Names and pronunciation
(sip-ro-floks′a-sin) Cipro, Cipro XR
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Individual generic drug information
Extracted information for ciprofloxacin only.
(sip-ro-floks′a-sin) Cipro, Cipro XR
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Func. class.: Antiinfective—broad spectrum
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Chem. class.: Fluoroquinolone
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Do not confuse: ciprofloxacin/cephalexin
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ACTION: Interferes with conversion of intermediate DNA fragments into high- molecular-weight DNA in bacteria; DNA gyrase inhibitor
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USES: Infection caused by susceptible Escherichia coli, Enterobacter cloa- cae, Proteus mirabilis, Klebsiella pneumoniae, Proteus vulgaris, Citro- bacter freundii, Serratia marcescens, Pseudomonas aeruginosa, Staphylo- coccus aureus, Staphylococcus epider- midis, Enterobacter, Campylobacter jejuni, Salmonella, Streptococcus pyo- genes, Bacillus anthracias; chronic bacterial prostatitis, acute sinusitis, postexposure inhalation anthrax, infec- tious diarrhea, typhoid fever, compli- cated intraabdominal infections, noso- comial pneumonia, urinary tract infections, plague
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Extracted information for ciprofloxacin only.
CONTRAINDICATIONS: Hyper- sensitivity to quinolones Precautions: Pregnancy, breastfeeding, children, geriatric patients, renal dis- ease, seizure disorder, stroke, CV dis- ease, hepatic disease, QT prolongation, hypokalemia, colitis
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Black Box Warning: Tendon pain/rup- ture, tendinitis, myasthenia gravis, neph rotoxicity Black Box Warning: Increase: tendinitis, tendon rupture—corticosteroids C Increase: nephrotoxicity—cycloSPORINE Increase: ciprofloxacin levels—proben- ecid; monitor for toxicity Increase: levels of theophylline, warfarin; monitor blood levels, reduce dose Increase: hypoglycemia risk— antidiabetics Increase: QT prolongation—astemizole, droperidol, class IA/III antidysrhythmics, tricyclics, tetracyclines, local anesthetics, phenothiazines, haloperidol, risperiDONE, sertindole, ziprasidone, alfuzosin, arsenic trioxide, beta-agonists, chloroquine, cloZA Pine, cyclobenzapine, dasatinib, dolasetron, droperidol, flecainide, halogenated anes- thetics, lapatinib, levomethadyl, macro- lides, methadone, octreotide, ondansetron, paliperidone, palonosetron, pentamidine, propafenone, ranolazine, SUNItinib, tacroli- mus, terfenadine, vardenafil, vorinostat; less likely than other quinolones Decrease: ciprofloxacin absorption— antacids that contain magnesium, alumi- num; zinc, iron, sucralfate, enteral feed- ings, calcium, sevelamer Drug/Food Increase: effect of caffeine Decrease: absorption—dairy products, food Drug/Lab Test Increase: AST, ALT, BUN, creatinine, LDH, bilirubin, alkaline phosphatase, glucose, proteinuria, albuminuria Decrease: WBC, glucose Black Box Warning: Myasthenia gravis: avoid use in these patients, increases muscle weakness • CNS symptoms: headache, dizziness, fatigue, insomnia, depression, seizures • Renal, hepatic studies: BUN, creati- nine, AST, ALT • I&O ratio, urine pH <5.5 is ideal, to prevent crystalluria Black Box Warning: Tendinitis, ten- don rupture: discontinue at first sign of tendon pain, inflammation; increased in those >60 yr, those taking corticoster- oids, organ transplants and children • Anaphylaxis: fever, flushing, rash, urticaria, pruritus, dyspnea; discontinue immediately, have emergency equipment nearby • Pseudotumor cerebri: may occur at excessive doses • Hepatotoxicity: report immediately dark urine, jaundice, pruritus, clay- colored stools • Limited intake of alkaline foods, products: milk, dairy products, alkaline antacids, sodium bicarbonate; caffeine intake if excessive cardiac or CNS stimu- lation • Increase fluids to 3 L/day to avoid crystallization in kidneys • Clostridium difficile–associated di- arrhea (CDAD): monitor for diarrhea, ab- dominal pain, cramps, fever, bloody stools; usually occurs several weeks after completion of therapy; report to pre- scriber immediately • Pregnancy/breastfeeding: no well- controlled studies; use in pregnancy only if benefits outweigh fetal risk; excreted in breast milk, discontinue breastfeeding or discontinue product Black Box Warning: To report tendon pain, chest pain, palpitations • To complete full course of product therapy; not to double or miss doses • To notify prescriber if rash occurs; discontinue product • To notify prescriber if pregnancy is planned or suspected; not to breastfeed • Suicidal thoughts/behaviors: To report immediately, suicidal thoughts, behaviors • To contact prescriber if taking theoph- ylline, warfarin • That extended-release and regular- release products are not interchangeable • Not to add or stop products without prescriber’s approval • To use calibrated measuring device for suspension
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SIDE EFFECTS CNS: Headache, dizziness, fatigue, insomnia, depression, restlessness, sei- zures, suicidal ideation, pseudotumor cerebri, confusion, hallucinations GI: Nausea, diarrhea, increased ALT/ AST, flatulence, vomiting, abdominal pain, pancreatitis, hepatotoxicity, CDAD GU: Vaginitis INTEG: Rash, pruritus, urticaria, photo- sensitivity, toxic epidermal necrolysis, injection site reactions MISC: Anaphylaxis, Stevens-Johnson syndrome, QT prolongation, pseudotumor cerebri MS: Arthralgia, tendon rupture META: Hypo- and hyperglycemia
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INTERACTIONS
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Extracted information for ciprofloxacin only.
