ciprofloxacin (Rx)

Brand and Other Names:Cipro, Cipro XR, more...ProQuin XR
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Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

infusion solution

  • 200mg/100mL
  • 200mg/20mL
  • 400mg/40mL
  • 400mg/200mL

oral suspension

  • 250mg/5mL
  • 500mg/5mL

tablet

  • 100mg
  • 250mg
  • 500mg
  • 750mg

tablet, extended release

  • 500mg
  • 1000mg

Acute Sinusitis

Mild/moderate: 500 mg PO q12hr or 400 mg IV q12hr for 10 days

Limitations-of-use: Reserve fluoroquinolones for patients who do not have other available treatment options for acute sinusitis

Bone & Joint Infections

Mild/moderate: 500 mg PO q12hr or 400 mg IV q12hr for ≥4-6 weeks

Severe/complicated: 750 mg PO q12hr or 400 mg IV q8hr for ≥4-6 weeks

Chronic Bacterial Prostatitis

Indicated for chronic bacterial prostatitis caused by Escherichia coli or Proteus mirabilis

Mild/moderate: 500 mg PO q12hr or 400 mg IV q12hr for 28 days

Infectious Diarrhea

Mild/moderate/severe: 500 mg PO q12hr for 5-7 days

Empirical Therapy in Febrile Neutropenic Patients

Severe: 400 mg IV q8hr for 7-14 days

Intra-abdominal Infections

Complicated: 500 mg PO q12hr or 400 mg IV q12hr for 7-14 days

Lower Respiratory Tract Infections

Mild/moderate: 500 mg PO q12hr or 400 mg IV q12hr for 7-14 days

Severe/complicated: 750 mg PO q12hr or 400 mg IV q8hr for 7-14 days

Limitations-of-use: Reserve fluoroquinolones for patients who do not have other available treatment options for acute bacterial exacerbation of chronic bronchitis

Nosocomial Pneumonia

Mild/moderate/severe: 400 mg IV q8hr for 10-14 days

Skin/Skin Structure Infections

Mild/moderate: 500 mg PO q12hr or 400 mg IV q12hr for 7-14 days

Severe/complicated: 750 mg PO q12hr or 400 mg IV q8hr for 7-14 days

Urinary Tract Infections

Acute uncomplicated: Immediate-release, 250 mg PO q12hr for 3 days; extended-release, 500 mg PO q24hr for 3 days

Mild/moderate: 250 mg PO q12hr or 200 mg IV q12hr for 7-14 days

Severe/complicated: 500 mg PO q12hr or 400 mg IV q12hr for 7-14 days

Limitations-of-use: Reserve fluoroquinolones for patients who do not have other available treatment options for uncomplicated urinary tract infections

Urethral & Cervical Gonococcal Infections

Uncomplicated: 250-500 mg PO once

Anthrax Infection

Postexposure therapy

Inhalation (prophylaxis/postexposure): 500 mg PO q12hr or 400 mg IV q12hr for 60 days

Cutaneous: 500 mg PO q12hr or 400 mg IV q12hr for 60 days

Plague

Indication for treatment and prophylaxis of plague due to Yersinia pestis

500-750 mg PO q12hr x14 days, OR

400 mg IV q8-12hr x 14 days

Bronchiectasis (Orphan)

Orphan indication sponsor

  • Aradigm Corporation, 3929 Point Eden Way, Hayward, CA 94545

Noncystic Fibrosis Bronchiectasis (Orphan)

Dry powder for inhalation: Orphan designation for patients with NCFB who suffer from frequent severe acute pulmonary bacterial exacerbations which lead to further inflammation, airway, and lung parenchyma damage

Sponsor

  • Bayer HealthCare

Dosage Modifications

Renal impairment

  • CrCl >50 mL/min
    • Dose adjustment not necessary
  • CrCl 30-50 mL/min
    • Immediate-release: 250-500 mg PO q12hr
    • Extended-release: 1 g PO q24hr
    • Intravenous: 400 mg IV q8-12hr
  • CrCl <30 mL/min
    • Immediate-release: 500 mg PO q24hr
    • Extended-release: 500 mg PO q24hr
    • Intravenous: 200-400 mg IV q12-24hr
  • Hemodialysis or peritoneal dialysis
    • Immediate-release: 250-500 mg PO q24hr
    • Extended-release: 500 mg PO q24hr
    • Intravenous: 200-400 mg IV q24hr

Dosing Considerations

ProQuin XR should be taken with a meal, preferably evening meal

Cipro XR may be taken with or without meal; drink fluids liberally

Susceptible organisms

  • Aeromonas hydrophila, Bacillus anthracis, Bacteroides fragilis, Campylobacter jejuni, Citrobacter freundii, Citrobacter diversus, Enterobacter cloacae, Enterococcus faecalis, Escherichia coli, Haemophilus ducreyi, Haemophilus influenzae, Haemophilus parainfluenzae, Klebsiella pneumoniae, Legionella pneumophila, Morganella morganii, Moraxella catarrhalis, certain mycobacteria, Neisseria gonorrhoeae, Proteus mirabilis, Providencia spp, Pseudomonas aeruginosa, Salmonella typhi, Serratia spp, Shigella spp, methicillin-sensitive Staphylococcus aureus (MSSA), Staphylococcus epidermis, Staphylococcus saprophyticus, Streptococcus pneumoniae, Vibrio cholerae, Yersinia enterocolitica
  • First-line therapy: B anthracis, C freundii, C jejuni, Enterobacter spp, Hafnia alvei, S typhi, Salmonella spp, Shigella spp; no unanimity on others (eg, K pneumoniae, M morganii, V cholerae, Y enterocolitica )

Dosage Forms & Strengths

infusion solution

  • 200mg/100mL
  • 200mg/20mL
  • 400mg/40mL
  • 400mg/200mL

oral suspension

  • 250mg/5mL
  • 500mg/5mL

tablet

  • 250mg
  • 500mg
  • 750mg

tablet, extended release

  • 500mg
  • 1000mg

Complicated Urinary Tract Infections or Pyelonephritis

<1 year: Safety and efficacy not established

≥1 year (IV): 6-10 mg/kg q8hr; individual dose not to exceed 400 mg for 10-21 days  

≥1 year (PO): 10-20 mg/kg q12hr; individual dose not to exceed 750 mg q12hr for 10-21 days

Cholera

Single dose: 30 mg/kg PO  

Multiple doses: 30 mg/kg/day PO divided q12hr for 3 days

Plague

Indication for treatment and prophylaxis of plague due to Yersinia pestis in pediatric patients from birth to 17 years of age

15 mg/kg PO q8-12hr x10-21 days; not to exceed 500 mg/dose, OR  

10 mg/kg IV q8-12hr x 10-21 days; not to exceed 400 mg/dose

Inhalational Anthrax (Off-label)

Postexposure therapy

IV: 10 mg/kg q12hr for 60 days; individual dose not to exceed 400 mg  

PO: 15 mg/kg q12hr for 60 days; individual dose not to exceed 500 mg

Change antibiotic to amoxicillin as soon as penicillin susceptibility confirmed

Cystic Fibrosis (Off-label)

PO: 40 mg/kg/day divided q12hr; not to exceed 2 g/day  

IV: 20-30 mg/kg/day divided q8-12hr; not to exceed 1.2 g/day

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Interactions

Interaction Checker

and ciprofloxacin

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            Contraindicated (1)

            • flibanserin

              ciprofloxacin will increase the level or effect of flibanserin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated. Coadministration of flibanserin with moderate or strong CYP3A4 inhibitors is contraindicated. Severe hypotension or syncope can occur.

            Serious - Use Alternative (57)

            • alosetron

              ciprofloxacin will increase the level or effect of alosetron by affecting hepatic enzyme CYP1A2 metabolism. Avoid or Use Alternate Drug. Alosetron is associated with potentially serious and life-threatening, dose-related gastrointestinal adverse effects, concomitant use with CYP450 1A2 inhibitors should generally be avoided if possible.

            • aluminum hydroxide

              aluminum hydroxide decreases levels of ciprofloxacin by inhibition of GI absorption. Applies only to oral form of both agents. Avoid or Use Alternate Drug. Separate by 2 hours.

            • aminolevulinic acid oral

              aminolevulinic acid oral, ciprofloxacin. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid administering other phototoxic drugs with aminolevulinic acid oral for 24 hr during perioperative period.

            • aminolevulinic acid topical

              ciprofloxacin increases toxicity of aminolevulinic acid topical by pharmacodynamic synergism. Avoid or Use Alternate Drug. Coadministration of photosensitizing drugs may enhance the phototoxic reaction to photodynamic therapy with aminolevulinic acid.

            • BCG vaccine live

              ciprofloxacin decreases effects of BCG vaccine live by pharmacodynamic antagonism. Contraindicated. Antibiotics may diminish therapeutic effects of BCG. Wait until Abx Tx complete to administer live bacterial vaccine.

            • carbonyl iron

              carbonyl iron decreases levels of ciprofloxacin by inhibition of GI absorption. Applies only to oral form of both agents. Avoid or Use Alternate Drug.

            • ceritinib

              ceritinib and ciprofloxacin both increase QTc interval. Avoid or Use Alternate Drug.

            • cholera vaccine

              ciprofloxacin, cholera vaccine. pharmacodynamic antagonism. Avoid or Use Alternate Drug. Avoid coadministration of cholera vaccine with systemic antibiotics since these agents may be active against the vaccine strain. Do not administer cholera vaccine to patients who have received oral or parenteral antibiotics within 14 days prior to vaccination.

            • clarithromycin

              clarithromycin and ciprofloxacin both increase QTc interval. Avoid or Use Alternate Drug.

            • clomipramine

              ciprofloxacin will increase the level or effect of clomipramine by affecting hepatic enzyme CYP1A2 metabolism. Avoid or Use Alternate Drug. Concurrent use of drugs that can cause QT interval prolongation may result in additive effects and increased risk of ventricular arrhythmias. It is important to monitor therapy carefully.

            • clozapine

              ciprofloxacin will increase the level or effect of clozapine by affecting hepatic enzyme CYP1A2 metabolism. Avoid or Use Alternate Drug. Use caution when administering ciprofloxacin in patients receiving drugs that prolong the QT interval. At elevated serum concentrations, clozapine may produce clinically significant prolongation of the QTc interval.

              clozapine and ciprofloxacin both increase QTc interval. Avoid or Use Alternate Drug.

            • cobimetinib

              ciprofloxacin will increase the level or effect of cobimetinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. If concurrent short term (14 days or less) use of moderate CYP3A inhibitors is unavoidable for patients who are taking cobimetinib 60 mg, reduce the cobimetinib dose to 20 mg. After discontinuation of a moderate CYP3A inhibitor, resume cobimetinib 60 mg. Use an alternative to a moderate CYP3A inhibitor in patients who are taking a reduced dose of cobimetinib (40 or 20 mg daily).

            • desflurane

              desflurane and ciprofloxacin both increase QTc interval. Avoid or Use Alternate Drug.

            • didanosine

              didanosine decreases levels of ciprofloxacin by inhibition of GI absorption. Applies only to oral form of both agents. Avoid or Use Alternate Drug. Oral ciprofloxacin should not be administered simultaneously with didanosine (chewable tablets or powder for oral solution). Administer oral doses of ciprofloxacin 2 hours before or 6 hours after didanosine, chewable tablets or powder for oral solution.

            • dofetilide

              dofetilide increases toxicity of ciprofloxacin by QTc interval. Avoid or Use Alternate Drug.

            • dronedarone

              ciprofloxacin and dronedarone both increase QTc interval. Avoid or Use Alternate Drug. The use of dronedarone in combination with other medications that can prolong the QT interval is contraindicated.

            • entrectinib

              ciprofloxacin and entrectinib both increase QTc interval. Avoid or Use Alternate Drug.

            • fexinidazole

              fexinidazole and ciprofloxacin both increase QTc interval. Avoid or Use Alternate Drug. Avoid coadministration of fexinidazole with drugs known to block potassium channels and/or prolong QT interval.

            • glasdegib

              ciprofloxacin and glasdegib both increase QTc interval. Avoid or Use Alternate Drug. If coadministration unavoidable, monitor for increased risk of QTc interval prolongation.

            • hydroxychloroquine sulfate

              hydroxychloroquine sulfate and ciprofloxacin both increase QTc interval. Avoid or Use Alternate Drug.

            • ibrutinib

              ciprofloxacin increases levels of ibrutinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid concomitant use of ibrutinib and strong CYP3A4 inhibitors. If a strong CYP3A4 inhibitor must be used short-term (eg, anti-infectives for =7 days), interrupt ibrutinib therapy until strong CYP3A4 inhibitor is discontinued.

