(ciprofloxacin injection)
Ciprofloxacin is an inhibitor of human cytochrome P450 1A2 (CYP1A2) mediated metabolism. Co-administration of ciprofloxacin with other drugs primarily metabolized by CYP1A2 results in increased plasma concentrations of these drugs and could lead to clinically significant adverse events of the co-administered drug.
| Drugs That are Affected by Ciprofloxacin | ||
| Drug(s) | Recommendation | Comments |
| Tizanidine | Contraindicated | Concomitant administration of tizanidine and ciprofloxacin is contraindicated due to the potentiation of hypotensive and sedative effects of tizanidine [see Contraindications (4.2)]. |
| Theophylline | Avoid Use (Plasma Exposure Likely to be Increased and Prolonged) | Concurrent administration of ciprofloxacin with theophylline may result in increased risk of a patient developing central nervous system (CNS) or other adverse reactions. If concomitant use cannot be avoided, monitor serum levels of theophylline and adjust dosage as appropriate [see Warnings and Precautions (5.10)]. |
| Drugs Known to Prolong QT Interval | Avoid Use | Ciprofloxacin may further prolong the QT interval in patients receiving drugs known to prolong the QT interval (for example, class lA or III antiarrhythmics, tricyclic antidepressants, macrolides, antipsychotics) [see Warnings and Precautions (5.12) and Use in Specific Populations (8.5)]. |
| Oral antidiabetic drugs | Use with caution Glucose-lowering effect potentiated | Hypoglycemia sometimes severe has been reported when ciprofloxacin and oral antidiabetic agents, mainly sulfonylureas (for example, glyburide, glimepiride), were co-administered, presumably by intensifying the action of the oral antidiabetic agent. Fatalities have been reported. Monitor blood glucose when ciprofloxacin is coadministered with oral antidiabetic drugs [see Adverse Reactions (6.1)]. |
| Phenytoin | Use with caution Altered serum levels of phenytoin (increased and decreased) | To avoid the loss of seizure control associated with decreased phenytoin levels and to prevent phenytoin overdose-related adverse reactions upon ciprofloxacin discontinuation in patients receiving both agents, monitor phenytoin therapy, including phenytoin serum concentration during and shortly after co-administration of ciprofloxacin with phenytoin. |
| Cyclosporine | Use with caution (transient elevations in serum creatinine) | Monitor renal function (in particular serum creatinine) when ciprofloxacin is co-administered with cyclosporine. |
| Anti-coagulant drugs | Use with caution (Increase in anticoagulant effect) | The risk may vary with the underlying infection, age and general status of the patient so that the contribution of ciprofloxacin to the increase in INR (international normalized ratio) is difficult to assess. Monitor prothrombin time and INR frequently during and shortly after co-administration of ciprofloxacin with an oral anti-coagulant (for example, warfarin). |
| Methotrexate | Use with caution Inhibition of methotrexate renal tubular transport potentially leading to increased methotrexate plasma levels | Potential increase in the risk of methotrexate associated toxic reactions. Therefore, carefully monitor patients under methotrexate therapy when concomitant ciprofloxacin therapy is indicated. |
| Ropinirole | Use with caution | Monitoring for ropinirole-related adverse reactions and appropriate dose adjustment of ropinirole is recommended during and shortly after co-administration with ciprofloxacin [see Warnings and Precautions (5.16)]. |
| Clozapine | Use with caution | Careful monitoring of clozapine associated adverse reactions and appropriate adjustment of clozapine dosage during and shortly after co- administration with ciprofloxacin are advised. |
| NSAIDs | Use with caution | Non-steroidal anti-inflammatory drugs (but not acetyl salicylic acid) in combination of very high doses of quinolones have been shown to provoke convulsions in pre-clinical studies and in postmarketing. |
| Sildenafil | Use with caution Two-fold increase in exposure | Monitor for sildenafil toxicity [see Clinical Pharmacology (12.3)]. |
| Duloxetine | Avoid Use Five-fold increase in duloxetine exposure | If unavoidable, monitor for duloxetine toxicity. |
| Caffeine/ Xanthine Derivatives | Use with caution Reduced clearance resulting in elevated levels and prolongation of serum half-life | Ciprofloxacin inhibits the formation of paraxanthine after caffeine administration (or pentoxifylline containing products). Monitor for xanthine toxicity and adjust dose as necessary. |
| Zolpidem | Avoid Use | Co-administration with ciprofloxacin may increase blood levels of zolpidem, concurrent use is not recommended. |
| Drug(s) Affecting Pharmacokinetics of Ciprofloxacin | ||
| Probenecid | Use with caution (interferes with renal tubular secretion of ciprofloxacin and increases ciprofloxacin serum levels) | Potentiation of ciprofloxacin toxicity may occur. |
This Medication Guide has been approved by the U.S. Food and Drug Administration. |
| MEDICATION GUIDE CIPROFLOXACIN (sip-row-FLOX-a-sin) INJECTION, USP (in 5% Dextrose Injection) (ciprofloxacin) for intravenous infusion |
| Read this Medication Guide before you start taking ciprofloxacin and each time you get a refill. There may be new information. This information does not take the place of talking to your healthcare provider about your medical condition or your treatment. |
What is the most important information I should know about ciprofloxacin? Ciprofloxacin, a fluoroquinolone antibacterial medicine, can cause serious side effects. Some of these serious side effects can happen at the same time and could result in death.If you get any of the following serious side effects while you take ciprofloxacin, you should stop taking ciprofloxacin immediately and get medical help right away. 1. Tendon rupture or swelling of the tendon (tendinitis).
