipro can cause your infection to come back. It can also cause the remaining bacteria to adapt, making them immune to the antibiotic. This is called antibiotic resistance.

Take Cipro according to your prescription until you finish your course.

Cipro and pregnancy

Cipro is listed as an FDA pregnancy category C¹ medication. This means human studies are limited.

The use of Cipro during pregnancy is not recommended and should only be considered when the potential benefits outweigh the risks.

Cipro and breastfeeding

Cipro is known to pass into breast milk and can potentially cause side effects like articular (joint) damage in a nursing infant. It should not be used during breastfeeding.

However, Cipro is recommended for use in breastfeeding women as an anthrax treatment and as an agent for postexposure prophylaxis.

If you are breastfeeding, your doctor will decide whether you should stop breastfeeding or taking Cipro. This decision will be based on how important Cipro is for your health.

Interactions with other drugs

Some drugs interact with Cipro, potentially causing harmful effects. This is why you should tell your doctor about all medications you are currently taking.

The following drugs interact with Cipro:

Antacids

Antacids like Gaviscon, Maalox, and Tums contain magnesium hydroxide, aluminum hydroxide, and calcium carbonate. These ingredients prevent your body from absorbing Cipro, which significantly reduces its medicinal effects.

It is recommended to take Cipro six hours after you take antacids, or two hours before.

Anticoagulant drugs

Cipro may interact with anticoagulant drugs like warfarin (Coumadin or Jantoven). Taking the two together can increase the drug’s anticoagulant effects, causing increased bleeding.

Drugs that prolong the QT interval

Drugs that affect the rhythm of the heartbeat can increase the risk of dangerous heartbeats when taken together with Cipro.

Examples of these medicines include procainamide, quinidine, tricyclic antidepressants, sotalol (Betapace), macrolide antibiotics like azithromycin (Zithromax), clarithromycin (Biaxin), erythromycin (PCE, ERY-C, and others), and roxithromycin, amiodarone (Cordarone or Pacerone), and antipsychotic medications.

Clozapine

Taking clozapine (Clozaril) with Cipro may increase side effects and raise levels of clozapine in the body.

Diabetes drugs

Taking Cipro with diabetes drugs like glimepiride (Amaryl) and glyburide (DiaBeta or Glynase) can lower your blood sugar levels, sometimes causing severe hypoglycemia, which could be fatal.

Methotrexate

Taking Cipro together with methotrexate (Rheumatrex or Trexall) can cause an increase in methotrexate levels in the body. This can increase the drug’s side effects.

Probenecid

Probenecid (Probalan) can increase Cipro levels in your body, potentially increasing the risk of side effects.

Ropinirole

Cipro can increase levels of ropinirole in your body, potentially increasing the risk of side effects.

Theophylline

Cipro can interact with theophylline (Elixophyllin, Theo-24, Quibron-T, and others), potentially causing a fatal outcome.

Avoid taking these two medications together unless absolutely necessary and under medical supervision. Your doctor may monitor the medication levels in your blood.

Drug approval history

Cipro was first approved by the FDA in 1987 as an oral tablet.

Cipro for oral suspension was first approved by the FDA in 1997.

Tips and advice for taking Cipro

Follow these tips to help you take Cipro safely and effectively:

• Do not take Cipro together with dairy products like cheese, milk, and yogurt. These products can affect how Cipro works in your body. You can consume milk, yogurt, and cheese together with your meals, but avoid consuming it alone together with Cipro.

• Taking Cipro without food can upset your stomach. If this happens, try taking Cipro together with food.

• Cipro tablets and liquid solution should be stored at room temperature. Do not store the tablets in the refrigerator. The liquid solution can be stored in the fridge for up to 14 days. Do not freeze any Cipro formula.

• Drink lots of water when taking Cipro to help prevent kidney problems.

• Don’t stop taking Cipro without your doctor’s advice, even if you start feeling better.

• Cipro can cause your skin to be more sensitive to the sun. Try to avoid sun exposure or use proper sunscreen if you are going outside.