Ciprofloxacin

Products

Ciprofloxacin is commercially available as film-coated tablets, oral suspension, infusion preparation, eye drops, eye ointment (Ciloxan), and ear drops (Ciproxin HC + hydrocortisone). In addition to the original Ciproxin, various generics are available. Ciprofloxacin was approved in many countries in 1987. This article refers to peroral administration.

Structure and Properties

Ciprofloxacin (C17H18FN3O3, Mr = 331.4 g/mol) exists as a white to pale yellow, crystalline, weakly hydrophilic powder that is practically insoluble in water. The ciprofloxacin hydrochloride monohydrate contained in the tablets is soluble in water. Structurally, it is a fluorinated quinolone and a piperazine derivative.

Effects

Ciprofloxacin (ATC J01MA02) has bactericidal properties against Gram-positive and many Gram-negative bacteria. The effects are due to inhibition of bacterial topoisomerase II (DNA gyrase) and topoisomerase IV, which are required for DNA replication and other processes. The half-life is four to seven hours.

Indications

For treatment of bacterial infectious diseases with susceptible pathogens.

Dosage

According to the SmPC. Medicines are usually administered twice daily and independently of meals. Ciprofloxacin should not be taken with dairy products or calcium-rich foods. Because ciprofloxacin can rarely make the skin sensitive to the sun, sunscreen should be applied during treatment and patients should avoid prolonged exposure to sunlight; see Photosensitivity.

Contraindications

  • Hypersensitivity
  • Pregnancy and lactation
  • Children and adolescents until the completion of the growth phase
  • Ciprofloxacin should not be combined with tizanidine because it may increase concentrations of the muscle relaxant to the point that adverse effects occur.

For complete precautions, see the drug label.

Interactions

Ciprofloxacin is an inhibitor of CYP1A2 and may lead to an increase in plasma concentrations of CYP1A2 substrates. These include, for example, theophylline, caffeine, tizanidine, duloxetine, and clozapine. Ciprofloxacin has a high interaction potential, and numerous other drug-drug interactions are possible.

Adverse effects

The most common potential adverse effects include nausea, vomiting, diarrhea, indigestion, loss of appetite, rash, and increased transaminase levels.