What are the risks of taking ciprofloxacin (Cipro)?
| Ciprofloxacin can cause serious health problems, especially in certain high-risk patients. Talk to your healthcare professionals if these are a concern for you. Other risks of ciprofloxacin (Cipro) use include:
- TENDINITIS AND TENDON RUPTURE: Fluoroquinolone antibiotics, including ciprofloxacin, can cause tendinitis and tendon rupture (inflammation and tearing of tendons). While this most commonly occurs in the Achilles tendon in the heel of the foot, it can happen anywhere in the body. The damage to tendons can occur within a few hours of the first dose or several months after you stop taking ciprofloxacin. Risk factors for these adverse reactions include age over 60, doing high-intensity physical activity, taking steroid medications, and having other tendon-related problems. Stop taking ciprofloxacin and tell your doctor right away if you experience pain or swelling in the tendons, muscles, or joints.
- SEVERE DIARRHEA: All antibiotics, including ciprofloxacin, can cause severe diarrhea. This can occur because antibiotics kill the good bacteria in the gut. Rarely, diarrhea caused by a bacteria called Clostridium difficile (C. diff) can lead to severe and potentially life-threatening dehydration. C. diff infections are very contagious. If someone in your household has this infection, they should wash their hands frequently and thoroughly and use a different bathroom from everyone else until the infection clears. The risk of C. diff is higher in people over 65, those taking multiple antibiotics or on long-term treatment with antibiotics, and people with a weak immune system. Taking probiotic supplements during ciprofloxacin treatment can help prevent this complication.
- LIVER DAMAGE: In a very small number of people, ciprofloxacin can cause potentially life-threatening damage to the liver. The risk of this occurring is greater in people over the age of 55 or those with pre-existing liver problems. The liver damage can occur after just one dose of ciprofloxacin tablets or suspension. Contact your doctor immediately if you have yellowing of the skin or eyes, nausea, vomiting, stomach pain, pale stools, or dark urine. Your doctor may order blood tests to check your liver function.
- ALLERGIC REACTIONS: Fluoroquinolone antibiotics like ciprofloxacin can cause severe allergic reactions, including serious and fatal reactions like anaphylaxis and Stevens-Johnson syndrome. If you get rash, hives, painful blisters on the body, swelling of the face, lips, mouth, or throat, and/or difficulty breathing or swallowing, call 911 immediately. Tell your doctor if you have an allergy to fluoroquinolone or quinolone antibiotics before starting ciprofloxacin treatment.
- NERVOUS SYSTEM AND PSYCHIATRIC ISSUES: Fluoroquinolone antibiotics like ciprofloxacin can increase the risk of developing nervous system problems. These adverse reactions can occur after just one dose of ciprofloxacin. Symptoms can include numbness, tingling, burning (peripheral neuropathy symptoms), weakness, and pain. These are present most commonly in the hands and feet. Ciprofloxacin can also affect the brain and cause tremors (uncontrolled shaking) or seizures (convulsions). This medicine can cause mental health symptoms including hallucinations (seeing or hearing things that are not there), psychosis (losing touch with reality), anxiety, depression, sleep problems, nightmares, and memory problems. Stop taking ciprofloxacin and contact your doctor immediately if you notice any such symptoms. The risk of these adverse reactions is higher in people with a history of seizures, brain disease, nerve problems, mental health conditions, and kidney disease.
- INJURY TO BLOOD VESSELS: In rare instances, ciprofloxacin can cause injury to the aorta, the large artery that carries blood from the heart to the rest of the body. This can lead to problems like aortic aneurysm and aortic dissection, which are life-threatening conditions. This can occur several weeks after you stop taking ciprofloxacin. Tell your doctor if you have a history of aortic aneurysms. Also, tell your doctor if taking a fluoroquinolone antibiotic in the past gave you sudden pain in the back, chest, or abdomen. If you get sudden pain that is severe and unrelenting while on ciprofloxacin, call 911 or go to the nearest emergency room immediately.
