Ciprofloxacin
- Atc Codes:J01MA02#S01AX13#S02AA15#S03AA07
- CAS Codes:86393-32-0
- PHARMGKB ID:86393-32-0
Table of contents
- Brand Names
- Drug Combinations
- Chemistry
- Pharmacologic Category
- Mechanism of Action
- Therapeutic Use
- Unlabeled Use
- Pregnancy and Lactation Implications
- Contraindications
- Warnings and Precautions
- Adverse Reactions
- Genes that may be involved
- Substrate of
- Inhibits
- Drug Interactions
- Nutrition/Nutraceutical Interactions
- Dosage
- Pharmacokinetics and Pharmacodynamics
- Special Considerations
Brand Names
Europe
Austria: Agyr, Ciflox, Ciloxan, Ciprofloxacin, CiproMed, Ciprostad, Ciproxin, Ciproxin, Otanol; Belgium: Ciloxan, Ciprobel, Ciproflomed, Ciprofloxacine, Ciproxine, Docciproflo; Bulgaria: Cifran, Ciloxan, Ciphin, Ciprinol, Ciproflav, Ciprofloxacin, Ciprolon, Ciprox, Citeral; Cyprus: Ciloxan, Ciproflox, Ciprofloxacin, Ravalton, Syntoflox, Topistin, Ufexil, Viprolox, Zindolin; Czech Republic: Cifloxinal, Cifran, Ciloxan, Ciphin, Ciplox, Ciprinol, Ciprofloxacin; Denmark: Cifin, Ciloxan, Ciprofloxacin, Ciproxin; Estonia: Bactiflox Lactab, Cifloxinal, Ciprinol, Ciprofloxacin, Ufexil; Finland: Ciprofloxacin, Cipromed, Ciproxin, Siprion; France: Ciflox, Ciprofloxacine, Uniflox; Germany: Baycip, Ciloxan, Cipro Basics, Ciprobay, Ciprobeta, Ciprodoc, Ciprodura, Ciprofat, Ciproflox, Ciprofloxacin, Ciprofloxacine, Ciprofloxacino, Ciprogamma, Ciprohexal, Ciprovert, Ciproxin, Gyracip, Infectocipro, Keciflox, Panotile Cipro; Greece: Afenoxin, Alciprocin, Aristin-C, Balepton, Biocipro, Bivorilan, Cidrops, Ciproel, Ciprofloxacin, Cipromycin, Ciproxin, Citrovenot, Edestis, Erfabiotic, Flociprin, Forterra, Ginorectol, Glossyfin, Grenis-Cipro, Labentrol, Ladinin, Limox, Medociprin, Nafloxin, Remena, Revionorm, Topistin, Ufexil; Hungary: Cifloxin, Cifran, Ciloxan, Ciplox, Ciprinol, Ciprobay, Ciprofloxacin, Ciprolen, Ciprum, Cydonin, Grenis-Cipro; Ireland: Biofloxcin, Cifloxager, Cifox, Ciloxan, Ciplox, Ciprofloxacin, Ciproxin, Profloxin, Truoxin; Italy: Basemar, Battizer, Chinocid, Ciperus, Ciprofloxac, Ciprosol, Ciproxin, Cuspis, Eoxin, Flontalexin, Generflon, Ibixacin, Kinox, Macar, Oftacilox, Prociflor, Samper; Latvia: Bactiflox Lactab, Cifloxinal, Cifran, Ciloxan, Ciplox, Ciprinol, Ciprofloxacin, Cipronex; Lithuania: Bactiflox Lactab, Cifloxinal, Cifran, Ciloxan, Ciprinol, Ciprofloxacin, Quintor; Luxembourg: Ciloxan; Malta: Aristin-C, Biofloxin, Ciloxan, Ciprofloxacin, Ciproxin, Medociprin, Sepcen, Siprox, Ufexil, Viprolox, Zindolin; Netherlands: Ciprinol, Ciprofloxacin, Ciprofloxacine, Ciproxin; Poland: Cifran, Ciloxan, Ciphin, Ciprinol, Cipro Tenlec, Ciprobay, Ciprofloxacin, Cipronex, Cipropol, Ciprum, Cyprofloksacyna, Proxacin, Quintor, Serviflox; Portugal: Ciplox, Ciprofloxacina, Ciproxina, Colintil, Estecina, Giroflox, Isino, Nivoflox, Oftacilox, Quinox, Utiminx; Romania: Alvebar, Cifran, Ciphin, Ciplox, Ciprinol, Ciprobay, Ciprocin, Ciprodar, Ciprofloxacin, Ciprofloxacina, Ciprolen, Ciprozone, Cuminol, Euciprin, Loxacil, Sifloks, Ufexil; Slovakia: Cifloxinal, Ciloxan, Ciphin, Ciprinol, Ciprofloxacin, Ciprolon, Ciplox, Medociprin; Slovenia: Ciloxan, Ciprinol, Ciprobay, Cyprofloksacyn, Ciprum; Spain: Aceoto, Baycip, Cetraxal, Ciflot, Ciprenit Ótico, Ciproctal, Ciprofloxacino, Cunesin, Doriman, Estecina, Felixene, Globuce, Numen, Oftacilox, Otociprin Ótico, Otosat, Rigoran, Septocipro Ótico; Sweden: Ciloxan, Ciprinomyl, Ciprofloxacin, Ciproxin, Utiminx; UK: Ciloxan, Ciprofloxacin, Ciproxin.
