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Drugs (Ciprofloxacin)*

FLUOROQUINOLONES (Systemic)
Generics / Brand Names

This information applies to the following medicines:

Ciprofloxacin (sip-roe-FLOX-a-sin)
Enoxacin (en-OX-a-sin)
Lomefloxacin (loe-me-FLOX-a-sin)
Norfloxacin (nor-FLOX-a-sin)
Ofloxacin (oe-FLOX-a-sin)

Some commonly used brand names are:

For Ciprofloxacin
In the U.S.
Cipro
Cipro IV

In Canada
Cipro

For Enoxacin
In the U.S.
Penetrex

In Canada
Penetrex

For Lomefloxacin
In the U.S.
Maxaquin

In Canada
Maxaquin

For Norfloxacin
In the U.S.
Noroxin

For Ofloxacin
In the U.S.
Floxin
Floxin IV

In Canada
Floxin

Description

Fluoroquinolones (flu-roe-KWIN-a-lones) are used to treat bacterial infections in many different parts of the body. They work by killing bacteria or preventing their growth. However, these medicines will not work for colds, flu, or other virus infections. Fluoroquinolones may be used for other problems as determined by your doctor.

Fluoroquinolones are available only with your doctor's prescription, in the following dosage forms:

Oral
Ciprofloxacin
• Tablets (U.S. and Canada)
Enoxacin
• Tablets (U.S. and Canada)
Lomefloxacin
• Tablets (U.S. and Canada)
Norfloxacin
• Tablets (U.S. and Canada)
Ofloxacin
• Tablets (U.S. and Canada)

Parenteral
Ciprofloxacin
• Injection (U.S. and Canada)
Ofloxacin
• Injection (U.S.)

It is very important that you read and understand the following information. If any of it causes you special concern, check with your doctor. Also, if you have any questions or if you want more information about this medicine or your medical problem, ask your doctor, nurse, or pharmacist.

Before Using This Medicine

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For the fluoroquinolones, the following should be considered:

Allergies -- Tell your doctor if you have ever had any unusual or allergic reaction to any of the fluoroquinolones or to any related medicines such as cinoxacin (e.g., Cinobac) or nalidixic acid (e.g., NegGram). Also tell your doctor and pharmacist if you are allergic to any other substances, such as foods, preservatives, or dyes.

Pregnancy -- Studies have not been done in humans. However, use is not recommended during pregnancy since fluoroquinolones have been reported to cause bone development problems in young animals.

Breast-feeding -- Some of the fluoroquinolones are known to pass into human breast milk. Since fluoroquinolones have been reported to cause bone development problems in young animals, breast-feeding is not recommended during treatment with these medicines.

Age Groups

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For the fluoroquinolones, the following should be considered:

Children -- Use is not recommended for infants or children since fluoroquinolones have been shown to cause bone development problems in young animals. However, your doctor may choose to use one of these medicines if other medicines cannot be used.

Teenagers -- Use is not recommended for teenagers up to 18 years of age since fluoroquinolones have been shown to cause bone development problems in young animals. However, your doctor may choose to use one of these medicines if other medicines cannot be used.

Older adults -- These medicines have been tested and, in effective doses, have not been shown to cause different side effects or problems in older people than they do in younger adults.

Other Therapy

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For the fluoroquinolones, the following should be considered:

Other medicines -- Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking a fluoroquinolone, it is especially important that your doctor and pharmacist know if you are taking any of the following:

• Aminophylline or
• Oxtriphylline (e.g., Choledyl) or
• Theophylline (e.g., Somophyllin-T, Theodur, Elixophyllin) -- Enoxacin, ciprofloxacin, and norfloxacin may increase the chance of side effects of aminophylline, oxtriphylline, or theophylline

• Antacids, aluminum-, calcium-, or magnesium-containing, or
• Iron supplements or
• Sucralfate -- Antacids, iron, or sucralfate may keep any of the fluoroquinolones from working properly

• Caffeine -- Enoxacin, ciprofloxacin, and norfloxacin may increase the chance of side effects of caffeine

• Didanosine (e.g., Videx, ddI) -- Didanosine may keep any of the fluoroquinolones from working properly

• Warfarin (e.g., Coumadin) -- Enoxacin, ciprofloxacin, and norfloxacin may increase the effect of warfarin, increasing the chance of bleeding

Other medical problems -- The presence of other medical problems may affect the use of fluoroquinolones. Make sure you tell your doctor if you have any other medical problems, especially:

• Brain or spinal cord disease, including hardening of the arteries in the brain or epilepsy or other seizures -- Fluoroquinolones may cause nervous system side effects

• Kidney disease or
• Kidney disease and liver disease -- Patients with kidney disease (alone) or kidney disease and liver disease (together) may have an increased chance of side effects

Before you begin using any new medicine (prescription or nonprescription) or if you develop any new medical problem while you are using this medicine, check with your doctor, nurse, or pharmacist.

Proper Use of This Medicine

Do not take fluoroquinolones if you are pregnant. Do not give fluoroquinolones to infants, children, or teenagers unless otherwise directed by your doctor. These medicines have been shown to cause bone development problems in young animals.

Fluoroquinolones are best taken with a full glass (8 ounces) of water. Several additional glasses of water should be taken every day, unless you are otherwise directed by your doctor. Drinking extra water will help to prevent some unwanted effects of ciprofloxacin and norfloxacin.

Ciprofloxacin and lomefloxacin may be taken with meals or on an empty stomach.

Enoxacin, norfloxacin, and ofloxacin should be taken on an empty stomach.