            • imipramine

              ciprofloxacin will increase the level or effect of imipramine by affecting hepatic enzyme CYP1A2 metabolism. Avoid or Use Alternate Drug. Concurrent use of drugs that can cause QT interval prolongation may result in additive effects and increased risk of ventricular arrhythmias. It is important to monitor therapy carefully.

            • inotuzumab

              inotuzumab and ciprofloxacin both increase QTc interval. Avoid or Use Alternate Drug. If unable to avoid concomitant use, obtain ECGs and electrolytes before and after initiation of any drug known to prolong QTc, and periodically monitor as clinically indicated during treatment.

            • iron sucrose

              iron sucrose decreases levels of ciprofloxacin by inhibition of GI absorption. Applies only to oral form of both agents. Avoid or Use Alternate Drug. Coadministration of ciprofloxacin with multivalent cation-containing products may reduce the bioavailability of ciprofloxacin by 90%. Administer ciprofloxacin at least 2 hours before or 6 hours after using these products. Use alternatives if available.

            • ivosidenib

              ivosidenib and ciprofloxacin both increase QTc interval. Avoid or Use Alternate Drug. Avoid coadministration of QTc prolonging drugs with ivosidenib or replace with alternate therapies. If coadministration of a QTc prolonging drug is unavoidable, monitor for increased risk of QTc interval prolongation.

            • lasmiditan

              lasmiditan increases levels of ciprofloxacin by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug.

            • lefamulin

              lefamulin and ciprofloxacin both increase QTc interval. Avoid or Use Alternate Drug.

            • lonafarnib

              ciprofloxacin will increase the level or effect of lonafarnib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. If coadministration of lonafarnib (a sensitive CYP3A substrate) with weak CYP3A inhibitors is unavoidable, reduce to, or continue lonafarnib at starting dose. Closely monitor for arrhythmias and events (eg, syncope, heart palpitations) since lonafarnib effect on QT interval is unknown.

            • macimorelin

              macimorelin and ciprofloxacin both increase QTc interval. Avoid or Use Alternate Drug. Macimorelin causes an increase of ~11 msec in the corrected QT interval. Avoid coadministration with drugs that prolong QT interval, which could increase risk for developing torsade de pointes-type ventricular tachycardia. Allow sufficient washout time of drugs that are known to prolong the QT interval before administering macimorelin.

            • mefloquine

              mefloquine increases toxicity of ciprofloxacin by QTc interval. Avoid or Use Alternate Drug. Mefloquine may enhance the QTc prolonging effect of high risk QTc prolonging agents.

            • methyl aminolevulinate

              ciprofloxacin, methyl aminolevulinate. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Each drug may increase the photosensitizing effect of the other.

            • mobocertinib

              mobocertinib and ciprofloxacin both increase QTc interval. Avoid or Use Alternate Drug. If coadministration unavoidable, reduce mobocertinib dose and monitor QTc interval more frequently.

            • olaparib

              ciprofloxacin will increase the level or effect of olaparib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. If coadministration with moderate CYP3A inhibitors cannot be avoided, reduce olaparib dose to 200 mg (capsule) or 150 mg (tablet) PO BID. Do not substitute tablets with capsules.

            • ondansetron

              ciprofloxacin and ondansetron both increase QTc interval. Avoid or Use Alternate Drug. Avoid with congenital long QT syndrome; ECG monitoring recommended with concomitant medications that prolong QT interval, electrolyte abnormalities, CHF, or bradyarrhythmias.

            • panobinostat

              ciprofloxacin and panobinostat both increase QTc interval. Avoid or Use Alternate Drug. Panobinostat is known to significantly prolong QT interval. Panobinostat prescribing information states use with drugs known to prolong QTc is not recommended.

            • pirfenidone

              ciprofloxacin will increase the level or effect of pirfenidone by affecting hepatic enzyme CYP1A2 metabolism. Avoid or Use Alternate Drug. Use of strong CYP1A2 inhibitors should be discontinued before initiating pirfenidone and avoided during treatment; if strong CYP1A2 inhibitors are the only drug of choice, dosage reductions are recommended

            • pitolisant

              ciprofloxacin and pitolisant both increase QTc interval. Avoid or Use Alternate Drug.

            • pomalidomide

              ciprofloxacin increases levels of pomalidomide by affecting hepatic enzyme CYP1A2 metabolism. Avoid or Use Alternate Drug.

            • rasagiline

              ciprofloxacin will increase the level or effect of rasagiline by affecting hepatic enzyme CYP1A2 metabolism. Avoid or Use Alternate Drug. Ciprofloxacin may increase rasagiline concentration resulting in increased adverse reactions. Patients should be closely monitored during concomitant use of these drugs.

            • ribociclib

              ribociclib increases toxicity of ciprofloxacin by QTc interval. Avoid or Use Alternate Drug.

            • saquinavir

              saquinavir increases levels of ciprofloxacin by pharmacodynamic synergism. Avoid or Use Alternate Drug. Potential for increased toxicity. Increased risk of QT prolongation and cardiac arrhythmias.

            • selinexor

              selinexor, ciprofloxacin. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.

            • sotorasib

              sotorasib will decrease the level or effect of ciprofloxacin by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug. If use is unavoidable, refer to the prescribing information of the P-gp substrate for dosage modifications.

            • tepotinib

              tepotinib will increase the level or effect of ciprofloxacin by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug. If concomitant use unavoidable, reduce the P-gp substrate dosage if recommended in its approved product labeling.

            • theophylline

              ciprofloxacin will increase the level or effect of theophylline by affecting hepatic enzyme CYP1A2 metabolism. Avoid or Use Alternate Drug. Concomitant use of theophylline and ciprofloxacin has decreased theophylline clearance and increased plasma levels and symptoms of toxicity. Serious and fatal reactions have included cardiac arrest, seizure, status epilepticus, and respiratory failure. If concomitant use cannot be avoided, monitor theophylline levels and adjust dosage as needed.

              ciprofloxacin will increase the level or effect of theophylline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Concomitant use of theophylline and ciprofloxacin has decreased theophylline clearance and increased plasma levels and symptoms of toxicity. Serious and fatal reactions have included cardiac arrest, seizure, status epilepticus, and respiratory failure. If concomitant use cannot be avoided, monitor theophylline levels and adjust dosage as needed.

            • tizanidine

              ciprofloxacin will increase the level or effect of tizanidine by affecting hepatic enzyme CYP1A2 metabolism. Avoid or Use Alternate Drug. Coadministration of ciprofloxacin and tizanidine is contraindicated.

            • toremifene

              ciprofloxacin and toremifene both increase QTc interval. Avoid or Use Alternate Drug. Concurrent use of toremifene with agents causing QT prolongation should be avoided. If concomitant use is required it's recommended that toremifene be interrupted. If interruption not possible, patients requiring therapy with a drug that prolongs QT should be closely monitored. ECGs should be obtained for high risk patients.

            • tretinoin

              ciprofloxacin, tretinoin. Mechanism: pharmacodynamic synergism. Avoid or Use Alternate Drug. Both drugs have increased risk of phototoxicity, use caution with concomitant use.

            • tretinoin topical

              ciprofloxacin, tretinoin topical. Mechanism: pharmacodynamic synergism. Avoid or Use Alternate Drug. Both drugs have increased risk of phototoxicity, use caution with concomitant use.

            • trilaciclib

              trilaciclib will decrease the level or effect of ciprofloxacin by Other (see comment). Avoid or Use Alternate Drug. Avoid coadministration of trilaciclib (OCT2, MATE1, and MATE-2K inhibitor) with substrates where minimal increased concentration in kidney or blood may lead to serious or life-threatening toxicities.

            • typhoid vaccine live

              ciprofloxacin decreases effects of typhoid vaccine live by pharmacodynamic antagonism. Contraindicated. Antibiotics may diminish the therapeutic effects of Typhoid Vaccine. Wait until Abx Tx complete to administer live bacterial vaccine.

            • umeclidinium bromide/vilanterol inhaled

              ciprofloxacin increases toxicity of umeclidinium bromide/vilanterol inhaled by QTc interval. Avoid or Use Alternate Drug. Exercise extreme caution when vilanterol coadministered with drugs that prolong QTc interval; adrenergic agonist effects on the cardiovascular system may be potentiated.

            • vandetanib

              ciprofloxacin, vandetanib. Either increases toxicity of the other by QTc interval. Avoid or Use Alternate Drug. Avoid coadministration with drugs known to prolong QT interval; if a drug known to prolong QT interval must be used, more frequent ECG monitoring is recommended.

            • vemurafenib

              vemurafenib and ciprofloxacin both increase QTc interval. Avoid or Use Alternate Drug. Concomitant use of vemurafenib with drugs that prolong QT interval is not recommended.

            • venetoclax

              ciprofloxacin will increase the level or effect of venetoclax by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. If a moderate CYP3A inhibitor must be used, reduce the venetoclax dose by at least 50%. Monitor more closely for signs of venetoclax toxicities.

            • vilanterol/fluticasone furoate inhaled

              ciprofloxacin increases toxicity of vilanterol/fluticasone furoate inhaled by QTc interval. Avoid or Use Alternate Drug. Exercise extreme caution when vilanterol coadministered with drugs that prolong QTc interval; adrenergic agonist effects on the cardiovascular system may be potentiated.

            • warfarin

              ciprofloxacin will increase the level or effect of warfarin by affecting hepatic enzyme CYP1A2 metabolism. Avoid or Use Alternate Drug. Quinolone antibiotics such as ciprofloxacin may enhance the anticoagulant effects of warfarin. Important to monitor INR/prothrombin time and toxic effects of warfarin. Patients receiving this combination should be closely monitored for adverse effects.

            Monitor Closely (216)

            • acarbose

              ciprofloxacin increases effects of acarbose by pharmacodynamic synergism. Use Caution/Monitor. Quinolone antibiotic administration may result in hyper- or hypoglycemia. .

            • albuterol

              albuterol and ciprofloxacin both increase QTc interval. Use Caution/Monitor.

            • alfuzosin

              ciprofloxacin and alfuzosin both increase QTc interval. Use Caution/Monitor.

              alfuzosin and ciprofloxacin both increase QTc interval. Use Caution/Monitor.

            • amifampridine

              ciprofloxacin increases toxicity of amifampridine by Other (see comment). Modify Therapy/Monitor Closely. Comment: Amifampridine can cause seizures. Coadministration with drugs that lower seizure threshold may increase this risk.

            • amiodarone

              ciprofloxacin and amiodarone both increase QTc interval. Use Caution/Monitor. Ciprofloxacin elicits minimal effects on QT interval. Caution if used in combination with other drugs known to affect QT interval or in patients with other risk factors.

            • arformoterol

              arformoterol and ciprofloxacin both increase QTc interval. Use Caution/Monitor.

            • aripiprazole

              aripiprazole and ciprofloxacin both increase QTc interval. Use Caution/Monitor.

            • arsenic trioxide

              ciprofloxacin and arsenic trioxide both increase QTc interval. Use Caution/Monitor. Ciprofloxacin elicits minimal effects on QT interval. Caution if used in combination with other drugs known to affect QT interval or in patients with other risk factors.

            • artemether

              ciprofloxacin and artemether both increase QTc interval. Use Caution/Monitor. Ciprofloxacin elicits minimal effects on QT interval. Caution if used in combination with other drugs known to affect QT interval or in patients with other risk factors.

            • artemether/lumefantrine

              ciprofloxacin and artemether/lumefantrine both increase QTc interval. Use Caution/Monitor. Ciprofloxacin elicits minimal effects on QT interval. Caution if used in combination with other drugs known to affect QT interval or in patients with other risk factors.

            • asenapine

              ciprofloxacin will increase the level or effect of asenapine by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor. Asenapine has been associated with dose-related prolongation of the QT interval; asenapine should not be used with other agents also known to have this effect.

              ciprofloxacin and asenapine both increase QTc interval. Use Caution/Monitor. Ciprofloxacin elicits minimal effects on QT interval. Caution if used in combination with other drugs known to affect QT interval or in patients with other risk factors.

            • aspirin

              aspirin decreases levels of ciprofloxacin by Other (see comment). Use Caution/Monitor. Comment: Buffered aspirin may decrease absorption of quinolones. Consider administering 2 hr before or 6 hr after, buffered aspirin administration.

            • aspirin/citric acid/sodium bicarbonate

              aspirin/citric acid/sodium bicarbonate decreases levels of ciprofloxacin by Other (see comment). Use Caution/Monitor. Comment: Buffered aspirin may decrease absorption of quinolones. Consider administering 2 hr before or 6 hr after, buffered aspirin administration.

            • atomoxetine

              atomoxetine and ciprofloxacin both increase QTc interval. Use Caution/Monitor.