North America
Canada: Cipro, Ciprofloxacin; USA: Cetraxal, Ciloxan, Cipro, Ciprofloxacin, Proquin XR.
Latin America
Argentina: Argeflox, Atibax, Biotic, Ciapar, Ciloxan, Cipro XR, Ciprofloxacina, Ciprolabsa, Cipromed, Ciprotenk, Cirflox-G, Ciriax, Crisacide, Exertial, Floraxina, Golysine, Lorbifloxacina, Medaflox, Microsulf, Neflox, Nexofloxacin, Ocefax, Omaflaxina, Quisegen, Rexner, Septicide, Ultramicina; Brazil: Biamotil, Ciflox, Cifloxatil, Cifloxtron, Ciloxan, Cinoflax, Ciprix, Cipro XR, Ciprocilin, Ciprodine, Ciprofar, Ciprofloxacino, Ciprofloxil, Cipronid, Cipronom, Ciproxen, Ductocina, Floxan, Maxiflox, Nixin, Ofoxin, Proxacin, Quiflox, Quinoflox; Mexico: Antimed, Apoflox, Arfloxina, Bacproin, Bioflox, Cifran, Ciloxan, Cimogal, Ciprain, Cipro XR, Ciprobac, Ciprobiotic, Ciproflox, Ciprofloxacina, Ciprofloxacino, Ciprofur, Ciproser, Ciprotec, Ciproxina, Ciqfadin, Ci-Son’s, Dinaflox, Eni Oftálmico, Eufloxin, Flovin, Floxager, Floxantina, Floxelena, Floxitul, Gibac, Italnik, Kenzoflex, Lemyflox, Liferxina, Microrgan, Mitroken, Novoquin, Opthaflox, Patox, Pharcina, Profluxol, Provay, Quinoflox, Rancif, Sinfexina, Sophixin Ofteno, Suiflox, Trigen, Vifloxina, Wasiprobil, Zipra, Z-Xin.
Asia
Japan: Ciflosacin, Cifroquinon, Ciprofloxacin, Ciproxan, Displotin, Flokisyl, Peiton, Primol, Shipkisanon, Sivastan.
Drug combinations
Ciprofloxacin and Dexamethasone
Ciprofloxacin and Fluocinolone
Ciprofloxacin and Hydrocortisone
Ciprofloxacin and Phenazopyridine
Ciprofloxacin, Hydrocortisone, and Lidocaine
Chemistry
Ciprofloxacin Hydrochloride: C~17~H~18~FN~3~O~3~ HCl H~2~O. Mw: 385.82. (1) 3-Quinolinecarboxylic acid, 1-cyclopropyl-6-fluoro-1,4-dihydro-4-oxo-7-(1-piperazinyl)-, monohydrochloride, monohydrate; (2) 1-Cyclopropyl-6-fluoro-1,4-dihydro-4-oxo-7-(1-piperazinyl)-3-quinolinecarboxylic acid, monohydrochloride, monohydrate. CAS-86393-32-0 (1987).
Pharmacologic Category
Antibacterials; Quinolones. Antimycobacterials; Antituberculosis Agents. (ATC-Code: J01MA02; S01AX13; S02AA15; S03AA07).