- QT PROLONGATION (HEART RHYTHM PROBLEM): Very rarely, ciprofloxacin can cause prolonged QT interval, a serious heart rhythm problem that can stop the heart. The risk of this occurring is higher in people with certain heart conditions and those over the age of 65. Other drugs can cause QT prolongation too. Tell your doctor if you have any heart problems before starting treatment with ciprofloxacin.
- WORSENING MYASTHENIA GRAVIS: People who have a neuromuscular condition called myasthenia gravis may experience worsening symptoms like muscle weakness or breathing difficulty while on ciprofloxacin. This can be life-threatening in rare cases. Talk to your doctor about which medications are safe for you if you have a history of myasthenia gravis.
- THEOPHYLLINE INTERACTION: If you are taking theophylline, a medication used to treat breathing problems, you should know that concurrent administration of ciprofloxacin can cause theophylline levels to build up in your body. This can cause adverse reactions like nausea, vomiting, shakiness, and life-threatening heart attacks, breathing difficulty, or seizures. If you are on theophylline, tell your doctor before starting ciprofloxacin. They may choose another antibiotic for you or check your theophylline levels during antibiotic treatment.
- CHANGES IN BLOOD SUGAR LEVELS: Ciprofloxacin can cause fluctuations in blood sugar levels (high or low blood sugar). The risk is especially high in people who take oral medications or insulin to control blood glucose. If you have diabetes, your doctor may ask you to check your blood sugar more frequently while on ciprofloxacin.
- MUSCULOSKELETAL PROBLEMS IN CHILDREN: Ciprofloxacin is not the first choice among antibiotics in children. It is reserved for serious infections like plague and anthrax. This is because ciprofloxacin can cause musculoskeletal problems in children (problems with the muscles, bones, and joints). Talk to your child’s doctor about the best antibiotic to treat an infection in your child.
- SUNBURNS: Ciprofloxacin can make your skin more sensitive to the sun and cause you to get sunburned more easily. Be sure to use sunscreen and wear protective clothing outdoors, including on cloudy or overcast days. Avoid tanning beds while on this antibiotic. If you notice your skin is red or sunburned, stop taking ciprofloxacin and call your doctor.
- URINE CRYSTALS: In rare instances, ciprofloxacin can form crystals in the urine. Tell your doctor if you take medications that make the urine less acidic, like acetazolamide or sodium bicarbonate. Drink plenty of water and stay well hydrated during ciprofloxacin treatment to reduce this risk.
- ANTIBIOTIC RESISTANCE: Antibiotics are only effective against bacterial infections. Taking ciprofloxacin or other antibiotics when they are unnecessary or ineffective, for example, to treat viral infections, can lead to antibiotic resistance in bacteria. This can make it much harder to cure bacterial infections in the future.
Speak to your doctor or pharmacist about other treatment options if you are at high risk for the above complications.
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What should I tell my doctor before starting ciprofloxacin (Cipro)?
Tell your doctor if you have an allergy to ciprofloxacin or any other fluoroquinolone or quinolone antibiotics (examples include Factive, Baxdela, Levaquin, Avelox, and others). Also, tell your doctor if you are allergic to any of the active or inactive ingredients in ciprofloxacin tablets or oral suspension. Your pharmacist can give you a list of ingredients.
Give your doctor a complete list of your medications, including prescription drugs, over-the-counter medicines, dietary supplements, vitamins, and herbal/natural products. This can help avoid serious drug interactions.
Tell your doctor about all your medical conditions. Ciprofloxacin may not be right for people with certain health conditions. Tell your doctor if you or someone in your family has prolonged QT intervals. Also, tell your doctor if you have heart rhythm abnormalities, heart failure, aortic aneurysm, high blood pressure, poor circulation, Ehlers-Danlos syndrome, Marfan syndrome, low magnesium or potassium levels, diabetes, kidney disease, or liver disease.
Tell your doctor if you are pregnant, could be pregnant, or plan to become pregnant. Also, tell your doctor if you are breastfeeding or plan to breastfeed.