            • avapritinib

              ciprofloxacin will increase the level or effect of avapritinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • axitinib

              ciprofloxacin increases levels of axitinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • azithromycin

              azithromycin increases toxicity of ciprofloxacin by QTc interval. Use Caution/Monitor.

            • bazedoxifene/conjugated estrogens

              ciprofloxacin will decrease the level or effect of bazedoxifene/conjugated estrogens by altering intestinal flora. Applies only to oral forms of hormone. Low risk of contraceptive failure. Use Caution/Monitor.

            • bedaquiline

              ciprofloxacin and bedaquiline both increase QTc interval. Modify Therapy/Monitor Closely. ECG should be monitored closely

            • benazepril

              benazepril increases toxicity of ciprofloxacin by unknown mechanism. Use Caution/Monitor. ACE Inhibitors may increase arrhythmogenic potential of ciprofloxacin, possibly by increasing serum potassium levels.

            • bendamustine

              ciprofloxacin increases levels of bendamustine by decreasing metabolism. Use Caution/Monitor. Decreased conversion of bendamustine to active metabolites. Concurrent administration of a CYP1A2 inhibitor such as ciprofloxacin may increase bendamustine concentrations. .

            • berotralstat

              berotralstat will increase the level or effect of ciprofloxacin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Monitor or titrate P-gp substrate dose if coadministered.

            • betamethasone

              betamethasone, ciprofloxacin. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: Coadministration of quinolone antibiotics and corticosteroids may increase risk of tendon rupture.

            • betaxolol

              ciprofloxacin increases levels of betaxolol by decreasing metabolism. Use Caution/Monitor. Consider modifying therapy; CYP1A2 inhibitors may decrease metabolism of 1A2 substrates.

            • biotin

              biotin will decrease the level or effect of ciprofloxacin by altering intestinal flora. Applies only to oral form of both agents. Use Caution/Monitor. Administer ciprofloxacin 4 hours before or 2 hours after biotin.

            • bosutinib

              bosutinib increases levels of ciprofloxacin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

            • caffeine

              ciprofloxacin will increase the level or effect of caffeine by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor. The hepatic metabolism of caffeine may be decreased by ciprofloxacin; pharmacologic effects of caffeine may be increased.

            • calcium acetate

              calcium acetate decreases effects of ciprofloxacin by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Ciprofloxacin should be administered 2 hr before or 6 hr after calcium salts.

            • calcium carbonate

              calcium carbonate decreases effects of ciprofloxacin by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Ciprofloxacin should be administered 2 hr before or 6 hr after calcium salts.

            • calcium chloride

              calcium chloride decreases effects of ciprofloxacin by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Ciprofloxacin should be administered 2 hr before or 6 hr after calcium salts.

            • calcium citrate

              calcium citrate decreases effects of ciprofloxacin by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Ciprofloxacin should be administered 2 hr before or 6 hr after calcium salts.

            • calcium gluconate

              calcium gluconate decreases effects of ciprofloxacin by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Ciprofloxacin should be administered 2 hr before or 6 hr after calcium salts.

            • captopril

              captopril increases toxicity of ciprofloxacin by Mechanism: unspecified interaction mechanism. Use Caution/Monitor. ACE Inhibitors increase arrhythmogenic potential of ciprofloxacin. Monitor ECG and QT interval.

            • carbamazepine

              ciprofloxacin will increase the level or effect of carbamazepine by decreasing metabolism. Modify Therapy/Monitor Closely. Monitor plasma levels when used concomitantly

            • celecoxib

              ciprofloxacin, celecoxib. Other (see comment). Modify Therapy/Monitor Closely. Comment: Mechanism: unknown. Increased risk of CNS stimulation and seizures with high doses of fluoroquinolones.

            • chloroquine

              chloroquine and ciprofloxacin both increase QTc interval. Use Caution/Monitor. Ciprofloxacin elicits minimal effects on QT interval. Caution if used in combination with other drugs known to affect QT interval or in patients with other risk factors.

            • chlorpromazine

              ciprofloxacin and chlorpromazine both increase QTc interval. Use Caution/Monitor. Ciprofloxacin elicits minimal effects on QT interval. Caution if used in combination with other drugs known to affect QT interval or in patients with other risk factors.

            • chlorpropamide

              ciprofloxacin increases effects of chlorpropamide by pharmacodynamic synergism. Use Caution/Monitor. Careful monitoring of blood glucose is recommended when quinolones and antidiabetic agents are coadministered. Hyperglycemia and hypoglycemia have been reported in patients treated concomitantly with quinolones and antidiabetic agent.

            • citalopram

              ciprofloxacin and citalopram both increase QTc interval. Use Caution/Monitor. ECG monitoring is recommended, along with drugs that may prolong the QT interval.

            • conjugated estrogens

              ciprofloxacin will decrease the level or effect of conjugated estrogens by altering intestinal flora. Applies only to oral forms of hormone. Low risk of contraceptive failure. Use Caution/Monitor.

            • corticotropin

              corticotropin and ciprofloxacin both increase Other (see comment). Use Caution/Monitor. Coadministration of quinolone antibiotics and corticosteroids may increase risk of tendon rupture.

            • cortisone

              cortisone and ciprofloxacin both increase Other (see comment). Use Caution/Monitor. Coadministration of quinolone antibiotics and corticosteroids may increase risk of tendon rupture.

            • crizotinib

              crizotinib and ciprofloxacin both increase QTc interval. Use Caution/Monitor. ECG monitoring is recommended, along with drugs that may prolong the QT interval.

            • dasatinib

              dasatinib and ciprofloxacin both increase QTc interval. Use Caution/Monitor.

            • degarelix

              ciprofloxacin and degarelix both increase QTc interval. Use Caution/Monitor. Ciprofloxacin elicits minimal effects on QT interval. Caution if used in combination with other drugs known to affect QT interval or in patients with other risk factors.

            • deutetrabenazine

              deutetrabenazine and ciprofloxacin both increase QTc interval. Use Caution/Monitor.

            • dexamethasone

              dexamethasone and ciprofloxacin both increase Other (see comment). Use Caution/Monitor. Coadministration of quinolone antibiotics and corticosteroids may increase risk of tendon rupture.

            • dichlorphenamide

              dichlorphenamide and ciprofloxacin both decrease serum potassium. Use Caution/Monitor.

            • diclofenac

              diclofenac, ciprofloxacin. Other (see comment). Modify Therapy/Monitor Closely. Comment: Mechanism: unknown. Increased risk of CNS stimulation and seizures with high doses of fluoroquinolones.

            • dienogest/estradiol valerate

              ciprofloxacin will decrease the level or effect of dienogest/estradiol valerate by altering intestinal flora. Applies only to oral forms of hormone. Low risk of contraceptive failure. Use Caution/Monitor. An alternate or additional form of birth control may be advisable during concomitant use.

            • diflunisal

              diflunisal, ciprofloxacin. Other (see comment). Modify Therapy/Monitor Closely. Comment: Mechanism: unknown. Increased risk of CNS stimulation and seizures with high doses of fluoroquinolones.

            • disopyramide

              ciprofloxacin and disopyramide both increase QTc interval. Use Caution/Monitor. Ciprofloxacin elicits minimal effects on QT interval. Caution if used in combination with other drugs known to affect QT interval or in patients with other risk factors.

            • dofetilide

              ciprofloxacin and dofetilide both increase QTc interval. Use Caution/Monitor. Ciprofloxacin elicits minimal effects on QT interval. Caution if used in combination with other drugs known to affect QT interval or in patients with other risk factors.

            • dolasetron

              ciprofloxacin and dolasetron both increase QTc interval. Use Caution/Monitor. Ciprofloxacin elicits minimal effects on QT interval. Caution if used in combination with other drugs known to affect QT interval or in patients with other risk factors.

            • droperidol

              ciprofloxacin and droperidol both decrease QTc interval. Use Caution/Monitor. Ciprofloxacin elicits minimal effects on QT interval. Caution if used in combination with other drugs known to affect QT interval or in patients with other risk factors.

            • duloxetine

              ciprofloxacin will increase the level or effect of duloxetine by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor. Coadministration of CYP1A2 inhibiting quinolones with duloxetine may lead to significant increases in duloxetine levels, AUC, and half-life. Consider therapy modification if duloxetine is necessary.

            • elagolix

              elagolix will increase the level or effect of ciprofloxacin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

            • eliglustat

              eliglustat increases levels of ciprofloxacin by P-glycoprotein (MDR1) efflux transporter. Modify Therapy/Monitor Closely. Monitor therapeutic drug concentrations, as indicated, or consider reducing the dosage of the P-gp substrate and titrate to clinical effect.

            • eltrombopag

              ciprofloxacin will increase the level or effect of eltrombopag by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor.

            • eluxadoline

              ciprofloxacin increases levels of eluxadoline by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor. As a precautionary measure due to incomplete information on the metabolism of eluxadoline, use caution when coadministered with strong CYP1A2 inhibitors.

            • erlotinib

              ciprofloxacin increases levels of erlotinib by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor. If severe adverse effects occur consider reducing erlotinib dose.

            • erythromycin base

              ciprofloxacin and erythromycin base both increase QTc interval. Use Caution/Monitor. Coadministration of ciprofloxacin with drugs known to prolong QT interval could increase risk of developing torsade de pointes in predisposed patients; however less likely with ciprofloxacin than other quinolones.

            • erythromycin ethylsuccinate

              ciprofloxacin and erythromycin ethylsuccinate both increase QTc interval. Use Caution/Monitor. Coadministration of ciprofloxacin with drugs known to prolong QT interval could increase risk of developing torsade de pointes in predisposed patients; however less likely with ciprofloxacin than other quinolones.

            • erythromycin lactobionate

              ciprofloxacin and erythromycin lactobionate both increase QTc interval. Use Caution/Monitor. Coadministration of ciprofloxacin with drugs known to prolong QT interval could increase risk of developing torsade de pointes in predisposed patients; however less likely with ciprofloxacin than other quinolones.

            • erythromycin stearate

              ciprofloxacin and erythromycin stearate both increase QTc interval. Use Caution/Monitor. Coadministration of ciprofloxacin with drugs known to prolong QT interval could increase risk of developing torsade de pointes in predisposed patients; however less likely with ciprofloxacin than other quinolones.

            • escitalopram

              escitalopram increases toxicity of ciprofloxacin by QTc interval. Use Caution/Monitor.

            • estradiol

              ciprofloxacin will decrease the level or effect of estradiol by altering intestinal flora. Applies only to oral forms of hormone. Low risk of contraceptive failure. Use Caution/Monitor.

            • estrogens conjugated synthetic

              ciprofloxacin will decrease the level or effect of estrogens conjugated synthetic by altering intestinal flora. Applies only to oral forms of hormone. Low risk of contraceptive failure. Use Caution/Monitor.

            • estropipate

              ciprofloxacin will decrease the level or effect of estropipate by altering intestinal flora. Applies only to oral forms of hormone. Low risk of contraceptive failure. Use Caution/Monitor.

            • ethinylestradiol

              ciprofloxacin will decrease the level or effect of ethinylestradiol by altering intestinal flora. Applies only to oral forms of hormone. Low risk of contraceptive failure. Use Caution/Monitor.

            • etodolac

              etodolac, ciprofloxacin. Other (see comment). Modify Therapy/Monitor Closely. Comment: Mechanism: unknown. Increased risk of CNS stimulation and seizures with high doses of fluoroquinolones.

            • ezogabine

              ezogabine, ciprofloxacin. Either increases toxicity of the other by QTc interval. Use Caution/Monitor. Slight and transient QT-prolongation observed with ezogabine, particularly when dose titrated to 1200 mg/day. QT interval should be monitored when ezogabine is prescribed with agents known to increase QT interval.

            • fenoprofen

              fenoprofen, ciprofloxacin. Other (see comment). Modify Therapy/Monitor Closely. Comment: Mechanism: unknown. Increased risk of CNS stimulation and seizures with high doses of fluoroquinolones.

            • ferric citrate

              ferric citrate will decrease the level or effect of ciprofloxacin by drug binding in GI tract. Use Caution/Monitor. Take at least 2 hours before or after ferric citrate

            • ferric maltol

              ferric maltol decreases effects of ciprofloxacin by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Coadministration of ciprofloxacin with multivalent cation-containing products may reduce the bioavailability of ciprofloxacin by 90%. Administer ciprofloxacin at least 2 hours before or 6 hours after using these products. Use alternatives if available.

            • ferrous fumarate

              ferrous fumarate decreases levels of ciprofloxacin by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Coadministration of ciprofloxacin with multivalent cation-containing products may reduce the bioavailability of ciprofloxacin by 90%. Administer ciprofloxacin at least 2 hours before or 6 hours after using these products. Use alternatives if available.