Mechanism of action
Inhibits bacterial DNA gyrase and topoisomerase IV. Inhibits relaxation of supercoiled DNA and promotes breakage of double-stranded DNA. Usually bactericidal. Generally less active against Gram-positive than Gram-negative bacteria. Some cross-resistance occurs between ciprofloxacin and other fluoroquinolones. Inactive against fungi and viruses.
Therapeutic use
Children: Complicated urinary tract infections and pyelonephritis due to E. coli. Children and Adults: Reduction of incidence or progression of disease following exposure to aerolized Bacillus anthracis. Ophthalmologically, for superficial ocular infections (corneal ulcers, conjunctivitis) due to susceptible strains. Adults: Urinary tract infections, acute uncomplicated cystitis in females, chronic bacterial prostatitis, lower respiratory tract infections (including acute exacerbations of chronic bronchitis), acute sinusitis, skin and skin structure infections, bone and joint infections, complicated intra-abdominal infections (in combination with metronidazole), infectious diarrhea, typhoid fever due to Salmonella typhi (eradication of chronic typhoid carrier state not proven), uncomplicated cervical and urethra gonorrhea (due to N. gonorrhoeae), nosocomial pneumonia, empirical therapy for febrile neutropenic patients (in combination with piperacillin), periodontitis associated with the presence of Actinobacillus actinomycetemcomitans, as well as enteric rods/pseudomonads.
Pregnancy and lactiation implications
Ciprofloxacin crosses the placenta. Because of concerns of cartilage damage in immature animals, ciprofloxacin should only be used during pregnancy if a safer option is not available. Ciprofloxacin is recommended for prophylaxis and treatment of pregnant women exposed to anthrax. Not recommended during lactation.
Unlabeled use
Acute pulmonary exacerbations in cystic fibrosis (children). Cutaneous/gastrointestinal/oropharyngeal anthrax (children and adults). Disseminated gonococcal infection (adults). Chancroid (adults). Prophylaxis to Neisseria meningitidis following close contact with an infected person. Febrile neutropenia in low-risk cancer patients. HACEK group endocarditis. Infectious diarrhea (children).
Contraindications
Hypersensitivity to ciprofloxacin, any component of the formulation, or other quinolones. Concurrent administration of tizanidine. Not recommended for use in pregnant women or during breast-feeding.
Warnings and precautions
Fluoroquinolones may prolong QTc interval (avoid use in history of QTc prolongation, uncorrected hypokalemia, hypomagnesemia, or concurrent administration of other medications known to prolong the QT interval). Tremor, restlessness, confusion, and very rarely hallucinations or seizures may occur (use with caution in known or suspected CNS disorder). Use with caution in individuals at risk of seizures (CNS disorders or concurrent therapy with medications which may lower seizure threshold). Potential for seizures, although very rare, may be increased with concomitant NSAID therapy. Rarely, crystalluria has occurred. Fluoroquinolones have been associated with the development of serious, and sometimes fatal, hypoglycemia (higher risk in elderly patients with diabetes) and hyperglycemia. Severe hypersensitivity reactions, including anaphylaxis, have occurred with quinolone therapy. The use of quinolones has been linked to peripheral neuropathy (rare). May cause moderate-to-severe phototoxicity reactions. Prolonged use may result in fungal or bacterial superinfection, including C. difficile-associated diarrhea and pseudomembranous colitis. Reports of tendon inflammation and/or rupture with quinolone antibiotics (risk may be increased with concurrent corticosteroids, organ transplant recipients, and in patients >60 years of age). Rupture of the Achilles tendon sometimes requiring surgical repair reported (frequently). Some quinolones may exacerbate myasthenia gravis (rare, potentially life-threatening weakness of respiratory muscles may occur). Use with caution in renal impairment (may increase risk of tendon rupture). Use with caution in rheumatoid arthritis (may increase risk of tendon rupture). Co-administration of drugs which depend on CYP1A2 pathway may lead to substantial increases in serum concentrations and adverse effects (ciprofloxacin is a potent inhibitor of CYP1A2). Adverse effects (e.g. tendon rupture, QT changes) may be increased in the elderly. Hemolytic reactions may (rarely) occur with quinolone use in latent or actual G6PD deficiency. Adverse effects, including those related to joints and/or surrounding tissues, are increased in pediatric patients and therefore, ciprofloxacin should not be considered as drug of choice in children (exception is anthrax treatment).