(ciprofloxacin injection)
Medication Guide
{{section_name_patient}}
{{section_body_html_patient}}
Prescribing Information
Drug Interactions
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. |
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.