DOSAGE AND ROUTES Uncomplicated urinary tract infections • Adult: PO 250 mg q12hr × 3 days or XL 500 mg q24hr × 3 days Mild-moderate UTI • Adult: PO 250 mg q12hr or IV 200 mg q12hr × 7-14 days Complicated/severe urinary tract infections • Adult: PO 500 mg q12hr or XL 1000 mg q24hr × 7-14 days; IV 400 mg q12hr • Child/adolescent: PO 10-20 mg/kg/ dose q12hr × 10-21 days; not first choice in pediatric patients due to high incidence of adverse reactions Respiratory, bone, skin, joint infections (mild-moderate) • Adult: PO 500-750 mg q12hr × 7-14 days; IV 400 mg q12hr Nosocomial pneumonia • Adult: IV 400 mg q8hr × 10-14 days Intraabdominal infections, complicated • Adult: PO 500 mg q12hr × 7-14 days; IV 400 mg q12hr × 7-14 days, usually given with metroNIDAZOLE Acute sinusitis, mild/moderate • Adult: PO 500 mg q12hr × 10 days; IV 400 mg q12hr × 10 days Inhalational anthrax (postexposure) • Adult: PO 500 mg q12hr × 60 days; IV 400 mg q12hr × 60 days • Child: PO 15 mg/kg/dose q12hr × 60 days, max 500 mg/dose; IV 10 mg/kg q12hr, max 400 mg/dose Plague • Adult: IV 400 mg q8-12hr or 500-750 mg q12hr × 14 days • Child 1-17 yr: IV 10 mg/kg or PO 15 mg/kg q8-12hr × 10-21 days Infectious diarrhea • Adult: PO 500-750 mg q12hr × 5-7 days Chronic bacterial prostatitis • Adult: PO 500 mg q12hr × 28 days; IV 400 mg q12hr × 28 days Renal disease • Adult: CCr 30-50 mL/min, PO 250-500 mg q12hr; CCr 5-29 mL/min, PO 250-500 mg q18hr, IV 200-400 mg q18-24hr
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Available forms: Tablets 100, 250, 500, 750 mg; extended-release tablets (XR) 500, 1000 mg; injection 200 mg/100 mL D5W, 400 mg/200 mL D5W; injection 200, 400 mg; oral suspension 250 mg, 500 mg/5 mL
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Administer: • Obtain C&S before use, may give first dose before results are received • Use caution when giving with antidys- rhythmics IA, III PO route • Do not break, crush, chew XR (ex- tended release) product, use adequate flu- ids to prevent crystalluria • Regular release and extended release are not interchangeable • 2 hr prior to or 6 hr after antacids, zinc, iron, calcium • Do not give oral suspension by GI tube • Use adequate fluids to prevent crystal- luria IV route • Over 1 hr as an infusion, comes in premixed plastic infusion container or di- luted 20- or 40-mL vial to a final concen- tration of 0.5-2 mg/mL of NS or D5W; give through Y-tube or 3-way stopcock, diluted vials can be stored for 14 days at room temperature or refrigerator; do not freeze Y-site compatibilities: Amifostine, anakinra, anidulafungin, argatroban, arsenic, ateno- lol, aztreonam, bivalirudin, bleomycin, cal- cium gluconate, CARBOplatin, caspofungin, cefTAZidime, cisatracurium, CISplatin, clarithromycin, codeine, cytarabine, DACTI- Nomycin, DAPTOmycin, dexmedetomidine, digoxin, diltiaZEM, diphenhydrAMINE, DOBUTamine, DOCEtaxel, doripenem, DOPamine, doxacurium, DOXOrubicin, epiRUBicin, eptifibatide, ertapenem, etopo- side, fenoldopam, fludarabine, gallium, gemcitabine, gentamicin, granisetron, HYDROmorphone, hydrOXYzine, IDArubi- cin, ifosfamide, irinotecan, lidocaine, line- zolid, LORazepam, LR, mechlorethamine, meperidine, methotrexate, metoclopramide, metroNIDAZOLE, midazolam, midodrine, milrinone, mitoXANTRONE, mycophenolate, nesiritide, octreotide, ondansetron, oxalipla- tin, oxytocin, PACLitaxel, palonosetron, pamidronate, pancuronium, piperacillin, potassium acetate/chloride, promethazine, raNITIdine, remifentanil, rocuronium, sodium chloride, tacrolimus, teniposide, thiotepa, tigecycline, tirofiban, TNA, tobra- mycin, trastuzumab, vasopressin, vecuronium, verapamil, vinCRIStine, vinorel- bine, voriconazole
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Extracted information for ciprofloxacin only.
Assess: • Infection: WBC, temperature before treatment, periodically • QT prolongation: monitor for changes in QTc if taking other products that in- crease QT
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Evaluate: • Therapeutic response: decreased pain, frequency, urgency, C&S; absence of infection
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CLINICAL CONSIDERATIONS
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Patient and caregiver information: • Not to take any products that contain magnesium, calcium (such as antacids), iron, aluminum with this product or 2 hr before, 6 hr after product; to drink fluids to prevent crystals in urine; not to crush, chew the extended-release product
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Extracted information for ciprofloxacin only.
PHARMACOKINETICS PO: Peak 1-2 hr; half-life 4 hr; excreted in urine as active product, metabolites 35%-40%, 20%-40% protein binding
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Filter the extracted dose blocks for this individual drug.
Uncomplicated urinary tract infections
• Child/adolescent: PO 10-20 mg/kg/ dose q12hr × 10-21 days; not first choice in pediatric patients due to high incidence of adverse reactions Respiratory, bone, skin, joint infections (mild-moderate)
Candidate age grouping · source page 282