Ciprofloxacin (marketed as Cipro, Cipro XR and other trade names) is an antibiotic from the quinolone group. It is active against a wide range of bacteria and is used to treat a variety of infections including urinary tract infection, sinusitis and prostatitis. As of July 2008, ciprofloxacin carries a black box warning because of an increased risk of tendinitis and tendon rupture. Several other warnings are also in place for ciprofloxacin.
Tendinitis and Tendon Rupture
Ciprofloxacin is associated with an increased risk of tendinitis and tendon rupture, especially in people over age 60. Tendonitis is an inflammation of the tissue connecting the muscle to bone and tendon rupture is a tear of this tissue. The risk of tendinitis and tendon rupture persists for up to several months after you stop taking ciprofloxacin. The Achilles tendon at the back of ankle is most frequently affected, but tendons of the shoulder, hand, upper arm and other areas of the body may also be involved. Immunosuppressive drugs to prevent organ transplant rejection and corticosteroid medication taken at the same time as ciprofloxacin increase the risk of tendinitis and tendon rupture.
Seizures
Ciprofloxacin may cause seizures. People with epilepsy or a history of seizures may be more prone to experience this side effect. Be sure to tell your doctor if you have a history of seizures.
Severe Allergic Reactions
Ciprofloxacin may cause a serious allergic reaction called anaphylaxis. This reaction typically occurs within minutes to hours of taking the medication. Symptoms include dizziness, hives, nausea and breathing problems such as shortness of breath, wheezing, and chest or throat tightness. Anaphylaxis is a life-threatening medical emergency. If you experience symptoms of anaphylaxis--especially difficulty breathing--call 911 immediately.
Severe Skin Reactions
Severe skin reactions may occur with ciprofloxacin including Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN). These two disorders cause severe blistering of the skin and mucosal surfaces--the linings of the cavities of the body that open to the outside environment such as the mouth, throat and airways. SJS and TEN are potentially life threatening because of extensive loss of fluid through the open skin and the high risk of serious infection.
Antibiotic-Associated Colitis
Powerful antibiotics such as ciprofloxacin kill some of the normal bacteria in the colon, which may permit an overgrowth of bacteria not killed by the drug. Ciprofloxacin can cause this inflammatory condition of the colon, which is called antibiotic-associated colitis or pseudomembranous colitis. Symptoms include watery diarrhea, abdominal pain or cramps, fever, blood or mucus in the stool, and bowel movement urgency.
Contraindication With Tizanidine
Ciprofloxacin should not be taken with the drug tizanidine (a medication to treat spasticity). Ciprofloxacin potentiates the effects of tizanidine, which may be life threatening.
Serious Reaction With Theophylline
Serious reactions have been reported in people taking both theophylline (a medicine for asthma and emphysema) and ciprofloxacin. Some of these reactions have been fatal. Use of theophylline and ciprofloxacin at the same time should be avoided if possible. Be sure to tell your doctor if you are taking theophylline.
Limited Pediatric Use
Ciprofloxacin is not a first-choice drug for children under age 18 because of the risk of adverse effects on the bones, joints and related tissues.
References
- Drugs: Ciprofloxacin, FDA information
- U.S. Food and Drug Administration: Information for healthcare professionals, fluoroquinolone antimicrobial drugs
- Medline Plus: Ciprofloxacin
- Archives of Internal Medicine: Increased risk of Achilles tendon rupture with quinolone antibacterial use, especially in elderly patients taking oral corticosteroids
- U.S. Food and Drug Administration: Cipro medication guide
