CiprofloxacinCiprofloxacin Hydrochloride

About Ciprofloxacin

Ciprofloxacin is a fluoroquinolone that kills susceptible bacteria; it does not treat viral infections such as colds or flu. In adults, the Cipro label covers skin, bone and joint, complicated intra-abdominal (with metronidazole), urinary, lower respiratory and sinus infections, chronic bacterial prostatitis, infectious diarrhea, typhoid fever, uncomplicated cervical and urethral gonorrhea, and acute uncomplicated cystitis in women. From birth to 17 years it is labeled after exposure to inhaled anthrax and for plague, and from 1 to 17 years for complicated urinary and kidney infections, though not as a drug of first choice. Adults usually take 250 to 750 mg every 12 hours, from 3 days for uncomplicated cystitis to 60 days after anthrax exposure, with lower or less frequent doses when kidney function is reduced.

Its boxed warning says fluoroquinolones have been associated with disabling and potentially irreversible serious reactions that have occurred together: tendinitis and tendon rupture, peripheral neuropathy (pain, burning, tingling, numbness or weakness) and central nervous system effects such as psychiatric reactions and seizures. It is stopped at once if any appear, and avoided with a history of myasthenia gravis, which it can worsen. In 2016 the FDA said these risks generally outweigh the benefits for acute sinusitis, acute bronchitis and uncomplicated urinary tract infections when other options exist. Tendon risk is higher over age 60, with corticosteroids and after a kidney, heart or lung transplant. Other warnings cover high and low blood sugar, usually in people taking diabetes medicines (severe lows have caused coma or death); a higher rate of aortic aneurysm and dissection in the two months after use, particularly in older adults, so with a known aneurysm or higher risk it is reserved for when no alternative is available; and QT prolongation, liver injury, serious allergic reactions, Clostridioides difficile diarrhea and sunburn-like skin reactions. Nausea, diarrhea, abnormal liver tests, vomiting and rash are the most common side effects.

Decades of published data in pregnancy have not identified a drug-associated risk of major birth defects or miscarriage; breastfeeding is not recommended during treatment and for 2 days afterward, though after anthrax exposure the risks and benefits of continuing are weighed. The extended-release brands, Cipro XR and Proquin XR, are listed as discontinued, though the Orange Book still lists one generic 1,000 mg extended-release tablet. Eye and ear forms are separate products: Ciloxan eye drops and ointment treat bacterial conjunctivitis (the drops also corneal ulcers), and ear drops for outer ear infections include ciprofloxacin alone (Cetraxal), with hydrocortisone (Cipro HC, not used if the eardrum may be perforated) or with dexamethasone (Ciprodex, also for middle ear infections in children 6 months and older with ear tubes).

Taking Ciprofloxacin

How to take it

With enough fluid, and not with milk, yogurt or calcium-fortified juice alone (a meal that includes them is fine). Shake the suspension vigorously for about 15 seconds before each dose, swallow the microcapsules without chewing, and do not give it through a feeding tube. Finish the prescription even if you feel better, unless a tendon, nerve, mood or allergic reaction means stopping and calling the prescriber.

If you miss a dose

If the next dose is 6 or more hours away, take the missed dose when you remember; otherwise skip it. Do not take a double dose, or more than two doses of tablets or suspension in a day.

Storage

Tablets at room temperature, away from excess heat and moisture. Keep the mixed suspension tightly closed in the refrigerator or below 86°F, do not freeze it, and discard it after 14 days.

Interactions to know about

Take it at least 2 hours before or 6 hours after antacids, sucralfate, phosphate binders and products containing calcium, iron or zinc. Tizanidine must not be taken with it; theophylline, duloxetine, zolpidem and QT-prolonging drugs are avoided; warfarin, glyburide, phenytoin, methotrexate, clozapine, ropinirole, cyclosporine and sildenafil need monitoring; and it slows caffeine clearance.

This summarizes the official prescribing information. Your prescriber’s and pharmacist’s instructions, and the leaflet that comes with your medicine, take priority.

Why the cash price for Ciprofloxacin differs from pharmacy to pharmacy

Generic ciprofloxacin tablets come from many makers, so quotes for the same course differ by each pharmacy’s fee and markup and by whether ciprofloxacin is on its flat-price generic list.

The suspension has one rated generic and is quoted by strength and bottle. Plain ciprofloxacin ear drops and the hydrocortisone and dexamethasone combinations are different medicines, and a pharmacist substitutes only a generic rated to the product written.

Ways to pay less for Ciprofloxacin without insurance

• Ask whether ciprofloxacin is on the pharmacy’s flat-price generic list, and compare more than one pharmacy.
• If the prescription names Cipro, check that it allows a generic.
• For ear or eye drops, ask for a generic rated to the product prescribed.
• Upload the prescription to Script Unlock so licensed pharmacies can quote their cash price. You pay the pharmacy directly.

Questions to ask your pharmacist about Ciprofloxacin

1. 1.How far apart should I take it from my antacid or mineral supplements?
2. 2.Do my age, steroid medicine or transplant raise my risk of tendon problems?
3. 3.Could it affect my blood sugar or my diabetes medicine?
4. 4.Which tendon, nerve or mood symptoms mean I should stop it and call?

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