1. Clinical Laboratory Standards, Methods for Dilution Antimicrobial Susceptibility Tests for Bacteria That Grow Aerobically; Approved Standard — Eighth Edition. CLSI Document M7-A8, Vol. 29, No. 2, CLSI, Wayne, PA, January, 2009.
2. Clinical and Laboratory Standards Institute. Performance Standards for Antimicrobial Disk Susceptibility Tests; Approved Standard — Tenth Edition. CLSI Document M2-A10, Vol. 29, No. 1, CLSI, Wayne, PA, January, 2009.
Ciprofloxacin Extended-Release Tablets
Read the Medication Guide that comes with ciprofloxacin extended-release tablets before you start taking it and each time you get a refill. There may be new information. This Medication Guide does not take the place of talking to your healthcare provider about your medical condition or your treatment.
Ciprofloxacin belongs to a class of antibiotics called fluoroquinolones. Ciprofloxacin can cause side effects that may be serious or even cause death. If you get any of the following serious side effects, get medical help right away. Talk with your healthcare provider about whether you should continue to take ciprofloxacin extended-release tablets.
1. Tendon rupture or swelling of the tendon (tendinitis)
- Tendon problems can happen in people of all ages who take ciprofloxacin. Tendons are tough cords of tissue that connect muscles to bones. Symptoms of tendon problems may include:
- Pain, swelling, tears and inflammation of tendons including the back of the ankle (Achilles), shoulder, hand, or other tendon sites.
- The risk of getting tendon problems while you take ciprofloxacin extended-release tablets is higher if you:
- Are over 60 years of age
- Are taking steroids (corticosteroids)
- Have had a kidney, heart or lung transplant
- Tendon problems can happen in people who do not have the above risk factors when they take ciprofloxacin. Other reasons that can increase your risk of tendon problems can include:
- Physical activity or exercise
- Kidney failure
- Tendon problems in the past, such as in people with rheumatoid arthritis (RA)
- Call your healthcare provider right away at the first sign of tendon pain, swelling or inflammation. Stop taking ciprofloxacin extended-release tablets until tendinitis or tendon rupture has been ruled out by your healthcare provider. Avoid exercise and using the affected area. The most common area of pain and swelling is the Achilles tendon at the back of your ankle. This can also happen with other tendons.
- Talk to your healthcare provider about the risk of tendon rupture with continued use of ciprofloxacin extended-release tablets. You may need a different antibiotic that is not a fluoroquinolone to treat your infection.
- Tendon rupture can happen while you are taking or after you have finished taking ciprofloxacin extended-release tablets. Tendon ruptures have happened up to several months after patients have finished taking their fluoroquinolone.
- Get medical help right away if you get any of the following signs or symptoms of a tendon rupture:
- Hear or feel a snap or pop in a tendon area
- Bruising right after an injury in a tendon area
- Unable to move the affected area or bear weight
2. Worsening of myasthenia gravis (a disease which causes muscle weakness). Fluoroquinolones like ciprofloxacin extended-release tablets may cause worsening of myasthenia gravis symptoms, including muscle weakness and breathing problems. Call your healthcare provider right away if you have any worsening muscle weakness or breathing problems.
See the section “What are the possible side effects of ciprofloxacin extended-release tablets?” for more information about side effects.
Ciprofloxacin extended-release tablets are a fluoroquinolone antibiotic medicine used to treat certain infections caused by certain germs called bacteria.
It is not known if ciprofloxacin extended-release tablets are safe and works in children under 18 years of age.
Sometimes infections are caused by viruses rather than by bacteria. Examples include viral infections in the sinuses and lungs, such as the common cold or flu. Antibiotics, including ciprofloxacin, do not kill viruses.
Call your healthcare provider if you think your condition is not getting better while you are taking ciprofloxacin extended-release tablets.
Do not take ciprofloxacin extended-release tablets if you:
- Have ever had a severe allergic reaction to an antibiotic known as a fluoroquinolone, or are allergic to any of the ingredients in ciprofloxacin extended-release tablets. Ask your healthcare provider if you are not sure. See the list of ingredients in ciprofloxacin extended-release tablets at the end of this Medication Guide.