            • ferrous gluconate

              ferrous gluconate decreases levels of ciprofloxacin by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Coadministration of ciprofloxacin with multivalent cation-containing products may reduce the bioavailability of ciprofloxacin by 90%. Administer ciprofloxacin at least 2 hours before or 6 hours after using these products. Use alternatives if available.

            • ferrous sulfate

              ferrous sulfate decreases effects of ciprofloxacin by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Coadministration of ciprofloxacin with multivalent cation-containing products may reduce the bioavailability of ciprofloxacin by 90%. Administer ciprofloxacin at least 2 hours before or 6 hours after using these products. Use alternatives if available.

            • finerenone

              ciprofloxacin will increase the level or effect of finerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Monitor serum potassium during initiation and dosage adjustment of either finererone or weak CYP3A4 inhibitors. Adjust finererone dosage as needed.

            • flecainide

              ciprofloxacin and flecainide both increase QTc interval. Use Caution/Monitor. Ciprofloxacin elicits minimal effects on QT interval. Caution if used in combination with other drugs known to affect QT interval or in patients with other risk factors.

            • fludrocortisone

              fludrocortisone and ciprofloxacin both increase Other (see comment). Use Caution/Monitor. Coadministration of quinolone antibiotics and corticosteroids may increase risk of tendon rupture.

            • fluoxetine

              ciprofloxacin and fluoxetine both increase QTc interval. Modify Therapy/Monitor Closely.

            • flurbiprofen

              flurbiprofen, ciprofloxacin. Other (see comment). Modify Therapy/Monitor Closely. Comment: Mechanism: unknown. Increased risk of CNS stimulation and seizures with high doses of fluoroquinolones.

            • fostamatinib

              fostamatinib will increase the level or effect of ciprofloxacin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Concomitant use of fostamatinib may increase concentrations of P-gp substrates. Monitor for toxicities of the P-gp substrate drug that may require dosage reduction when given concurrently with fostamatinib.

            • fostemsavir

              ciprofloxacin and fostemsavir both increase QTc interval. Use Caution/Monitor. QTc prolongation reported with higher than recommended doses of fostemsavir.

            • gemtuzumab

              ciprofloxacin and gemtuzumab both increase QTc interval. Use Caution/Monitor.

            • glecaprevir/pibrentasvir

              glecaprevir/pibrentasvir will increase the level or effect of ciprofloxacin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

            • glimepiride

              ciprofloxacin increases effects of glimepiride by pharmacodynamic synergism. Use Caution/Monitor. Hyper and hypoglycemia have been reported in patients treated concomitantly with quinolones and antidiabetic agents. Careful monitoring of blood glucose is recommended.

            • glipizide

              ciprofloxacin increases effects of glipizide by pharmacodynamic synergism. Use Caution/Monitor. Hyper and hypoglycemia have been reported in patients treated concomitantly with quinolones and antidiabetic agents. Careful monitoring of blood glucose is recommended.

            • glyburide

              ciprofloxacin increases effects of glyburide by pharmacodynamic synergism. Use Caution/Monitor. Hyper and hypoglycemia have been reported in patients treated concomitantly with quinolones and antidiabetic agents. Careful monitoring of blood glucose is recommended.

            • goserelin

              goserelin increases toxicity of ciprofloxacin by QTc interval. Use Caution/Monitor. Increases risk of torsades de pointes.

            • haloperidol

              ciprofloxacin and haloperidol both increase QTc interval. Use Caution/Monitor. Ciprofloxacin elicits minimal effects on QT interval. Caution if used in combination with other drugs known to affect QT interval or in patients with other risk factors.

            • histrelin

              histrelin increases toxicity of ciprofloxacin by QTc interval. Use Caution/Monitor. Increases risk of torsades de pointes.

            • hydrocortisone

              hydrocortisone and ciprofloxacin both increase Other (see comment). Use Caution/Monitor. Coadministration of quinolone antibiotics and corticosteroids may increase risk of tendon rupture.

            • hydrocortisone rectal

              hydrocortisone rectal and ciprofloxacin both increase Other (see comment). Use Caution/Monitor. Coadministration of quinolone antibiotics and corticosteroids may increase risk of tendon rupture.

            • ibuprofen

              ibuprofen, ciprofloxacin. Other (see comment). Modify Therapy/Monitor Closely. Comment: Mechanism: unknown. Increased risk of CNS stimulation and seizures with high doses of fluoroquinolones.

            • ibuprofen IV

              ibuprofen IV, ciprofloxacin. Other (see comment). Modify Therapy/Monitor Closely. Comment: Mechanism: unknown. Increased risk of CNS stimulation and seizures with high doses of fluoroquinolones.

            • ibutilide

              ciprofloxacin and ibutilide both increase QTc interval. Use Caution/Monitor. Ciprofloxacin elicits minimal effects on QT interval. Caution if used in combination with other drugs known to affect QT interval or in patients with other risk factors.

            • ifosfamide

              ciprofloxacin will decrease the level or effect of ifosfamide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Use of a CYP3A4 inhibitor may decrease metabolism of ifosfamide, potentially reducing ifosfamide therapeutic effects.

            • iloperidone

              ciprofloxacin and iloperidone both increase QTc interval. Use Caution/Monitor. Ciprofloxacin elicits minimal effects on QT interval. Caution if used in combination with other drugs known to affect QT interval or in patients with other risk factors.

            • indacaterol, inhaled

              indacaterol, inhaled, ciprofloxacin. QTc interval. Use Caution/Monitor. Drugs that are known to prolong the QTc interval may have an increased the risk of ventricular arrhythmias.

            • indomethacin

              indomethacin, ciprofloxacin. Other (see comment). Modify Therapy/Monitor Closely. Comment: Mechanism: unknown. Increased risk of CNS stimulation and seizures with high doses of fluoroquinolones.

            • insulin aspart

              ciprofloxacin increases effects of insulin aspart by pharmacodynamic synergism. Use Caution/Monitor. Hyper and hypoglycemia have been reported in patients treated concomitantly with quinolones and antidiabetic agents. Careful monitoring of blood glucose is recommended.

            • insulin lispro

              ciprofloxacin increases effects of insulin lispro by pharmacodynamic synergism. Use Caution/Monitor. Hyper and hypoglycemia have been reported in patients treated concomitantly with quinolones and antidiabetic agents. Careful monitoring of blood glucose is recommended.

            • insulin regular human

              ciprofloxacin increases effects of insulin regular human by pharmacodynamic synergism. Use Caution/Monitor. Hyper and hypoglycemia have been reported in patients treated concomitantly with quinolones and antidiabetic agents. Careful monitoring of blood glucose is recommended.

            • iron dextran complex

              iron dextran complex decreases levels of ciprofloxacin by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Coadministration of ciprofloxacin with multivalent cation-containing products may reduce the bioavailability of ciprofloxacin by 90%. Administer ciprofloxacin at least 2 hours before or 6 hours after using these products. Use alternatives if available.

            • isavuconazonium sulfate

              ciprofloxacin will increase the level or effect of isavuconazonium sulfate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • istradefylline

              istradefylline will increase the level or effect of ciprofloxacin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Istradefylline 40 mg/day increased peak levels and AUC of P-gp substrates in clinical trials. Consider dose reduction of sensitive P-gp substrates.

            • ivacaftor

              ivacaftor increases levels of ciprofloxacin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Ivacaftor and its M1 metabolite has the potential to inhibit P-gp; may significantly increase systemic exposure to sensitive P-gp substrates with a narrow therapeutic index.

              ciprofloxacin increases levels of ivacaftor by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Monitor when coadministered with weak CYP3A4 inhibitors .

            • ivosidenib

              ciprofloxacin will increase the level or effect of ivosidenib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Coadministration with moderate CYP3A4 inhibitors may increase ivosidenib plasma concentrations, thus increasing the risk of QTc prolongation. Monitor for increased risk of QTc interval prolongation.

            • ketoprofen

              ketoprofen, ciprofloxacin. Other (see comment). Modify Therapy/Monitor Closely. Comment: Mechanism: unknown. Increased risk of CNS stimulation and seizures with high doses of fluoroquinolones.

            • ketorolac

              ketorolac, ciprofloxacin. Other (see comment). Modify Therapy/Monitor Closely. Comment: Mechanism: unknown. Increased risk of CNS stimulation and seizures with high doses of fluoroquinolones.

            • lanthanum carbonate

              lanthanum carbonate decreases levels of ciprofloxacin by cation binding in GI tract. Use Caution/Monitor. Administer oral quinolone antibiotics at least 1 hr before or 4 hr after lanthanum. Interaction applies only to oral quinolones.

            • lemborexant

              ciprofloxacin will increase the level or effect of lemborexant by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Lower nightly dose of lemborexant recommended if coadministered with weak CYP3A4 inhibitors. See drug monograph for specific dosage modification.

            • lenvatinib

              ciprofloxacin and lenvatinib both increase QTc interval. Use Caution/Monitor. Lenvatinib prescribing information recommends monitoring ECG closely when coadministered with QT prolonging drugs.

            • leuprolide

              leuprolide increases toxicity of ciprofloxacin by QTc interval. Use Caution/Monitor. Increases risk of torsades de pointes.

            • levonorgestrel oral/ethinylestradiol/ferrous bisglycinate

              ciprofloxacin will decrease the level or effect of levonorgestrel oral/ethinylestradiol/ferrous bisglycinate by altering intestinal flora. Applies only to oral forms of hormone. Low risk of contraceptive failure. Use Caution/Monitor. Antibiotics may decrease hormonal contraceptive efficacy.

            • lidocaine

              ciprofloxacin will increase the level or effect of lidocaine by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor. Lidocaine plasma levels may be elevated, increasing the risk of toxicity. Monitor cardiac function and symptoms of toxicity.

            • lomitapide

              ciprofloxacin increases levels of lomitapide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Lomitapide dose should not exceed 30 mg/day.

              lomitapide increases levels of ciprofloxacin by P-glycoprotein (MDR1) efflux transporter. Modify Therapy/Monitor Closely. Consider reducing dose when used concomitantly with lomitapide.

            • lumefantrine

              ciprofloxacin and lumefantrine both increase QTc interval. Use Caution/Monitor. Ciprofloxacin elicits minimal effects on QT interval. Caution if used in combination with other drugs known to affect QT interval or in patients with other risk factors.

            • magnesium chloride

              magnesium chloride decreases levels of ciprofloxacin by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Coadministration of ciprofloxacin with multivalent cation-containing products may reduce the bioavailability of ciprofloxacin by 90%. Administer ciprofloxacin at least 2 hours before or 6 hours after using these products. Use alternatives if available.

            • magnesium citrate

              magnesium citrate decreases levels of ciprofloxacin by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Coadministration of ciprofloxacin with multivalent cation-containing products may reduce the bioavailability of ciprofloxacin by 90%. Administer ciprofloxacin at least 2 hours before or 6 hours after using these products. Use alternatives if available.

            • magnesium hydroxide

              magnesium hydroxide decreases levels of ciprofloxacin by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Coadministration of ciprofloxacin with multivalent cation-containing products may reduce the bioavailability of ciprofloxacin by 90%. Administer ciprofloxacin at least 2 hours before or 6 hours after using these products. Use alternatives if available.

            • magnesium oxide

              magnesium oxide decreases levels of ciprofloxacin by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

            • magnesium sulfate

              magnesium sulfate decreases levels of ciprofloxacin by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Coadministration of ciprofloxacin with multivalent cation-containing products may reduce the bioavailability of ciprofloxacin by 90%. Administer ciprofloxacin at least 2 hours before or 6 hours after using these products. Use alternatives if available.

            • magnesium supplement

              magnesium supplement will decrease the level or effect of ciprofloxacin by Other (see comment). Modify Therapy/Monitor Closely. Formation of an insoluble complex reduces absorption of the drug through intestinal tract; administer magnesium 2hr before the quinolone or 6hr after the quinolone

            • meclofenamate

              meclofenamate, ciprofloxacin. Other (see comment). Modify Therapy/Monitor Closely. Comment: Mechanism: unknown. Increased risk of CNS stimulation and seizures with high doses of fluoroquinolones.

            • mefenamic acid

              mefenamic acid, ciprofloxacin. Other (see comment). Modify Therapy/Monitor Closely. Comment: Mechanism: unknown. Increased risk of CNS stimulation and seizures with high doses of fluoroquinolones.

            • mefloquine

              ciprofloxacin and mefloquine both increase QTc interval. Use Caution/Monitor. Ciprofloxacin elicits minimal effects on QT interval. Caution if used in combination with other drugs known to affect QT interval or in patients with other risk factors.

