Generic Name: ciprofloxacin lactate
Product Name: Ciproxin IV
Indication: What Ciproxin IV is used for
Ciproxin IV is used to treat serious infections in the lungs, skin, blood, bone, joints, kidneys, and bowel. Ciproxin IV is also used to treat inhalational anthrax (an infection caused by breathing in the spores of bacteria).
Ciproxin IV is used in hospitalised patients where the use of Ciproxin tablets is inappropriate.
Ciproxin IV will not work against infections caused by viruses such as colds or the flu.
Ask your doctor if you have any questions about why this medicine has been prescribed for you. Your doctor may have prescribed it for another reason.
Action: How Ciproxin IV works
Ciproxin IV contains the active ingredient, ciprofloxacin, which is an antibiotic belonging to a group of medicines called quinolones. These antibiotics work by killing the bacteria that are causing your infection.
Ciprofloxacin has in vitro and in vivo activity against a wide range of Gram-negative and Gram-positive organisms. The bactericidal action of ciprofloxacin appears to result from interference with the enzyme, DNA gyrase.
- Escherichia coli;
- Klebsiella species (including Klebsiella pneumoniae and Klebsiella oxytoca);
- Enterobacter species;
- Citrobacter species;
- Salmonella species;
- Shigella species;
- Proteus mirabilis;
- Proteus vulgaris;
- Providencia stuartii;
- Providencia rettgeri (formerly Proteus rettgeri);
- Morganella morganii (formerly Proteus morganii);
- Serratia species (including Serratia marcescens);
- Pseudomonas aeruginosa;
- Pseudomonas fluorescens;
- Haemophilus influenzae;
- Moraxella (Branhamella) catarrhalis;
- Campylobacter species.
- Staphylococcus aureus (including methicillin susceptible and methicillin-resistant strains);
- coagulase negative Staphylococcus species (including Staphylococcus epidermidis);
- Streptococcus pyogenes (group A);
- Streptococcus pneumoniae;
- Enterococcus faecalis.
- Gram-positive organisms and Pseudomonas aeruginosa are generally less sensitive to ciprofloxacin than other Gram-negative organisms which results in lower medicine efficacy rates;
- Most strains of streptococci are only moderately susceptible to ciprofloxacin. Clinical studies have shown the medicine to be effective for urinary tract infections caused by Enterococcus faecalis. Although bronchial infections caused by Streptococcus pneumoniae and skin infections caused by Streptococcus pyogenes have been shown to respond to ciprofloxacin, it is not the medicine of first choice in such infections, particularly Streptococcus pneumoniae infection of the lower respiratory tract;
- Most strains of Burkholderia cepacia and many strains of Stenotrophomonas maltophilia are resistant to ciprofloxacin as are most anaerobic bacteria, including Bacteroides fragilis and Clostridium difficile;
- Enterococcus faecium, Ureaplasma urealyticum and Nocardia asteroides are generally resistant. Ciprofloxacin is ineffective against Treponema pallidum;
- The in vitro MIC of several strains of Serratia approaches or exceeds the peak plasma concentrations with the recommended doses of ciprofloxacin.
Ciproxin IV 100 contains 100 mg of the active ingredient ciprofloxacin (as lactate)/50 mL vial. Ciproxin IV 200 contains 200 mg of the active ingredient ciprofloxacin (as lactate)/100 mL vial.
It also contains the inactive ingredients lactic acid, sodium chloride, water for injection, and small amounts of hydrochloric acid to adjust the acidity of the solution.
Dose advice: How to use Ciproxin IV
Before you are given Ciproxin IV
When you must not be given it
You must not be given Ciproxin IV if you have an allergy to:
- Ciprofloxacin, the active ingredient in Ciproxin IV;
- Any of the ingredients listed here;
- Other medicines belonging to the quinolone chemical family (e.g. moxifloxacin, norfloxacin, nalidixic acid).