- Also take a medicine called tizanidine (Zanaflex®). Serious side effects from
tizanidine are likely to happen.
What should I tell my healthcare provider before taking ciprofloxacin extended-release tablets?
See “What is the most important information I should know about ciprofloxacin?”
Tell your healthcare provider about all your medical conditions, including if you:
- Have tendon problems.
- Have a disease that causes muscle weakness (myasthenia gravis).
- Have central nervous system problems (such as epilepsy).
- Have nerve problems.
- Have or anyone in your family has an irregular heartbeat, especially a condition called “QT prolongation”.
- Have a history of seizures.
- Have kidney problems. You may need a lower dose of ciprofloxacin extended-release tablets if your kidneys do not work well.
- Have rheumatoid arthritis (RA) or other history of joint problems.
- Have trouble swallowing pills.
- Are pregnant or planning to become pregnant. It is not known if ciprofloxacin extended-release tablets will harm your unborn child.
- Are breast-feeding or planning to breast-feed. Ciprofloxacin passes into breast milk. You and your healthcare provider should decide whether you will take ciprofloxacin extended-release tablets or breast-feed.
Tell your healthcare provider about all the medicines you take , including prescription and non-prescription medicines, vitamins and herbal and dietary supplements. Ciprofloxacin extended-release tablets and other medicines can affect each other causing side effects. Especially tell your healthcare provider if you take:
- An NSAID (Non-Steroidal Anti-Inflammatory Drug). Many common medicines for pain relief are NSAIDs. Taking an NSAID while you take ciprofloxacin extended-release tablets or other fluoroquinolones may increase your risk of central nervous system effects and seizures. See “What are the possible side effects of ciprofloxacin extended-release tablets?. ”
- A blood thinner (such as warfarin, Coumadin® , Jantoven®).
- Tizanidine (Zanaflex®). You should not take ciprofloxacin extended-release tablets if you are already taking tizanidine. See “Who should not take ciprofloxacin extended-release tablets?”
- Theophylline (such as Theo-24® , Elixophyllin® , Theochron® , Uniphyl® , Theolair®).
- Glyburide (Micronase® , Glynase® , Diabeta® , Glucovance®). See “What are the possible side effects of ciprofloxacin extended-release tablets? ”.
- Phenytoin (Fosphenytoin Sodium® , Cerebyx® , Dilantin-125® , Dilantin® , Extended Phenytoin Sodium® , Prompt Phenytoin Sodium® , Phenytek®).
- Products that contain caffeine.
- A medicine to control your heart rate or rhythm (antiarrhythmics) See “What are the possible side effects of ciprofloxacin extended-release tablets? ”
- An anti-psychotic medicine.
- A tricyclic antidepressant.
- A water pill (diuretic).
- A steroid medicine. Corticosteroids taken by mouth or by injection may increase the chance of tendon injury. See “What is the most important information I should know about ciprofloxacin? ”.
- Methotrexate (Trexall®).
- Probenecid (Probalan® , Col-probenecid®).
- Metoclopromide (Reglan® , Reglan ODT®).
- Ropinirole (Requip®).
- Lidocaine (Xylocaine® intravenous infusion).
- Clozapine (Clozaril® , Fazaclo® ODT®).
- Pentoxifylline (Trental®).
- Sildenafil (Viagra® , Revatio®).
- Cyclosporine (Gengraf® , Neoral® , Sandimmune® , Sangcya®).
- Certain medicines may keep Ciprofloxacin Tablets, Ciprofloxacin Oral Suspension from working correctly. Take Ciprofloxacin Tablets and Oral Suspension either 2 hours before or 6 hours after taking these products:
- An antacid, multivitamin, or other product that has magnesium, calcium, aluminum, iron, or zinc.
- Sucralfate (Carafate®).
- Didanosine (Videx® , Videx EC®).
Ask your healthcare provider if you are not sure if any of your medicines are listed above.
Know the medicines you take. Keep a list of your medicines and show it to your healthcare provider and pharmacist when you get a new medicine.
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