            • meloxicam

              meloxicam, ciprofloxacin. Other (see comment). Modify Therapy/Monitor Closely. Comment: Mechanism: unknown. Increased risk of CNS stimulation and seizures with high doses of fluoroquinolones.

            • mestranol

              ciprofloxacin will decrease the level or effect of mestranol by altering intestinal flora. Applies only to oral forms of hormone. Low risk of contraceptive failure. Use Caution/Monitor.

            • metformin

              ciprofloxacin increases effects of metformin by pharmacodynamic synergism. Use Caution/Monitor. Hyper and hypoglycemia have been reported in patients treated concomitantly with quinolones and antidiabetic agents. Careful monitoring of blood glucose is recommended.

            • methadone

              ciprofloxacin and methadone both increase QTc interval. Use Caution/Monitor. Ciprofloxacin elicits minimal effects on QT interval. Caution if used in combination with other drugs known to affect QT interval or in patients with other risk factors.

            • methotrexate

              ciprofloxacin will increase the level or effect of methotrexate by Other (see comment). Use Caution/Monitor. Renal tubular transport of methotrexate may be inhibited by coadministration of ciprofloxacin, potentially leading to increased methotrexate plasma levels and toxicity.

            • methylprednisolone

              methylprednisolone and ciprofloxacin both increase Other (see comment). Use Caution/Monitor. Coadministration of quinolone antibiotics and corticosteroids may increase risk of tendon rupture.

            • mexiletine

              ciprofloxacin will increase the level or effect of mexiletine by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor. Mexiletine concentrations may be elevated and may produce an increase in therapeutic and adverse reactions.

            • midazolam intranasal

              ciprofloxacin will increase the level or effect of midazolam intranasal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Coadministration of mild CYP3A4 inhibitors with midazolam intranasal may cause higher midazolam systemic exposure, which may prolong sedation.

            • mifepristone

              ciprofloxacin will increase the level or effect of mifepristone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Use alternatives if available.

            • miglitol

              ciprofloxacin increases effects of miglitol by pharmacodynamic synergism. Use Caution/Monitor. Hyper and hypoglycemia have been reported in patients treated concomitantly with quinolones and antidiabetic agents. Careful monitoring of blood glucose is recommended.

            • mometasone inhaled

              mometasone inhaled and ciprofloxacin both increase Other (see comment). Use Caution/Monitor. Coadministration of quinolone antibiotics and corticosteroids may increase risk of tendon rupture.

            • moxifloxacin

              ciprofloxacin and moxifloxacin both increase QTc interval. Use Caution/Monitor. Ciprofloxacin elicits minimal effects on QT interval. Caution if used in combination with other drugs known to affect QT interval or in patients with other risk factors.

            • nabumetone

              nabumetone, ciprofloxacin. Other (see comment). Modify Therapy/Monitor Closely. Comment: Mechanism: unknown. Increased risk of CNS stimulation and seizures with high doses of fluoroquinolones.

            • naproxen

              naproxen, ciprofloxacin. Other (see comment). Modify Therapy/Monitor Closely. Comment: Mechanism: unknown. Increased risk of CNS stimulation and seizures with high doses of fluoroquinolones.

            • nateglinide

              ciprofloxacin increases effects of nateglinide by pharmacodynamic synergism. Use Caution/Monitor. Hyper and hypoglycemia have been reported in patients treated concomitantly with quinolones and antidiabetic agents. Careful monitoring of blood glucose is recommended.

            • nilotinib

              ciprofloxacin and nilotinib both increase QTc interval. Use Caution/Monitor. Ciprofloxacin elicits minimal effects on QT interval. Caution if used in combination with other drugs known to affect QT interval or in patients with other risk factors.

            • olanzapine

              ciprofloxacin will increase the level or effect of olanzapine by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor. Olanzapine plasma concentrations may be elevated, increasing the risk of adverse reactions such as orthostatic hypotension or sedation. It is important to use caution and observe patient and adjust the olanzapine dosage as needed.

            • olodaterol inhaled

              ciprofloxacin and olodaterol inhaled both increase QTc interval. Use Caution/Monitor. Drugs that prolong the QTc interval and may potentiate the effects of beta2 agonists on the cardiovascular system; increased risk of ventricular arrhythmias

            • omeprazole

              omeprazole will decrease the level or effect of ciprofloxacin by unknown mechanism. Use Caution/Monitor. Absorption of the ciprofloxacin ER tablet was slightly diminished (20%) when coadministered with omeprazole.

            • osilodrostat

              osilodrostat and ciprofloxacin both increase QTc interval. Use Caution/Monitor.

            • osimertinib

              osimertinib and ciprofloxacin both increase QTc interval. Use Caution/Monitor. Conduct periodic monitoring with ECGs and electrolytes in patients taking drugs known to prolong the QTc interval.

            • oxaliplatin

              oxaliplatin will increase the level or effect of ciprofloxacin by Other (see comment). Use Caution/Monitor. Monitor for ECG changes if therapy is initiated in patients with drugs known to prolong QT interval.

            • oxaprozin

              oxaprozin, ciprofloxacin. Other (see comment). Modify Therapy/Monitor Closely. Comment: Mechanism unknown. Increased risk of CNS stimulation and seizures with high doses of fluoroquinolones.

            • ozanimod

              ozanimod and ciprofloxacin both increase QTc interval. Modify Therapy/Monitor Closely. The potential additive effects on heart rate, treatment with ozanimod should generally not be initiated in patients who are concurrently treated with QT prolonging drugs with known arrhythmogenic properties.

            • paliperidone

              ciprofloxacin and paliperidone both increase QTc interval. Use Caution/Monitor. Ciprofloxacin elicits minimal effects on QT interval. Caution if used in combination with other drugs known to affect QT interval or in patients with other risk factors.

            • pasireotide

              ciprofloxacin and pasireotide both increase QTc interval. Modify Therapy/Monitor Closely.

            • patiromer

              patiromer will decrease the level or effect of ciprofloxacin by drug binding in GI tract. Use Caution/Monitor. May administer 3 hours apart

            • pentamidine

              ciprofloxacin and pentamidine both increase QTc interval. Use Caution/Monitor. Ciprofloxacin elicits minimal effects on QT interval. Caution if used in combination with other drugs known to affect QT interval or in patients with other risk factors.

            • pentoxifylline

              ciprofloxacin will increase the level or effect of pentoxifylline by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor.

            • phenytoin

              ciprofloxacin decreases effects of phenytoin by unknown mechanism. Use Caution/Monitor. Ciprofloxacin has been reported to both increase and decrease phenytoin concentrations. Additional clinical evidence is needed however; phenytoin serum concentrations should be monitored in patients.

            • pimozide

              ciprofloxacin and pimozide both increase QTc interval. Use Caution/Monitor. Ciprofloxacin elicits minimal effects on QT interval. Caution if used in combination with other drugs known to affect QT interval or in patients with other risk factors.

            • pioglitazone

              ciprofloxacin increases effects of pioglitazone by pharmacodynamic synergism. Use Caution/Monitor. Hyper and hypoglycemia have been reported in patients treated concomitantly with quinolones and antidiabetic agents. Careful monitoring of blood glucose is recommended.

            • piroxicam

              piroxicam, ciprofloxacin. Other (see comment). Modify Therapy/Monitor Closely. Comment: Mechanism: unknown. Increased risk of CNS stimulation and seizures with high doses of fluoroquinolones.

            • polysaccharide iron

              polysaccharide iron decreases levels of ciprofloxacin by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Coadministration of ciprofloxacin with multivalent cation-containing products may reduce the bioavailability of ciprofloxacin by 90%. Administer ciprofloxacin at least 2 hours before or 6 hours after using these products. Use alternatives if available.

            • ponatinib

              ponatinib increases levels of ciprofloxacin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

            • prednisolone

              prednisolone and ciprofloxacin both increase Other (see comment). Use Caution/Monitor. Coadministration of quinolone antibiotics and corticosteroids may increase risk of tendon rupture.

            • prednisone

              prednisone and ciprofloxacin both increase Other (see comment). Use Caution/Monitor. Coadministration of quinolone antibiotics and corticosteroids may increase risk of tendon rupture.

            • probenecid

              probenecid will increase the level or effect of ciprofloxacin by Other (see comment). Use Caution/Monitor. Probenecid interferes with renal tubular secretion of ciprofloxacin and produces an increase in the ciprofloxacin levels in the serum

            • procainamide

              ciprofloxacin and procainamide both increase QTc interval. Use Caution/Monitor. Ciprofloxacin elicits minimal effects on QT interval. Caution if used in combination with other drugs known to affect QT interval or in patients with other risk factors.

            • quetiapine

              quetiapine, ciprofloxacin. Either increases toxicity of the other by QTc interval. Use Caution/Monitor. Avoid use with drugs that prolong QT and in patients with risk factors for prolonged QT interval. Postmarketing cases show QT prolongation with overdose in patients with concomitant illness or with drugs known to cause electrolyte imbalance or prolong QT.

            • quinapril

              quinapril will decrease the level or effect of ciprofloxacin by Other (see comment). Use Caution/Monitor. Separate doses of quinapril and oral quinolones by 2 hr; interaction likely due to chelation

            • quinidine

              ciprofloxacin and quinidine both increase QTc interval. Use Caution/Monitor. Ciprofloxacin elicits minimal effects on QT interval. Caution if used in combination with other drugs known to affect QT interval or in patients with other risk factors.

            • quinine

              ciprofloxacin and quinine both increase QTc interval. Use Caution/Monitor. Ciprofloxacin elicits minimal effects on QT interval. Caution if used in combination with other drugs known to affect QT interval or in patients with other risk factors.

            • ramelteon

              ciprofloxacin will increase the level or effect of ramelteon by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor. Ciprofloxacin may decrease the metabolism of ramelteon; if ciprofloxacin is coadministered with ramelteon, monitor the patient closely for toxicity.

            • ranolazine

              ciprofloxacin and ranolazine both increase QTc interval. Use Caution/Monitor. Ciprofloxacin elicits minimal effects on QT interval. Caution if used in combination with other drugs known to affect QT interval or in patients with other risk factors.

            • repaglinide

              ciprofloxacin increases effects of repaglinide by pharmacodynamic synergism. Use Caution/Monitor. Hyper and hypoglycemia have been reported in patients treated concomitantly with quinolones and antidiabetic agents. Careful monitoring of blood glucose is recommended.

            • rilpivirine

              rilpivirine increases toxicity of ciprofloxacin by QTc interval. Use Caution/Monitor. Rilpivirine should be used with caution when co-administered with a drug with a known risk of Torsades de Pointes.

            • riluzole

              ciprofloxacin will increase the level or effect of riluzole by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor.

            • ropinirole

              ciprofloxacin will increase the level or effect of ropinirole by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor. Ciprofloxacin may decrease the metabolism of ropinirole; monitor for increased effects of ropinirole.

            • ropivacaine

              ciprofloxacin will increase the level or effect of ropivacaine by Mechanism: decreasing metabolism. Use Caution/Monitor. Monitor for increased ropivacaine toxicity.

            • rosiglitazone

              ciprofloxacin increases effects of rosiglitazone by pharmacodynamic synergism. Use Caution/Monitor. Hyper and hypoglycemia have been reported in patients treated concomitantly with quinolones and antidiabetic agents. Careful monitoring of blood glucose is recommended.

            • saquinavir

              ciprofloxacin and saquinavir both increase QTc interval. Use Caution/Monitor. Ciprofloxacin elicits minimal effects on QT interval. Caution if used in combination with other drugs known to affect QT interval or in patients with other risk factors.

            • sarecycline

              sarecycline will increase the level or effect of ciprofloxacin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Monitor for toxicities of P-gp substrates that may require dosage reduction when coadministered with P-gp inhibitors.

            • saxagliptin

              ciprofloxacin increases effects of saxagliptin by pharmacodynamic synergism. Use Caution/Monitor. Hyper and hypoglycemia have been reported in patients treated concomitantly with quinolones and antidiabetic agents. Careful monitoring of blood glucose is recommended.

            • selpercatinib

              selpercatinib increases toxicity of ciprofloxacin by QTc interval. Use Caution/Monitor.

            • sevelamer

              sevelamer decreases levels of ciprofloxacin by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Administer oral quinolones at least 1 hour before or 3 hours after sevelamer. .

            • sitagliptin

              ciprofloxacin increases effects of sitagliptin by pharmacodynamic synergism. Use Caution/Monitor. Hyper and hypoglycemia have been reported in patients treated concomitantly with quinolones and antidiabetic agents. Careful monitoring of blood glucose is recommended.