Some of the symptoms of an allergic reaction may include:
- Shortness of breath;
- Wheezing or difficulty breathing;
- Swelling of the face, lips, tongue or other parts of the body;
- Rash, itching or hives on the skin.
Do not use Ciproxin IV if you are also taking a medicine called tizanidine, a muscle relaxant used to treat spasticity associated with multiple sclerosis, injury or diseases of the spinal cord). Ciproxin IV can interfere with tizanidine and can lead to undesirable side effects.
Do not use this medicine after the expiry date printed on the pack and vial. The expiry date is printed on the carton and on each vial after “EXP” (e.g. 11 13 refers to November 2013). The expiry date refers to the last day of that month. If it has expired return it to the pharmacist for disposal.
Do not take this medicine if the packaging is torn or shows signs of tampering. If the packaging is damaged, return it to your pharmacist for disposal.
The contents of the vial are not to be used if it is cloudy or has little specks in it. If you are not sure whether you should be given this medicine, talk to your doctor.
Before you are given it
Tell your doctor if you have allergies to any other medicines, foods, preservatives or dyes.
Tell your doctor if you are pregnant or plan to become pregnant. Ciproxin IV is not recommended if you are pregnant but your doctor will assess the benefit if required. Medicines similar to Ciproxin IV have caused joint disease in immature animals.
Tell your doctor if you are breastfeeding. Ciproxin is excreted into the breast milk. Your doctor will tell you whether you should take it and temporarily stop breastfeeding while you are receiving Ciproxin IV.
Ciproxin IV is not recommended for children under 18 years of age except for use in inhalational anthrax.
Ciproxin IV should be used with caution in elderly patients as they are more prone to side effects.
Tell your doctor if you:
- Suffer from epilepsy (seizures, convulsions), have had a stroke, or have kidney or liver disease;
- Have arrhythmias (fast or irregular heartbeats). Ciproxin IV may increase the risk of arrhythmias, especially in the elderly or patients with low potassium levels;
- Have previously taken corticosteroids. You may be at increased risk of swelling of the tendons. Symptoms include pain, tenderness and sometimes restricted movement;
- Have congestive heart failure, renal failure, nephrotic syndrome. Sodium intake may be of medical concern and the additional sodium load from using Ciproxin IV should be taken into account;
- Have myasthenia gravis, a condition where the muscles become weak. Ciproxin IV can worsen the symptoms of this condition;
- Have a history of tendon disorders with the use of quinolones (e.g. moxifloxacin, norfloxacin, nalidixic acid).
If you have not told your doctor or pharmacist about any of the above, tell them before you are given Ciproxin IV.
Taking other medicines
Tell your doctor or pharmacist if you are taking any other medicines, including any that you get without a prescription from your pharmacy, supermarket or health food shop.
Some medicines may be affected by Ciproxin IV. These include:
- Medicines used to treat arrhythmias (fast or irregular heartbeats);
- Theophylline, a medicine used to treat asthma;
- Oral anticoagulants, warfarin and its derivatives, medicines used to stop blood clots;
- Phenytoin, a medicine used to treat epilepsy;
- Oral antidiabetic agents cyclosporin, a medicine used to suppress the immune system;
- Non-steroidal anti-inflammatory drugs (NSAIDs), medicines used to treat pain, arthritis and other inflammatory conditions;
- Methotrexate, a medicine used to treat certain types of cancers, severe psoriasis or severe rheumatoid arthritis;
- Duloxetine, a medicine used to treat depression, anxiety, and nerve pain in people with diabetes;
- Clozapine, a medicine used to treat schizophrenia;
- Ropinirole, a medicine used to treat Parkinson’s disease or restless legs syndrome;
- The local anaesthetic lidocaine, a medicine used to numb pain or cause loss of sensation;
- Oxpentifylline, a medicine used to treat circulation disorders;
- Sildenafil, a medicine used to treat erectile dysfunction;
- Agomelatine, a medicine used to treat depression;
- Zolpidem, a medicine used to treat sleep disorders.
