The relative risk increased to 3. Among the 46, quinolone users in the study, 38 0. A study performed using an Italian healthcare database reached qualitatively similar conclusions. Ciprofloxacin, like other fluoroquinolones, is known to trigger seizures or lower the seizure threshold, and may cause other central nervous system side effects.
Headache, dizziness, and insomnia have been reported as occurring fairly commonly in postapproval review articles, along with a much lower incidence of serious CNS side effects such as tremors, psychosis, anxiety, hallucinations, paranoia, and suicide attempts, especially at higher doses. Results from photo co-carcinogenicity testing indicate ciprofloxacin does not reduce the time to appearance of UV-induced skin tumors as compared to vehicle control.
Other[ edit ] The other black box warning is that ciprofloxacin should not be used in people with myasthenia gravis due to possible exacerbation of muscle weakness which may lead to breathing problems resulting in death or ventilator support. Fluoroquinolones are known to block neuromuscular transmission. FDA or the subject of case reports published in medical journals includes, but is not limited to, toxic epidermal necrolysis , Stevens-Johnson syndrome , abnormal heart rhythms torsades de pointes or QT prolongation , low blood pressure, allergic pneumonitis, bone marrow suppression, hepatitis or liver failure, and sensitivity to light.
Treatment of overdose includes emptying of the stomach by induced vomiting or gastric lavage , as well as administration of antacids containing magnesium, aluminum, or calcium to reduce drug absorption. Renal function and urinary pH should be monitored. Important support includes adequate hydration and urine acidification if necessary to prevent crystalluria.
Ciprofloxacin should not be taken with antacids containing magnesium or aluminum, highly buffered drugs sevelamer , lanthanum carbonate , sucralfate , didanosine , or with supplements containing calcium, iron, or zinc. It should be taken two hours before or six hours after these products. However, ciprofloxacin may be taken with dairy products or calcium-fortified juices as part of a meal.
CYP1A2 substrates that exhibit increased serum levels in ciprofloxacin-treated patients include tizanidine , theophylline , caffeine , methylxanthines , clozapine , olanzapine , and ropinirole. Interference with Timely Diagnosis of Syphilis Ciprofloxacin has not been shown to be effective in the treatment of syphilis. Antimicrobial agents used in high dose for short periods of time to treat gonorrhea may mask or delay the symptoms of incubating syphilis.
Perform a serologic test for syphilis in all patients with gonorrhea at the time of diagnosis. Perform follow-up serologic test for syphilis three months after Cipro XR treatment. Crystalluria Crystals of ciprofloxacin have been observed rarely in the urine of human subjects but more frequently in the urine of laboratory animals, which is usually alkaline [see Nonclinical Toxicology Crystalluria related to ciprofloxacin has been reported only rarely in humans because human urine is usually acidic.
Avoid alkalinity of the urine in patients receiving Cipro XR. Hydrate patients well to prevent the formation of highly concentrated urine [see Dosage and Administration 2. Adverse Reactions The following serious and otherwise important adverse drug reactions are discussed in greater detail in other sections of labeling: Clinical trials in patients with urinary tract infections enrolled patients treated with mg or mg Cipro XR. The overall incidence, type and distribution of adverse reactions were similar in patients receiving both mg and mg of Cipro XR.
The adverse reaction information from clinical studies does, however, provide a basis for identifying the adverse events that appear to be related to drug use and for approximating rates. Cipro XL Storage Cipro XL Warnings Before taking ciprofloxacin, tell your doctor or pharmacist if you are allergic to it; or to other quinolone antibiotics such as norfloxacin, gemifloxacin, levofloxacin, moxifloxacin, or ofloxacin; or if you have any other allergies.
This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details. Ciprofloxacin may cause a condition that affects the heart rhythm QT prolongation. The risk of QT prolongation may be increased if you have certain medical conditions or are taking other drugs that may cause QT prolongation. Before using ciprofloxacin, tell your doctor or pharmacist of all the drugs you take and if you have any of the following conditions: Low levels of potassium or magnesium in the blood may also increase your risk of QT prolongation.
Talk to your doctor about using ciprofloxacin safely. Check your blood sugar regularly as directed and share the results with your doctor.
Ciprofloxacin may increase the blood-sugar-lowering effects of the medication glyburide. It is a good habit to carry glucose tablets or gel to treat low blood sugar.
If you don't have these reliable forms of glucose, rapidly raise your blood sugar by eating a quick source of sugar such as table sugar, honey, or candy, or by drinking fruit juice or non- diet soda. Tell your doctor right away about the reaction and the use of this product. To help prevent low blood sugar, eat meals on a regular schedule, and do not skip meals. Your doctor may need to switch you to another antibiotic or adjust your diabetes medications if any reaction occurs.
Alcohol or marijuana can make you more dizzy. Do not drive, use machinery, or do anything that needs alertness until you can do it safely. Talk to your doctor if you are using marijuana. Limit your time in the sun. Use sunscreen and wear protective clothing when outdoors. Ciprofloxacin may cause live bacterial vaccines such as typhoid vaccine to not work as well.
Before having surgery, tell your doctor or dentist about all the products you use including prescription drugs , nonprescription drugs, and herbal products. Older adults may be more sensitive to the side effects of this drug, especially tendon problems especially if they are also taking corticosteroids such as prednisone or hydrocortisone and QT prolongation see above. During pregnancy , this medication should be used only when clearly needed.
Discuss the risks and benefits with your doctor. This medication passes into breast milk. Consult your doctor before breast -feeding.
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