            • sodium bicarbonate

              sodium bicarbonate decreases levels of ciprofloxacin by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. A large proportion of ciprofloxacin is normally excreted unchanged in the urine. When urinary alkalinizing agents such as sodium bicarbonate are used concomitantly, the solubility of ciprofloxacin can be decreased because of alkaline urine. Patients should be monitored for crystalluria and nephrotoxicity.

            • sodium citrate/citric acid

              sodium citrate/citric acid decreases levels of ciprofloxacin by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. A large proportion of ciprofloxacin is normally excreted unchanged in the urine. When urinary alkalinizing agents such as sodium citrate are used concomitantly, the solubility of ciprofloxacin can be decreased because of alkaline urine. Patients should be monitored for crystalluria and nephrotoxicity.

            • sodium picosulfate/magnesium oxide/anhydrous citric acid

              ciprofloxacin decreases effects of sodium picosulfate/magnesium oxide/anhydrous citric acid by altering metabolism. Use Caution/Monitor. Coadministration with antibiotics decreases efficacy by altering colonic bacterial flora needed to convert sodium picosulfate to active drug.

              sodium picosulfate/magnesium oxide/anhydrous citric acid decreases levels of ciprofloxacin by cation binding in GI tract. Use Caution/Monitor. Take at least 2 hours before and not less than 6 hours after administration of sodium picosulfate, magnesium oxide and anhydrous citric acid to avoid magnesium chelation.

            • sodium sulfate/?magnesium sulfate/potassium chloride

              sodium sulfate/?magnesium sulfate/potassium chloride decreases levels of ciprofloxacin by inhibition of GI absorption. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Administer fluoroquinolones at least 2 hr before and no less than 6 hr after each dose to avoid chelation with magnesium. .

            • sodium sulfate/potassium sulfate/magnesium sulfate

              sodium sulfate/potassium sulfate/magnesium sulfate decreases levels of ciprofloxacin by inhibition of GI absorption. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Administer fluoroquinolones at least 2 hr before and no less than 6 hr after each dose to avoid chelation with magnesium. .

            • sorafenib

              sorafenib and ciprofloxacin both increase QTc interval. Use Caution/Monitor.

            • sotalol

              ciprofloxacin and sotalol both increase QTc interval. Use Caution/Monitor. Ciprofloxacin elicits minimal effects on QT interval. Caution if used in combination with other drugs known to affect QT interval or in patients with other risk factors.

            • stiripentol

              stiripentol will increase the level or effect of ciprofloxacin by P-glycoprotein (MDR1) efflux transporter. Modify Therapy/Monitor Closely. Consider reducing the dose of P-glycoprotein (P-gp) substrates, if adverse reactions are experienced when administered concomitantly with stiripentol.

            • sucralfate

              sucralfate decreases levels of ciprofloxacin by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. The oral absorption of ciprofloxacin may be significantly reduced by sucralfate secondary to chelation within the GI tract. To help avoid interactions due to chelation, ciprofloxacin should be taken 2 hours before or 6 hours after administration of sucralfate.

            • sulindac

              sulindac, ciprofloxacin. Other (see comment). Modify Therapy/Monitor Closely. Comment: Mechanism: unknown. Increased risk of CNS stimulation and seizures with high doses of fluoroquinolones.

            • sunitinib

              ciprofloxacin and sunitinib both increase QTc interval. Use Caution/Monitor. Ciprofloxacin elicits minimal effects on QT interval. Caution if used in combination with other drugs known to affect QT interval or in patients with other risk factors.

            • tasimelteon

              ciprofloxacin will increase the level or effect of tasimelteon by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor. Avoid coadministration; potentially large increase in tasimelteon exposure and greater risk of adverse reactions with strong CYP1A2 inhibitors

            • telavancin

              ciprofloxacin and telavancin both increase QTc interval. Use Caution/Monitor. Ciprofloxacin elicits minimal effects on QT interval. Caution if used in combination with other drugs known to affect QT interval or in patients with other risk factors.

            • terbinafine

              ciprofloxacin will increase the level or effect of terbinafine by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor.

            • tetrabenazine

              ciprofloxacin and tetrabenazine both increase QTc interval. Use Caution/Monitor. Ciprofloxacin elicits minimal effects on QT interval. Caution if used in combination with other drugs known to affect QT interval or in patients with other risk factors.

            • thioridazine

              ciprofloxacin and thioridazine both increase QTc interval. Use Caution/Monitor. Ciprofloxacin elicits minimal effects on QT interval. Caution if used in combination with other drugs known to affect QT interval or in patients with other risk factors.

            • tinidazole

              ciprofloxacin will increase the level or effect of tinidazole by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • tobramycin inhaled

              tobramycin inhaled and ciprofloxacin both increase nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely. Avoid concurrent or sequential use to decrease risk for ototoxicity

            • tolazamide

              ciprofloxacin increases effects of tolazamide by pharmacodynamic synergism. Use Caution/Monitor. Hyper and hypoglycemia have been reported in patients treated concomitantly with quinolones and antidiabetic agents. Careful monitoring of blood glucose is recommended.

            • tolbutamide

              ciprofloxacin increases effects of tolbutamide by pharmacodynamic synergism. Use Caution/Monitor. Hyper and hypoglycemia have been reported in patients treated concomitantly with quinolones and antidiabetic agents. Careful monitoring of blood glucose is recommended.

            • tolmetin

              tolmetin, ciprofloxacin. Other (see comment). Modify Therapy/Monitor Closely. Comment: Mechanism: unknown. Increased risk of CNS stimulation and seizures with high doses of fluoroquinolones.

            • triamcinolone acetonide injectable suspension

              triamcinolone acetonide injectable suspension and ciprofloxacin both increase Other (see comment). Use Caution/Monitor. Coadministration of quinolone antibiotics and corticosteroids may increase risk of tendon rupture.

            • trimagnesium citrate anhydrous

              trimagnesium citrate anhydrous decreases levels of ciprofloxacin by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Multivalent cation-containing products may reduce bioavailability of quinolones; administer quinolone at least 2 hr before or 6 hr after magnesium; use alternatives if available.

            • triptorelin

              triptorelin increases toxicity of ciprofloxacin by QTc interval. Use Caution/Monitor. Increases risk of torsades de pointes.

            • tucatinib

              tucatinib will increase the level or effect of ciprofloxacin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Consider reducing the dosage of P-gp substrates, where minimal concentration changes may lead to serious or life-threatening toxicities.

            • vildagliptin

              ciprofloxacin increases effects of vildagliptin by pharmacodynamic synergism. Use Caution/Monitor. Hyper and hypoglycemia have been reported in patients treated concomitantly with quinolones and antidiabetic agents. Careful monitoring of blood glucose is recommended.

            • voclosporin

              voclosporin, ciprofloxacin. Either increases effects of the other by QTc interval. Use Caution/Monitor.

            • zinc

              zinc will decrease the level or effect of ciprofloxacin by cation binding in GI tract. Modify Therapy/Monitor Closely. Ciprofloxacin should be administered 2 hr before or 6 hr after zinc salts.

            • ziprasidone

              ciprofloxacin and ziprasidone both increase QTc interval. Use Caution/Monitor. Ciprofloxacin elicits minimal effects on QT interval. Caution if used in combination with other drugs known to affect QT interval or in patients with other risk factors.

            • zolpidem

              ciprofloxacin will increase the level or effect of zolpidem by affecting hepatic enzyme CYP1A2 metabolism. Modify Therapy/Monitor Closely.

              ciprofloxacin will increase the level or effect of zolpidem by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely.

            Minor (33)

            • acebutolol

              ciprofloxacin increases levels of acebutolol by decreasing metabolism. Minor/Significance Unknown. May also rarely decrease beta blocker levels.

            • alprazolam

              ciprofloxacin increases levels of alprazolam by decreasing metabolism. Minor/Significance Unknown.

            • balsalazide

              ciprofloxacin will decrease the level or effect of balsalazide by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.

            • carvedilol

              ciprofloxacin increases levels of carvedilol by decreasing metabolism. Minor/Significance Unknown. May also rarely decrease beta blocker levels.

            • chlordiazepoxide

              ciprofloxacin increases levels of chlordiazepoxide by decreasing metabolism. Minor/Significance Unknown.

            • clonazepam

              ciprofloxacin increases levels of clonazepam by decreasing metabolism. Minor/Significance Unknown.

            • clorazepate

              ciprofloxacin increases levels of clorazepate by decreasing metabolism. Minor/Significance Unknown.

            • diazepam

              ciprofloxacin increases levels of diazepam by decreasing metabolism. Minor/Significance Unknown.

            • digoxin

              ciprofloxacin will increase the level or effect of digoxin by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.

            • esmolol

              ciprofloxacin increases levels of esmolol by decreasing metabolism. Minor/Significance Unknown.

            • estazolam

              ciprofloxacin increases levels of estazolam by decreasing metabolism. Minor/Significance Unknown.

            • fennel

              fennel decreases levels of ciprofloxacin by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown. Fennel may decrease the amount of ciprofloxacin the body absorbs. Take fennel at least 1 hour after ciprofloxacin administration.

            • flurazepam

              ciprofloxacin increases levels of flurazepam by decreasing metabolism. Minor/Significance Unknown.

            • foscarnet

              ciprofloxacin, foscarnet. Mechanism: unknown. Minor/Significance Unknown. Based on 2 case reports it was reported that there is a potential for an increased risk of seizures.

            • frovatriptan

              ciprofloxacin will increase the level or effect of frovatriptan by affecting hepatic enzyme CYP1A2 metabolism. Minor/Significance Unknown.

            • green tea

              ciprofloxacin increases levels of green tea by decreasing elimination. Minor/Significance Unknown. (Caffeine). Some quinolones can inhibit the hepatic clearance of caffeine. Caution is advised.

            • isotretinoin

              ciprofloxacin, isotretinoin. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Both drugs have increased risk of phototoxicity, use caution with concomitant use.

            • metoprolol

              ciprofloxacin increases levels of metoprolol by decreasing metabolism. Minor/Significance Unknown. Ciprofloxacin may increase metoprolol plasma concentrations however mechanism is unknown. Further clinical evidence is needed but it may be appropriate to monitor patients during concomitant therapy with ciprofloxacin.

            • midazolam

              ciprofloxacin increases levels of midazolam by decreasing metabolism. Minor/Significance Unknown.

            • nadolol

              ciprofloxacin increases levels of nadolol by decreasing metabolism. Minor/Significance Unknown.

            • nebivolol

              ciprofloxacin increases levels of nebivolol by decreasing metabolism. Minor/Significance Unknown.

            • penbutolol

              ciprofloxacin increases levels of penbutolol by decreasing metabolism. Minor/Significance Unknown.

            • pindolol

              ciprofloxacin increases levels of pindolol by decreasing metabolism. Minor/Significance Unknown.

            • propranolol

              ciprofloxacin increases levels of propranolol by decreasing metabolism. Minor/Significance Unknown.

            • pyridoxine

              ciprofloxacin will decrease the level or effect of pyridoxine by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.

            • quazepam

              ciprofloxacin increases levels of quazepam by decreasing metabolism. Minor/Significance Unknown.

            • quercetin

              quercetin decreases effects of ciprofloxacin by pharmacodynamic antagonism. Minor/Significance Unknown.

            • ruxolitinib

              ciprofloxacin will increase the level or effect of ruxolitinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

            • temazepam

              ciprofloxacin increases levels of temazepam by decreasing metabolism. Minor/Significance Unknown.

            • thiamine

              ciprofloxacin will decrease the level or effect of thiamine by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.

            • timolol

              ciprofloxacin increases levels of timolol by decreasing metabolism. Minor/Significance Unknown. May also rarely decrease beta blocker levels.

            • triazolam

              ciprofloxacin increases levels of triazolam by decreasing metabolism. Minor/Significance Unknown.

            • vitamin K1 (phytonadione)

              ciprofloxacin will decrease the level or effect of vitamin K1 (phytonadione) by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.