These medicines may be affected by Ciproxin IV or may affect how well it works. You may need different amounts of your medicine, or you may need to take different medicines.
Some medicines may interfere with Ciproxin IV. These include:
- Probenecid, a medicine used to treat gout;
- Omeprazole, a medicine used to treat stomach ulcers and other conditions where the stomach produces too much acid.
You can still take these medicines while you are receiving Ciproxin IV. However, you must use Ciproxin IV at least 2 hours before or 2 hours after taking any of these medicines.
Your doctor and pharmacist have more information on medicines to be careful with or avoid while receiving this medicine.
How Ciproxin IV is given
Ciproxin IV is given as a slow injection into a vein over a period of 60 minutes, usually as a drip, by a doctor or a nurse.
How much to receive
This depends on your condition and will be decided by your doctor. The usual adult dose is 200-300 mg twice a day for one to two weeks. Normally your doctor will put you on antibiotic tablets as soon as possible; but for difficult infections, longer intravenous therapy may be required.
If you have not been given the next dose, tell the doctor or nurse on duty as soon as possible.
If you are given too much (overdose)
Immediately tell your doctor or nurse on duty or telephone your doctor, or the Poisons Information Centre (telephone in Australia 13 11 26, in New Zealand 0800 POISON or 0800 764 766), or go to the Accident and Emergency department at your nearest hospital, if you think you or anyone else may have received too much Ciproxin IV. Do this even if there are no signs of discomfort or poisoning. You may need urgent medical attention.
While you are receiving Ciproxin IV
Things you must do
Tell all doctors, dentists, nurses and pharmacists who are treating you that you are receiving Ciproxin IV.
Tell your doctor if you need to have a surgical or dental procedure that you are receiving Ciproxin IV.
The use of Ciproxin IV may affect the results of certain laboratory tests. If you are about to have any tests, tell your doctor that you are receiving this medicine.
If you are about to be started on any new medicine, remind your doctor and pharmacist that you are receiving Ciproxin IV.
Drink plenty of water while you are receiving Ciproxin IV. This helps to stop crystals forming in your urine.
If you become pregnant while you are taking Ciproxin IV, tell your doctor immediately.
If you develop diarrhoea, tell your doctor or pharmacist immediately – even after you have stopped receiving Ciproxin IV. Diarrhoea may mean that you have a serious condition affecting your bowel. You may need urgent medical care. Do not take any medications for diarrhoea without first checking with your doctor or pharmacist.
Tell your doctor immediately if you experience symptoms of depression or self-endangering behaviour. Ciproxin IV should be discontinued immediately.
Tell your doctor immediately if you develop pain, burning, tingling, numbness or weakness in any part of the body. Ciproxin IV should be discontinued immediately.
Things you must not do
Do not give Ciproxin IV to anyone else, even if they have the same condition as you.
Do not use Ciproxin IV to treat other conditions unless your doctor tells you to.
Do not stop using Ciproxin IV because you are feeling better unless your doctor told you to do so. If you do not complete the full course prescribed by your doctor, some of the bacteria causing your infection may not be killed. These bacteria may continue to grow and multiply so that your infection may not clear up completely or it may return.
What to be careful of
Avoid excessive exposure to direct sunlight. Your skin may become more prone to sunburn. If such a reaction occurs, tell your doctor,
Be careful driving or operating machinery until you know how Ciproxin IV affects you. Ciproxin IV may cause dizziness in some patients, especially after the first few doses. Your ability to drive and/or operate machinery may be impaired. If you drink alcohol while using this medicine, dizziness may be worse.
Ciproxin IV may increase the stimulatory effects of caffeine.
After receiving Ciproxin IV
When treatment is to be stopped, your prescribing doctor may need to alter the dose of other medicine(s) accordingly and monitor your condition.
Each vial of Ciproxin IV is to be used once only. Any unused portion remaining in the vial must be discarded.