2. Changes in sensation and possible nerve damage (Peripheral Neuropathy). Damage to the nerves in arms, hands, legs, or feet can happen in people who take fluoroquinolones, including ciprofloxacin. Stop taking ciprofloxacin immediately and talk to your healthcare provider right away if you get any of the following symptoms of peripheral neuropathy in your arms, hands, legs, or feet:
3. Central Nervous System (CNS) effects. Mental health problems and seizures have been reported in people who take fluoroquinolone antibacterial medicines, including ciprofloxacin. Tell your healthcare provider if you have a history of seizures before you start taking ciprofloxacin. CNS side effects may happen as soon as after taking the first dose of ciprofloxacin. Stop taking ciprofloxacin immediately and talk to your healthcare provider right away if you get any of these side effects, or other changes in mood or behavior:
4. Worsening of myasthenia gravis (a problem that causes muscle weakness). Fluoroquinolones like ciprofloxacin may cause worsening of myasthenia gravis symptoms, including muscle weakness and breathing problems. Tell your healthcare provider if you have a history of myasthenia gravis before you start taking ciprofloxacin. Call your healthcare provider right away if you have any worsening muscle weakness or breathing problems. |
| What is ciprofloxacin? Ciprofloxacin is a fluoroquinolone antibacterial medicine used in adults age 18 years and older to treat certain infections caused by certain germs called bacteria. These bacterial infections include:
|
| Who should not take ciprofloxacin? Do not take ciprofloxacin if you:
|
| What should I tell my healthcare provider before taking ciprofloxacin? Before you take ciprofloxacin, tell your healthcare provider about all your medical conditions, including if you:
Know the medicines you take. Keep a list of them to show your healthcare provider and pharmacist when you get a new medicine. |
How should I take ciprofloxacin?
|
What should I avoid while taking ciprofloxacin?
|
What are the possible side effects of ciprofloxacin? Ciprofloxacin may cause serious side effects, including:
These are not all the possible side effects of ciprofloxacin. For more information, ask your healthcare provider or pharmacist. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088. |
| Keep ciprofloxacin and all medicines out of the reach of children. |
| General Information about the safe and effective use of ciprofloxacin. Medicines are sometimes prescribed for purposes other than those listed in a Medication Guide. Do not use ciprofloxacin for a condition for which it is not prescribed. Do not give ciprofloxacin to other people, even if they have the same symptoms that you have. It may harm them. This Medication Guide summarizes the most important information about ciprofloxacin. If you would like more information about ciprofloxacin, talk with your healthcare provider. You can ask your healthcare provider or pharmacist for information about ciprofloxacin that is written for healthcare professionals. |
| What are the ingredients in ciprofloxacin? Ciprofloxacin Injection, USP (in 5% Dextrose Injection):
Brands listed are the trademarks of their respective owners. Hospira Distributed by Hospira, Inc., Lake Forest, IL 60045 USA Revised: August 2022 |
L54USCFX00
Additional Resources
Chat online with Pfizer Medical Information regarding your inquiry on a Pfizer medicine or vaccine.
Speak with a Pfizer Medical Information Professional regarding your Pfizer medicine or vaccine inquiry.
Available 9AM-5PM ET Monday to Friday; excluding holidays.
Submit a medical question for a Pfizer medicine or a vaccine.
The submission will be reviewed during our standard business hours.
To report an adverse event related to a Pfizer product and you are not part of a clinical trial* for this medication, click the link below to submit your information:
Pfizer Safety Reporting Site
*If you are involved in a clinical trial for either product, adverse events should be reported to your coordinating study site.
If you cannot use the above website to report an adverse event related to a Pfizer medication, please call (800) 438-1985.
You may also contact the U.S. Food and Drug Administration (FDA) directly to report adverse events or product quality concerns either online at www.fda.gov/medwatch or by calling (800) 332-1088.