Ciprofloxacin (ciprofloxacin hydrochloride)

The US label says ciprofloxacin tablets treat infections caused by bacteria that are susceptible to it. It says they should be used only for infections proven or strongly suspected to be bacterial.

The label lists several adult uses. The main ones are below. Some, such as anthrax after exposure and plague, also apply to children.

The label also says that, because of serious risks, ciprofloxacin should be kept for patients with no alternative for acute worsening of chronic bronchitis, simple bladder infection and acute sinusitis.

• Skin and skin structure infections
• Bone and joint infections
• Complicated infections inside the abdomen (with metronidazole)
• Infectious diarrhoea
• Typhoid (enteric) fever
• Uncomplicated gonorrhoea of the cervix and urethra
• Anthrax after exposure and plague
• Chronic bacterial prostatitis
• Lower respiratory tract infections
• Urinary tract infections
• Acute sinusitis

The label places ciprofloxacin in the fluoroquinolone class of antibacterial medicines.

The label sections we reviewed do not explain its action in more detail.

The dosing here comes from a US tablet label (ciprofloxacin tablets, taken by mouth) for adults. Other Indian pack forms exist, and the prescriber decides.

The US label for adults gives a dose and length that depend on the infection. Doses are usually every 12 hours.

Examples from the label table: skin infections 500 to 750 mg every 12 hours for 7 to 14 days; typhoid 500 mg every 12 hours for 10 days; infectious diarrhoea 500 mg every 12 hours for 5 to 7 days.

Further examples: urinary tract infection 250 to 500 mg every 12 hours for 7 to 14 days; simple bladder infection 250 mg every 12 hours for 3 days; gonorrhoea 250 mg as a single dose.

The label says the dose and length depend on the infection, the germ, and kidney and liver function. It lowers the dose in kidney impairment.

It says to continue at least 2 days after signs of infection have gone, apart from anthrax after exposure.

This is label information, not a prescription. Indian pack labels may differ from the US label, and your prescriber's instruction always comes first.

Boxed warning: the label says fluoroquinolones have been linked to disabling and possibly permanent reactions together, including tendon rupture, nerve damage and brain effects. It says to stop at the first sign and avoid fluoroquinolones in people who had these reactions.

Myasthenia gravis: the label says it may worsen muscle weakness and to avoid it in people with a known history.

Allergy: it is not for people with a history of allergy to ciprofloxacin or other quinolones. It must not be combined with tizanidine.

Tendon risk is higher in people over 60, people taking corticosteroids, and people with kidney, heart or lung transplants.

Heart rhythm: the label says to avoid it in people with known QT prolongation or low potassium.

Elderly: higher risk of tendon problems, aortic aneurysm and QT effects. Kidney function may need checking.

Pregnancy: long experience in studies did not show a clear risk of birth defects. The label has limits, so ask your doctor.

Breastfeeding: the label says it is not recommended. A mother may pump and discard milk during treatment and for 2 days after the last dose.

Children: the label says it is not a first-choice medicine in children because of joint-related reactions.

• Tizanidine: contraindicated
• Theophylline: avoid
• QT-prolonging medicines: avoid
• Diabetes tablets such as sulfonylureas: low blood sugar
• Phenytoin, cyclosporine, warfarin, methotrexate: caution and monitoring
• The label says ciprofloxacin must not be combined with tizanidine, because tizanidine effects on blood pressure and sedation are increased.
• It says to avoid theophylline where possible, because blood levels may rise and cause serious reactions.
• It says to avoid use with other medicines that prolong the QT interval, such as some antiarrhythmics, tricyclic antidepressants, macrolides and antipsychotics.
• It says to use caution with diabetes medicines (low blood sugar, sometimes severe), phenytoin, cyclosporine, warfarin-type anticoagulants and methotrexate.
• Tell your doctor about every medicine you use.

No match in this label text. Ask your pharmacist about any medicine you take.

The label says an overdose has caused reversible kidney toxicity in some cases. Treatment is supportive, with fluids and monitoring of kidney function.

Antacids with magnesium, aluminium or calcium can reduce absorption. Only a small part is removed by dialysis. Get medical help right away.

The label says to store it at 20 to 25 degrees C (68 to 77 degrees F). Short excursions to 15 to 30 degrees C are allowed.

In the Drugs Rules schedules we checked, ciprofloxacin is listed under Schedule H (Schedule H, serial 113 (rules 65 and 97)). Schedule H medicines are sold only on a doctor's prescription.

Ciprofloxacin appears in the National List of Essential Medicines 2022 on page 71, 93, 99. Listed forms include 250 mg and 500 mg tablets, an oral liquid, an injection, and eye and ear drops and eye ointment.

NPPA lists ceiling prices for several ciprofloxacin formulations. The table shows the rows we found. Check NPPA directly for the current list.

Banned combinations: 4 mentions of ciprofloxacin in the banned-combination list we checked. Use the checker for your exact combination.

NPPA ceiling prices set the most a seller can charge per unit for the listed formulations, before local taxes. Check the pack and the seller.

Jan Aushadhi (PMBJP) lists ciprofloxacin products in the file we checked. We have not shown a brand price here.

• Ciprofloxacin 250mg and Tinidazole 300mg Tablets (pack 10's)
• Ciprofloxacin 500mg and Tinidazole 600mg Tablets (pack 10's)
• Ciprofloxacin Hydrochloride Tablets IP 250 mg (pack 10's)
• Ciprofloxacin Hydrochloride Tablets IP 500 mg (pack 10's)
• Ciprofloxacin Injection IP 200mg (pack 100 ml)
• Ciprofloxacin Eye Drops IP 0.3% w/v (pack 5 ml)
• Ciprofloxacin 0.3% w/v and Dexamethasone 0.1% w/v Eye/Ear Drops (pack 10 ml)