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            Adverse Effects

            1-10%

            Nausea (3%)

            Abdominal pain (2%)

            Diarrhea (2% adults; 5% children)

            Increased aminotransferase levels (2%)

            Vomiting (1% adults; 5% children)

            Headache (1%)

            Increased serum creatinine (1%)

            Rash (2%)

            Restlessness (1%)

            <1%

            Acidosis

            Allergic reaction

            Angina pectoris

            Anorexia

            Arthralgia

            Ataxia

            Back pain

            Bad taste

            Blurred vision

            Breast pain

            Bronchospasm

            Diplopia

            Dizziness

            Drowsiness

            Dysphagia

            Dyspnea

            Flushing

            Foot pain

            Hallucinations

            Hiccups

            Hypertension

            Hypotension

            Insomnia

            Irritability

            Joint stiffness

            Lethargy

            Migraine

            Nephritis

            Nightmares

            Oral candidiasis

            Palpitation

            Photosensitivity

            Polyuria

            Syncope

            Tachycardia

            Tinnitus

            Tremor

            Urinary retention

            Vaginitis

            Postmarketing Reports

            Acute generalized exanthematous pustulosis (AGEP), erythema multiforme, exfoliative dermatitis, fixed eruption, photosensitivity/phototoxicity reaction

            Agitation, confusion, delirium

            Agranulocytosis, albuminuria, serum cholesterol and TG elevations, blood glucose disturbances, hemolytic anemia, marrow depression (life threatening), pancytopenia (life threatening or fatal outcome), potassium elevation (serum)

            Anaphylactic reactions (including life-threatening anaphylactic shock), serum sickness like reaction, Stevens-Johnson syndrome

            Anosmia, hypesthesia

            Constipation, dyspepsia, dysphagia, flatulence, hepatic failure (including fatal cases), hepatic necrosis, jaundice, pancreatitis

            Hypertonia, hypotension (postural), increased INR (in patients treated with Vitamin K antagonists), QT prolongation, torsade de pointes, ventricular arrhythmia

            Methemoglobinemia

            Myasthenia, exacerbation of myasthenia gravis, myoclonus, nystagmus, peripheral neuropathy that may be irreversible, phenytoin alteration (serum), polyneuropathy, psychosis

            Myalgia, tendinitis, tendon rupture, toxic epidermal necrolysis (Lyell’s Syndrome), twitching

            Infections: Candiduria, vaginal candidiasis, moniliasis (oral, gastrointestinal, vaginal), pseudomembranous colitis

            Renal calculi

            Vasculitis

            Aortic aneurysm and dissection

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            Warnings

            Black Box Warnings

            Serious adverse effects

            • Fluoroquinolones have been associated with disabling and potentially irreversible serious adverse reactions that have occurred together including: tendinitis and tendon rupture, peripheral neuropathy, and central nervous system (CNS) effects
            • Discontinue treatment immediately and avoid use of systemic fluoroquinolones in patients who experience any of these serious adverse reactions
            • May exacerbate muscle weakness in patients with myasthenia gravis; avoid fluoroquinolones with known history of myasthenia gravis

            Because the risk of these serious side effects generally outweighs the benefits for patients with acute bacterial sinusitis, acute exacerbation of chronic bronchitis, and uncomplicated UTIs, that fluoroquinolones should be reserved for use in patients with these conditions who have no alternative treatment options

            Contraindications

            Documented hypersensitivity; concurrent tizanidine administration

            Cautions

            Use in pregnancy, though generally contraindicated for all quinolones, is allowed for life-threatening situations; limited data from use of ciprofloxacin in pregnancy show no higher rate of birth defects than background

            Do not use oral suspension in nasogastric tube; to prepare, add microcapsules to diluent

            Commonly seen adverse reactions include tendinitis, tendon rupture, arthralgia, myalgia, peripheral neuropathy, and central nervous system effects (hallucinations, anxiety, depression, insomnia, severe headaches, and confusion); these reactions can occur within hours to weeks after starting therapy, including in patients of any age or without pre-existing risk factors; discontinue therapy immediately at first signs or symptoms of any serious adverse reaction; in addition, avoid use of fluoroquinolones, in patients who have experienced any serious adverse reactions associated with fluoroquinolones (see Black Box Warnings)

            Peripheral neuropathy: sensory or sensorimotor axonal polyneuropathy affecting small and/or large axons resulting in paresthesias, hypoesthesias, dysesthesias, and weakness reported; peripheral neuropathy may occur rapidly after initiating and may potentially become permanent

            In prolonged therapy, perform periodic evaluations of organ system functions (eg, renal, hepatic, hematopoietic); adjust dose in renal impairment; superinfections may occur with prolonged or repeated antibiotic therapy; discontinue use immediately if signs and symptoms of hepatitis occur

            Not first drug of choice in pediatrics (except in anthrax), because of increased incidence of adverse events in comparison with control subjects, including arthropathy; no data exist on dosing for pediatric patients with renal impairment (ie, CrCl <50 mL/min)

            Crystalluria may occur; urine alkalinity may increase risk; ensure adequate hydration during therapy

            Serious and sometimes fatal hypoglycemia reported with fluoroquinolone use; hyperglycemia also reported; monitor patients closely for signs/symptoms of abnormal glucose levels; if hypoglycemic reaction occurs in a patient being treated discontinue therapy and initiate appropriate treatment immediately

            Moderate-to-severe phototoxicity reactions reported; avoid excessive sunlight and take precautions to limit exposure; discontinue use if phototoxicity occurs

            Acute onset of retinal detachment increased 4.5-fold with oral fluoroquinolones in a single case-controlled study - JAMA 2012;307(13):1414-1419; another study disputes these findings (relative risk, 1.29) - JAMA 2013;310(20):2184-2190

            Clostridium difficile-associated diarrhea (CDAD) reported; if CDAD suspected or confirmed, ongoing antibiotic use not directed against C. difficile may need to be discontinued; appropriate fluid and electrolyte management, protein supplementation, antibiotic treatment of C. difficile, and surgical evaluation should be instituted as clinically indicated

            Prescribing antibiotics in absence of a proven or strongly suspected bacterial infection or a prophylactic indication is unlikely to provide benefit to patient and increases risk of development of drug-resistant bacteria

            Fluoroquinolones may exacerbate muscle weakness in patients with myasthenia gravis; postmarketing serious adverse reactions, including deaths and requirement for ventilatory support, have been associated with fluoroquinolone use in patients with myasthenia gravis; avoid in patients with known history of myasthenia gravis

            CNS effects

            • Fluoroquinolones are associated with an increased risk of CNS effects(eg, convulsions, increased intracranial pressure [including pseudotumor cerebri], and toxic psychosis)
            • May also cause CNS events including: nervousness, agitation, insomnia, anxiety, nightmares, paranoia, dizziness, confusion, tremors, hallucinations, depression, and psychotic reactions have progressed to suicidal ideations/thoughts and self-injurious behavior such as attempted or completed suicide; reactions may occur following the first dose; advise patients to inform their healthcare provider immediately if these reactions occur, discontinue treatment, and institute appropriate care
            • Fluoroquinolone are also known to trigger seizures or lower the seizure threshold; exercise caution in epileptic patients and patients with known or suspected CNS disorders that may predispose to seizures or lower the seizure threshold (eg, severe cerebral arteriosclerosis, previous history of convulsion, reduced cerebral blood flow, altered brain structure, stroke), or in the presence of other risk factors that may predispose to seizures or lower the seizure threshold (eg, certain drug therapy, renal dysfunction)
            • Cases of status epilepticus have been reported; if seizures occur, discontinue treatment

            FDA MedWatch Safety Alert

            • Issued 12-20-2018
            • Increase in rate of aortic aneurysm and dissection reported within two months following use of fluoroquinolones, particularly in elderly patients
            • May occur with fluoroquinolones for systemic use (IV or PO)
            • Patients who have an aortic aneurysm or are at risk for an aortic aneurysm (eg, patients with peripheral atherosclerotic vascular diseases, hypertension, certain genetic conditions [eg, Marfan syndrome, Ehlers-Danlos syndrome], elderly patients)
            • Prescribe fluoroquinolones to these patients only when no other treatment options are available
            • Advise patients to seek immediate medical treatment for any symptoms associated with aortic aneurysm
            • Stop treatment immediately if a patient reports side effects suggestive of aortic aneurysm or dissection

            FDA MedWatch Safety Alert

            • Issued July 10, 2018
            • The FDA is strengthening the current warnings in the prescribing information for fluoroquinolone antibiotics to inform clinicians of significant decreases in blood glucose and certain mental health adverse effects
            • Hypoglycemia, sometimes resulting in coma, occurred more frequently in elderly patients or in diabetic patients taking oral hypoglycemic medicine or insulin
            • Alert patients regarding hypoglycemic symptoms and carefully monitor blood glucose levels; instruct patients how to treat themselves if symptoms of hypoglycemia occur
            • This safety alert affects only systemic formulations; early signs and symptoms of low blood glucose include confusion, dizziness, feeling shaky, unusual hunger, headaches, irritability, pounding heart or very fast pulse, pale skin, sweating, trembling, weakness, and/or unusual anxiety
            • Mental health side effects are to be added to or updated across all the fluoroquinolones are disturbances in attention, disorientation, agitation, nervousness, memory impairment, and delirium
            • Inform patients of the potential risk of psychiatric adverse reactions that can occur after just 1 dose
            • Immediately discontinue treatment if CNS adverse effects occur, including psychiatric adverse reactions, or blood glucose disturbances occur and switch to a nonfluoroquinolone antibiotic if possible

            Drug interactions overview

            • Serious and fatal reactions have reported in patients receiving concurrent administration of ciprofloxacin and theophylline; if concomitant use cannot be avoided, monitor serum levels of theophylline and adjust dosage as appropriate
            • Coadministration of IV ciprofloxacin and other drugs primarily metabolized by CYP1A2 (for example, theophylline, methylxanthines, caffeine, tizanidine, ropinirole, clozapine, olanzapine, and zolpidem) results in increased plasma concentrations of co-administered drug and could lead to clinically significant pharmacodynamic adverse reactions of the co-administered drug
            • Use with caution in patients with history of seizures taking concurrent therapy that lowers seizure threshold; risk increases rarely when administered concomitantly with NSAIDs
            • Avoid IV administration in patients who have known QT prolongation, carry risk factors for prolonged QT, or are taking class 1A or class III antiarrhythmic drugs
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            Pregnancy & Lactation

            Pregnancy

            Prolonged experience with ciprofloxacin in pregnant women over several decades, based on available published information from case reports, case control studies and observational studies during pregnancy, have not identified any drug-associated risk of major birth defects, miscarriage or adverse maternal or fetal outcomes

            Oral administration during organogenesis at doses up to 100 mg/kg to pregnant mice and rats, and up to 30 mg/kg to pregnant rabbits did not cause fetal malformations; these doses were up to 0.3, 0.6, and 0.4 times the maximum recommended clinical oral dose in mice, rats, and rabbits, respectively, based on body surface area

            Lactation

            Published literature reports that ciprofloxacin is present in human milk following intravenous and oral administration; there is no information regarding effects on milk production or breastfed infant; because of potential risk of serious adverse reactions in breastfed infants, including arthropathy shown in juvenile animal studies

            For most indications a lactating woman may consider pumping and discarding breast milk during treatment and an additional two days (five half-lives) after last dose; alternatively, advise a woman that breastfeeding is not recommended during treatment and for an additional two days (five half-lives) after last dose

            However, for inhalation anthrax (post exposure), during an incident resulting in exposure to anthrax, the risk-benefit assessment of continuing breastfeeding while the mother (and potentially the infant) is (are) on CIPRO may be acceptable

            The developmental and health benefits of breastfeeding should be considered along with the mother's clinical need for therapy and any potential adverse effects on breastfed child from drug or from underlying maternal condition

            Ciprofloxacin may cause intestinal flora alteration of breastfeeding infant; advise a woman to monitor breastfed infant for loose or bloody stools and candidiasis (thrush, diaper rash)

            Pregnancy Categories

            A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

            B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

            C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

            D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

            X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

            NA: Information not available.