Ciproxin IV will be stored in the pharmacy or on the ward. The vial should not be stored in the refrigerator.
Keep your medicine in the carton until it is time to use them. If you take the vial out of the box they may not keep well.
Keep your medicine in a cool, dry place (away from sunlight) where the temperature stays below 30°C. Do not store Ciproxin IV or any other medicine in the bathroom, near a sink, or on a window sill. Do not leave it in the car. Heat and damp can destroy some medicines.
Keep the medicine where children cannot reach them. A locked cupboard at least one and a half metres above the ground is a good place to store medicines.
If your doctor tells you to stop taking Ciproxin IV or your medicine has passed their expiry date, ask your pharmacist what to do with any that are left over. Return any unused medicine to your pharmacist.
Schedule of Ciproxin IV
Ciproxin IV is a Schedule 4 (prescription only) medicine.
Side effects of Ciproxin IV
Tell your doctor or nurse as soon as possible if you do not feel well while you are receiving Ciproxin IV. All medicines have unwanted side effects. Sometimes they are serious, most of the time they are not. In serious cases, you may need medical attention.
Ciproxin IV is usually well tolerated.
Do not be alarmed by the following lists of side effects. You may not experience any of them. Ask your doctor to answer any questions you may have.
Ciproxin IV can cause redness, pain, and inflammation at the injection site.
Vomiting and rash were common in patients switching from Ciproxin IV to Ciproxin tablets.
Tell your doctor if you notice any of the following and they worry you:
These are the common side effects of Ciproxin IV. They are usually mild and short-lived.
Tell your doctor immediately, or go to the Accident and Emergency department at your nearest hospital if you notice any of the following:
- Severe skin rashes, peeling of the skin and/or mucosal reactions;
- Signs of allergy such as rash, swelling of the face, lips, mouth, throat or other parts of the body, shortness of breath, wheezing or trouble breathing;
- Yellowing of the skin and eyes also called jaundice;
- Severe watery or bloody diarrhoea, even if it occurs several weeks after receiving Ciproxin IV;
- Fits (seizures, convulsions);
- Confusion, nightmares, hallucinations, and psychotic reaction (even progressing to self-endangering behaviour);
- Fast or irregular heartbeats;
- Visual disturbances (eyesight problems);
- Ringing in the ear, loss of hearing;
- Abdominal pain/cramps. Very rarely this can progress to a serious condition accompanied by fever and fatigue;
- Pain, burning, tingling, numbness and/or weakness in your limbs.
These serious side effects are rare. If you have them, you may need urgent medical attention.
Photosensitivity (getting sunburnt very easily) can occasionally occur with Ciproxin IV. However, it is temporary and staying out of direct sunlight while on Ciproxin IV will prevent it from happening.
Rarely, there can be a worsening of the symptoms of myasthenia gravis. This is a condition in which the muscles become weak and tire easily, causing drooping eyelids, double vision, difficulty in speaking and swallowing and sometimes muscle weakness in the arms or legs.
Rarely, the Achilles tendon (extending from the calf to the heel of the foot) or other tendons have been torn after Ciproxin IV therapy. Tell your doctor immediately if you feel any discomfort, pain, inflammation of a tendon.
Rarely, you may experience hyperglycaemia (high blood sugar) or hypoglycaemia (low blood sugar). Symptoms of hyperglycaemia include increased thirst, appetite and urination. Symptoms of hypoglycaemia include weakness, shaking, sweating, lightheadedness, headache, behavioural changes, confusion, numbness/pins and needles in the lips, fingers or toes, irritability and hunger. Tell your doctor if you experience these symptoms.
If you experience any of these symptoms during the treatment with Ciproxin IV, tell your doctor, nurse or pharmacist immediately. Ciproxin IV may need to be discontinued.
Tell your doctor, pharmacist or nurse if you notice anything that is making you feel unwell. Other side effects not listed above may also occur in some patients.
For further information talk to your doctor.