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Ciprofloxacin: Drug Administration

Drug administration route

In a comparison of intravenous and oral ciprofloxacin in children, treatment associated adverse events were reported in 11% of children taking oral ciprofloxacin, compared with 19% of the children who were treated intravenously. In 31 children (1.5%) arthralgia occurred, but it was generally mild to moderate and resolved spontaneously.

Drug overdose

A patient developed acute renal insufficiency after ciprofloxacin overdose. This was mediated by tubulointerstitial nephritis with distal nephron apoptosis, as evidenced by renal biopsy.

Drug-Drug Interactions


In 42 patients who had received a kidney transplant, cases were treated with ciprofloxacin in the first 1-6 months after transplantation, and matched controls (two per case) were not. The proportion of cases with at least one episode of biopsy-proven rejection 1-3 months after transplantation (45%) was significantly higher than in the controls (19%). The authors speculated that ciprofloxacin increases rejection rates in renal transplant recipients by antagonizing ciclosporin-dependent inhibition of interleukin-2 production.


Ciprofloxacin can alter plasma clozapine concentrations, perhaps by inhibition of cytochrome P450 enzymes.


Didanosine one enteric-coated capsule/day (400 mg/day) did not affect the absorption of ciprofloxacin in 16 patients.


Hypoglycemia and raised serum concentrations of glibenclamide, which is metabolized by CYP2C9, occurred after treatment with ciprofloxacin for 1 week in a patient taking long-term glibenclamide.


Hypoglycemia occurred in a patient treated with insulin and ciprofloxacin 500 mg bd.


Ciprofloxacin, given to a patient who had been successfully treated with methadone for more than 6 years, caused profound sedation, confusion, and respiratory depression. This may have been due to inhibition of CYP1A2 and CYP3A4, two of the isozymes involved in the metabolism of methadone.


Methotrexate elimination can be delayed by ciprofloxacin. Two adolescents with malignant diseases had reduced elimination of methotrexate (12 g/m2 4-hourly) when they took ciprofloxacin 500 mg bd.

Oral contraceptives

Some antibiotics can reduce the efficacy of oral contraceptives. However, there is pharmacokinetic evidence that plasma concentrations of oral contraceptive steroids are unchanged by co-administration of ciprofloxacin. Furthermore, ciprofloxacin (500 mg bd) did not interfere with the ovarian suppression produced by the oral contraceptive Marvelon (30 micrograms of ethiny-lestradiol plus 150 micrograms of desogestrel) in 24 healthy women in a randomized, double-blind, placebo-controlled, crossover trial.


Ciprofloxacin may interact with phenytoin reducing phenytoin concentrations.

A lower than expected phenytoin serum concentration has been measured in a 78-year-old white woman with a grade III astrocytoma of the right parieto-occipital region treated with ciprofloxacin (500 mg bd).

Increased renal excretion has been suggested to be at least partly responsible for the increased clearance.

Besides this kinetic interaction, the possible epileptogenic potential of ciprofloxacin itself may contribute to the development of seizure activity.


The renal excretion of ciprofloxacin was reduced and plasma concentrations increased by probenecid.


Serum quinidine concentrations rose during concomitant administration of ciprofloxacin. The authors speculated that the mechanism was inhibition of cytochrome P450 by ciprofloxacin.


Rifampicin-induced lupus-like syndrome is associated with combination therapy with ciprofloxacin, since rifampicin is metabolized by (among others) CYP3A4, which is inhibited by ciprofloxacin, and combined usage may lead to higher rifampicin blood concentrations.


During co-administration of ciprofloxacin with ropinirole in 12 patients there was an increase in the plasma ropinirole concentration, which is metabolized by CYP1A2.


Ciprofloxacin can occasionally cause an exaggerated hypoprothombinemic response and bleeding in patients taking warfarin. In 66 patients (median age 72 years, range, the mean time to detection of the coagulo-pathy after ciprofloxacin challenge was 5.5 days. Hospitalization was reported in 15 cases, bleeding in 25, and death in one. The median INR was 10.0. Patients in their seventh decade and those requiring polypharmacy were most at risk.

Food-Drug Interactions

The systemic availability of ciprofloxacin is reduced by 30-36% when it is taken with dairy products.

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Synonyms of Ciprofloxacin:

Ciprofloxacin, Ciprofloxacin Dihydrochloride, Ciprofloxacin HCl, Ciprofloxacin Hydrochloride, Ciprofloxacin Monohydrochloride, Ciprofloxacina

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