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            Pharmacology

            Mechanism of Action

            Inhibits relaxation of DNA; inhibits DNA gyrase in susceptible organisms; promotes breakage of double-stranded DNA

            Absorption

            Bioavailability (PO): ~50-85%

            Peak plasma time (PO): Immediate-release, 0.5-2 hr; extended-release, 1-2.5 hr

            Distribution

            Distributed widely throughout body; tissue concentrations often exceed serum concentrations, especially in kidneys, gallbladder, liver, lungs, gynecologic tissue, and prostatic tissue; cerebrospinal fluid (CSF) concentration is 10% in noninflamed meninges and 14-37% in inflamed meninges; crosses placenta; enters breast milk

            Protein bound: 20-40%

            Vd: 2.1-2.7 L/kg

            Metabolism

            Metabolized in liver

            Enzyme inhibitor: CYP1A2

            Elimination

            Half-life: 2-5 hr (children); 3-5 hr (adults)

            Excretion: Urine (30-50%), feces (15-43%)

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            Administration

            IV Incompatibilities

            Additive: Aminophylline, amoxicillin, amoxicillin-clavulanate, amphotericin, ampicillin-sulbactam, ceftazidime, cefuroxime, clindamycin, floxacillin, heparin, piperacillin, sodium bicarbonate, ticarcillin

            Y-site: Aminophylline, ampicillin-sulbactam, azithromycin, cefepime, dexamethasone sodium phosphate, furosemide, heparin, hydrocortisone sodium succinate, magnesium sulfate(?), methylprednisolone sodium succinate, phenytoin, potassium phosphates, propofol, sodium bicarbonate(?), sodium phosphates, total parenteral nutrition formulations, warfarin

            IV Compatibilities

            Solution: Compatible with most IV fluids

            Additive: Amikacin, aztreonam, dobutamine, dopamine, fluconazole, gentamicin, lidocaine, linezolid, metronidazole (ready-to-use form is compatible; hydrochloride form in vial is incompatible), midazolam, potassium chloride, tobramycin

            Y-site: Amiodarone, calcium gluconate, clarithromycin, digoxin, diphenhydramine, dobutamine, dopamine, linezolid, lorazepam, midazolam, promethazine, quinupristin/dalfopristin, tacrolimus

            IV Administration

            Infuse 1-2 mg/mL (diluted in D5W or NS) into large vein over 60 minutes

            When administering intermittently through Y-site, temporarily discontinue primary solution

            Stability

            Stable at concentration of 0.5-2 mg/mL in D5W or NS for 14 days at room temperature or refrigerated

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            Images

            BRAND FORM. UNIT PRICE PILL IMAGE
            Cipro oral
            -
            250 mg/5 mL suspension
            Cipro oral
            -
            500 mg/5 mL suspension
            Cipro oral
            -
            250 mg tablet
            Cipro oral
            -
            500 mg tablet
            Cipro oral
            -
            250 mg tablet
            ciprofloxacin oral
            -
            500 mg/5 mL suspension
            ciprofloxacin oral
            -
            250 mg/5 mL suspension

            Copyright © 2010 First DataBank, Inc.

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            Patient Handout

            Patient Education
            ciprofloxacin oral

            CIPROFLOXACIN SUSPENSION - ORAL

            (SIP-roe-FLOX-a-sin)

            COMMON BRAND NAME(S): Cipro

            WARNING: Quinolone antibiotics (including ciprofloxacin) may cause serious and possibly permanent tendon damage (such as tendonitis, tendon rupture), nerve problems in the arms and legs (peripheral neuropathy), and nervous system problems. Get medical help right away if you have any of the following symptoms: pain/numbness/burning/tingling/weakness in your arms/hands/legs/feet, changes in how you sense touch/pain/temperature/vibration/body position, severe/lasting headache, vision changes, shaking (tremors), seizures, mental/mood changes (such as agitation, anxiety, confusion, hallucinations, depression, rare thoughts of suicide).Tendon damage may occur during or after treatment with this medication. Stop exercising, rest, and get medical help right away if you develop joint/muscle/tendon pain or swelling. Your risk for tendon problems is greater if you are over 60 years of age, if you are taking corticosteroids (such as prednisone), or if you have a kidney, heart, or lung transplant.This medication may make a certain muscle condition (myasthenia gravis) worse. Tell your doctor right away if you have new or worsening muscle weakness (such as drooping eyelids, unsteady walk) or trouble breathing.Discuss the risks and benefits with your doctor before using this medication.

            USES: This medication is used to treat a variety of bacterial infections. Ciprofloxacin belongs to a class of drugs called quinolone antibiotics. It works by stopping the growth of bacteria.This antibiotic treats only bacterial infections. It will not work for virus infections (such as common cold, flu). Using any antibiotic when it is not needed can cause it to not work for future infections.

            HOW TO USE: Read the Medication Guide and, if available, the Patient Information Leaflet provided by your pharmacist before you start taking ciprofloxacin and each time you get a refill. If you have any questions, ask your doctor or pharmacist.This medication may be taken with or without food as directed by your doctor, usually twice a day (every 12 hours) in the morning and evening.Shake the container well for 15 seconds before pouring each dose. Carefully measure the dose using a special measuring device/spoon. Do not use a household spoon because you may not get the correct dose. Do not chew the contents of the suspension.Do not use the suspension with feeding tubes because the suspension may clog the tube.The dosage and length of treatment is based on your medical condition and response to treatment. Drink plenty of fluids while taking this medication unless your doctor tells you otherwise.Take this medication at least 2 hours before or 6 hours after taking other products that may bind to it, decreasing its effectiveness. Ask your pharmacist about the other products you take. Some examples include: quinapril, sevelamer, sucralfate, vitamins/minerals (including iron and zinc supplements), and products containing magnesium, aluminum, or calcium (such as antacids, didanosine solution, calcium supplements).Calcium-rich foods, including dairy products (such as milk, yogurt) or calcium-enriched juice, can also decrease the effect of this medication. Take this medication at least 2 hours before or 6 hours after eating calcium-rich foods, unless you are eating these foods as part of a larger meal that contains other (non-calcium-rich) foods. These other foods decrease the calcium binding effect.Ask your doctor or pharmacist about safely using nutritional supplements/replacements with this medication.For the best effect, take this antibiotic at evenly spaced times. To help you remember, take this medication at the same time(s) every day.Continue to take this medication until the full prescribed amount is finished, even if symptoms disappear after a few days. Stopping the medication too early may result in a return of the infection.Tell your doctor if your condition persists or worsens.

            SIDE EFFECTS: See also Warning section.Nausea, diarrhea, dizziness, lightheadedness, headache, or trouble sleeping may occur. If any of these effects persist or worsen, tell your doctor or pharmacist promptly.Remember that this medication has been prescribed because your doctor has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.Tell your doctor right away if you have any serious side effects, including: unusual bruising/bleeding, signs of a new infection (such as new/persistent fever, persistent sore throat), signs of kidney problems (such as change in the amount of urine, red/pink urine), signs of liver problems (such as unusual tiredness, stomach/abdominal pain, persistent nausea/vomiting, yellowing eyes/skin, dark urine).Get medical help right away if you have any very serious side effects, including: severe dizziness, fainting, fast/irregular heartbeat, signs of a tear/break in the main blood vessel called the aorta (sudden/severe pain in the stomach/chest/back, cough, shortness of breath).This medication may rarely cause a severe intestinal condition due to a bacteria called C. difficile. This condition may occur during treatment or weeks to months after treatment has stopped. Tell your doctor right away if you develop: diarrhea that doesn't stop, abdominal or stomach pain/cramping, blood/mucus in your stool.If you have these symptoms, do not use anti-diarrhea or opioid products because they may make symptoms worse.Use of this medication for prolonged or repeated periods may result in oral thrush or a new yeast infection. Contact your doctor if you notice white patches in your mouth, a change in vaginal discharge, or other new symptoms.A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any of the following symptoms of a serious allergic reaction: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

            PRECAUTIONS: Before taking ciprofloxacin, tell your doctor or pharmacist if you are allergic to it; or to other quinolone antibiotics such as norfloxacin, gemifloxacin, levofloxacin, moxifloxacin, or ofloxacin; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.Before using this medication, tell your doctor or pharmacist your medical history, especially of: diabetes, heart problems (such as recent heart attack), joint/tendon problems (such as tendonitis, bursitis), kidney disease, liver disease, mental/mood disorders (such as depression), myasthenia gravis, nerve problems (such as peripheral neuropathy), seizures, conditions that increase your risk of seizures (such as brain/head injury, brain tumors, cerebral atherosclerosis), blood vessel problems (such as aneurysm or blockage of the aorta or other blood vessels, hardening of the arteries), high blood pressure, certain genetic conditions (Marfan syndrome, Ehlers-Danlos syndrome).Ciprofloxacin may cause a condition that affects the heart rhythm (QT prolongation). QT prolongation can rarely cause serious (rarely fatal) fast/irregular heartbeat and other symptoms (such as severe dizziness, fainting) that need medical attention right away.The risk of QT prolongation may be increased if you have certain medical conditions or are taking other drugs that may cause QT prolongation. Before using ciprofloxacin, tell your doctor or pharmacist of all the drugs you take and if you have any of the following conditions: certain heart problems (heart failure, slow heartbeat, QT prolongation in the EKG), family history of certain heart problems (QT prolongation in the EKG, sudden cardiac death).Low levels of potassium or magnesium in the blood may also increase your risk of QT prolongation. This risk may increase if you use certain drugs (such as diuretics/"water pills") or if you have conditions such as severe sweating, diarrhea, or vomiting. Talk to your doctor about using ciprofloxacin safely.This medication may rarely cause serious changes in blood sugar, especially if you have diabetes. Check your blood sugar regularly as directed and share the results with your doctor. Watch for symptoms of high blood sugar such as increased thirst/urination. Ciprofloxacin may increase the blood-sugar-lowering effects of the medication glyburide. Also watch for symptoms of low blood sugar such as sudden sweating, shaking, fast heartbeat, hunger, blurred vision, dizziness, or tingling hands/feet. It is a good habit to carry glucose tablets or gel to treat low blood sugar. If you don't have these reliable forms of glucose, rapidly raise your blood sugar by eating a quick source of sugar such as table sugar, honey, or candy, or by drinking fruit juice or non- diet soda. Tell your doctor right away about the reaction and the use of this product. To help prevent low blood sugar, eat meals on a regular schedule, and do not skip meals. Your doctor may need to switch you to another antibiotic or adjust your diabetes medications if any reaction occurs.This drug may make you dizzy. Alcohol or marijuana (cannabis) can make you more dizzy. Do not drive, use machinery, or do anything that needs alertness until you can do it safely. Limit alcoholic beverages. Talk to your doctor if you are using marijuana (cannabis).This medication may make you more sensitive to the sun. Limit your time in the sun. Avoid tanning booths and sunlamps. Use sunscreen and wear protective clothing when outdoors. Tell your doctor right away if you get sunburned or have skin blisters/redness.Ciprofloxacin may cause live bacterial vaccines (such as typhoid vaccine) to not work as well. Do not have any immunizations/vaccinations while using this medication unless your doctor tells you to.Before having surgery, tell your doctor or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).This medication contains sucrose. It is not recommended if you have a rare hereditary metabolic condition (such as fructose intolerance, sucrase-isomaltase deficiency, glucose-galactose malabsorption).Children may be more sensitive to the side effects of this drug, especially joint/tendon problems.Older adults may be at greater risk for tendon problems (especially if they are also taking corticosteroids such as prednisone or hydrocortisone), QT prolongation, and a sudden tear/break in the main blood vessel (aorta).During pregnancy, this medication should be used only when clearly needed. Discuss the risks and benefits with your doctor.This medication passes into breast milk and may have undesirable effects on a nursing infant. Consult your doctor before breast-feeding.

            DRUG INTERACTIONS: See also How to Use and Precautions sections.Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval.Some products that may interact with this drug include: "blood thinners" (such as acenocoumarol, warfarin), strontium.Many drugs besides ciprofloxacin may affect the heart rhythm (QT prolongation), including amiodarone, dofetilide, quinidine, procainamide, sotalol, among others.This medication can slow down the removal of other medications from your body, which may affect how they work. Examples of affected drugs include duloxetine, flibanserin, lomitapide, pirfenidone, tasimelteon, tizanidine, among others.Avoid drinking large amounts of beverages containing caffeine (coffee, tea, colas), eating large amounts of chocolate, or taking over-the-counter products that contain caffeine. This drug may increase and/or prolong the effects of caffeine.

            OVERDOSE: If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center.

            NOTES: Do not share this medication with others.This medication has been prescribed for your current condition only. Do not use it later for another infection unless your doctor tells you to.Laboratory and/or medical tests (such as kidney function, blood counts, cultures) should be performed periodically to monitor your progress or to check for side effects. Consult your doctor for more details.Do not change brands of this medication without asking your doctor or pharmacist. Not all brands have the same effects.

            MISSED DOSE: If you miss a dose, take it as soon as you remember. If it is less than 6 hours before the next dose, skip the missed dose. Take your next dose at the regular time. Do not double the dose to catch up.

            STORAGE: Before mixing, store the dry powder and mixing solution in an upright position at room temperature. Do not freeze.Once mixed, the suspension may be stored in an upright position in the refrigerator or at room temperature. Discard any unused suspension 14 days after mixing. Do not freeze. Do not store in the bathroom. Keep all medications away from children and pets.Discard any unused medicine after treatment is completed.Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company.

            Information last revised August 2021. Copyright(c) 2021 First Databank, Inc.

            IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.

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            Formulary

            FormularyPatient Discounts

            Adding plans allows you to compare formulary status to other drugs in the same class.

            To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.

            Adding plans allows you to:

            • View the formulary and any restrictions for each plan.
            • Manage and view all your plans together – even plans in different states.
            • Compare formulary status to other drugs in the same class.
            • Access your plan list on any device – mobile or desktop.

            The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
            3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
            4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
            QL Quantity Limits
            Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
            ST Step Therapy
            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
            OR Other Restrictions
            Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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            Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.