To help clear up your infection completely, keep taking your medicine for the full time of treatment, even if you begin to feel better after a few days. If you stop taking this medicine too soon, your symptoms may return.

This medicine works best when there is a constant amount in the blood or urine. To help keep the amount constant, do not miss any doses. Also, it is best to take the doses at evenly spaced times, day and night. For example, if you are to take 2 doses a day, the doses should be spaced about 12 hours apart. If this interferes with your sleep or other daily activities, or if you need help in planning the best times to take your medicine, check with your doctor, nurse, or pharmacist.

Storage -- To store this medicine:

• Keep out of the reach of children.

• Store away from heat and direct light.

• Do not store in the bathroom, near the kitchen sink, or in other damp places. Heat or moisture may cause the medicine to break down.

• Do not keep outdated medicine or medicine no longer needed. Be sure that any discarded medicine is out of the reach of children.

Dosing

Dosing -- The dose of fluoroquinolones will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of fluoroquinolones. Your dose may be different if you have kidney disease. If your dose is different, do not change it unless your doctor tells you to do so.

The number of tablets that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using a fluoroquinolone.

For ciprofloxacin
• For oral dosage form (tablets):
-- Adults: 250 to 750 milligrams (mg) every twelve hours for five to fourteen days, depending on the medical problem being treated.

-- Children up to 18 years of age: This medicine is not recommended in infants, children, or teenagers.

• For injection dosage form:
-- Adults: 200 to 400 mg every twelve hours.

-- Children up to 18 years of age: This medicine is not recommended in infants, children, or teenagers.

For enoxacin
• For oral dosage form (tablets):
-- Adults: 200 to 400 mg every twelve hours for seven to fourteen days, depending on the medical problem being treated. Gonorrhea is usually treated with a single, oral dose of 400 mg.

-- Children up to 18 years of age: This medicine is not recommended in infants, children, or teenagers.

For lomefloxacin
• For oral dosage form (tablets):
-- Adults: 400 mg once a day for ten to fourteen days, depending on the medical problem being treated.

-- Children up to 18 years of age: This medicine is not recommended in infants, children, or teenagers.

For norfloxacin
• For oral dosage form (tablets):
-- Adults: 400 mg every twelve hours for three to twenty-one days, depending on the medical problem being treated. Gonorrhea is usually treated with a single, oral dose of 800 mg.

-- Children up to 18 years of age: This medicine is not recommended in infants, children, or teenagers.

For ofloxacin
• For oral dosage form (tablets):
-- Adults: 200 to 400 mg every twelve hours for three to ten days, depending on the medical problem being treated. Gonorrhea is usually treated with a single, oral dose of 400 mg.

-- Children up to 18 years of age: This medicine is not recommended in infants, children, or teenagers.

• For injection dosage form:
-- Adults: 200 to 400 mg every twelve hours for three to ten days, depending on the medical problem being treated. Gonorrhea is usually treated with a single, oral dose of 400 mg.

-- Children up to 18 years of age: This medicine is not recommended in infants, children, or teenagers.

Missed dose -- If you miss a dose of this medicine, take it as soon as possible. This will help to keep a constant amount of medicine in the blood or urine. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses.

Precautions While Using This Medicine

If your symptoms do not improve within a few days, or if they become worse, check with your doctor.

If you are taking aluminum- or magnesium-containing antacids, or sucralfate do not take them at the same time that you take this medicine. It is best to take these medicines at least 2 hours before or 2 hours after taking norfloxacin or ofloxacin, at least 4 hours before or 2 hours after taking ciprofloxacin or lomefloxacin, and at least 8 hours before or 2 hours after taking enoxacin. These medicines may keep fluoroquinolones from working properly.

Some people who take fluoroquinolones may become more sensitive to sunlight than they are normally. Exposure to sunlight, even for brief periods of time, may cause severe sunburn; skin rash, redness, itching, or discoloration; or vision changes. When you begin taking this medicine:

• Stay out of direct sunlight, especially between the hours of 10:00 a.m. and 3:00 p.m., if possible.

• Wear protective clothing, including a hat and sunglasses.

• Apply a sun block product that has a skin protection factor (SPF) of at least 15. Some patients may require a product with a higher SPF number, especially if they have a fair complexion. If you have any questions about this, check with your doctor or pharmacist.

• Do not use a sunlamp or tanning bed or booth.

If you have a severe reaction from the sun, check with your doctor.

Fluoroquinolones may also cause some people to become dizzy, lightheaded, drowsy, or less alert than they are normally. Make sure you know how you react to this medicine before you drive, use machines, or do anything else that could be dangerous if you are dizzy or are not alert. If these reactions are especially bothersome, check with your doctor.

Side Effects of This Medicine

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor immediately if any of the following side effects occur:

Rare
Agitation; confusion; fever; hallucinations (seeing, hearing, or feeling things that are not there); pain at site of injection; peeling of the skin; shakiness or tremors; shortness of breath; skin rash, itching, or redness; swelling of face or neck

Other side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. However, check with your doctor if any of the following side effects continue or are bothersome:

More common
Abdominal or stomach pain or discomfort; diarrhea; dizziness; drowsiness; headache; lightheadedness; nausea or vomiting; nervousness; trouble in sleeping

Less frequent or rare
Increased sensitivity of skin to sunlight

Other side effects not listed above may also occur in some patients. If you notice any other effects, check with your doctor.

*This information is reproduced from the Mayo Clinic Family Pharmacist v 2.0
Copyright 1994-1995 IVI Publishing Inc.

This information may not be complete and/or up to date.  Please do not use this as any sort of authoritative text for this drug.  Please consult with a physician before taking this or any drug.  This is presented only for reference usage within this site.