What precautions should I take while on ciprofloxacin (Cipro)?
Keep all your appointments with your healthcare provider. Your doctor may want to adjust the dosage or check blood tests to see if your infection has cleared and to keep an eye on your overall health.
Tell your doctor if you become pregnant while on ciprofloxacin.
Do not drive a car, operate heavy machinery, or do anything that requires focus and attention until you know how ciprofloxacin affects you.
Avoid prolonged sun exposure and tanning beds while taking ciprofloxacin. Wear protective clothing and sunscreen when you step outdoors. Call your doctor if you develop skin redness and swelling like a bad sunburn while on ciprofloxacin.
You should not take ciprofloxacin with only dairy products or calcium-fortified foods. You can, however, take this antibiotic with a meal that contains these foods. Take oral ciprofloxacin at least 2 hours before or 6 hours after other drugs such as antacids (Mylanta, Maalox, Tums); zinc, iron, or calcium supplements; didanosine (Videx); sucralfate (Carafate); lanthanum carbonate (Fosrenol); and sevelamer (Renvela, Renagel).
You should avoid caffeinated drinks like tea, coffee, colas, energy drinks, and chocolate while taking ciprofloxacin. Ciprofloxacin can worsen the nervousness, sleeplessness, pounding heart, and anxiety caused by caffeine. Drink plenty of water and fluids during ciprofloxacin treatment.
You will probably start to feel better after a few days of ciprofloxacin treatment. If you do not feel better or if your symptoms worsen, tell your doctor. Do not stop taking ciprofloxacin before you finish your prescription, even if your symptoms are gone. Skipping doses of an antibiotic or not finishing the prescribed course can lead to incomplete treatment of your infection and cause the bacteria to become resistant to antibiotics.
What are ciprofloxacin (Cipro) interactions?
Taking ciprofloxacin with certain medications can affect how the medicines work or increase the risk of severe adverse reactions. Your doctor or pharmacist may choose a different medication for you, change the dose or frequency of one or both medicines, and/or monitor you carefully for side effects if there are known drug interactions between ciprofloxacin and your other medicines.
Your doctor will advise you not to take ciprofloxacin if you are taking the following medications:
- Tizanidine (Zanaflex), which is a muscle relaxer
There can also be interactions between ciprofloxacin and the following medicines:
- Anticoagulants or blood thinners like warfarin (Coumadin, Jantoven)
Medications used to treat mental illnesses such as some antidepressants (Cymbalta) and antipsychotics (Clozaril, Zyprexa)
Some nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (Advil, Motrin, Aleve, Naprosyn)
Certain medicines used to treat irregular heartbeat (Pacerone, Norpace, Betapace, Sorine, Sotylize)
Ropinirole (Requip)
Diuretics or water pills
Antibiotics like azithromycin (Zithromax, Zmax), clarithromycin (Biaxin, in Prevpac), and erythromycin (Eryped, Eryc, E.E.S.)
Medications that contain caffeine (Vivarin, Excedrin)
Phenytoin (Dilantin, Phenytek)
Pentoxifylline (Pentoxil)
Sildenafil (Viagra, Revatio)
Cyclosporine (Neoral, Gengraf, Sandimmune)
Insulin and oral medications used to treat diabetes (Amaryl, Glucotrol, DiaBeta)
Tolazamide and tolbutamide
Methotrexate (Trexall, Rasuvo, Otrexup)
Probenecid (Probalan)
Zolpidem (Ambien)
Theophylline (Theo-24, Elixophyllin, Uniphyl)
This list does not describe all possible ciprofloxacin interactions. Give your doctor or pharmacist a complete list of your medications, including prescription drugs, over-the-counter medicines, dietary supplements, vitamins, and natural or herbal products. Also tell your doctor or pharmacist if you smoke cigarettes, drink alcohol, or use illegal drugs because some of these substances can cause serious health complications when used with prescription medications.
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