Dienstag, 20. Februar 2007

Buy Cipro(Ciprofloxacin) - Cipro side effects - Cipro antibiotic

Ciprociprofloxacin (sip row FLOX a sin)Cipro, Cipro XR



What is the most important information I should know about Cipro?




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Do not take Cipro with dairy products such as milk or yogurt, or with calcium-fortified juice. You may eat or drink dairy products or calcium-fortified juice with a regular meal, but do not use them alone when taking Cipro. They could make the medication less effective.

Take all of the Cipro that has been prescribed for you even if you begin to feel better. Your symptoms may start to improve before the infection is completely treated.

Drink several extra glasses of fluid every day while taking Cipro. If you drink dairy products (milk, yogurt) or calcium-fortified juice, drink them with a meal and not when you are taking your Cipro dose.

Certain medicines should be taken at least 2 hours after or 6 hours before you take Cipro. This includes didanosine (Videx) chewable/buffered tablets or powder; sucralfate (Carafate); antacids that contain calcium, magnesium or aluminum (such as Tums or Rolaids); or vitamin or mineral supplements that contain calcium, iron, or zinc.

Taking Cipro can make your skin more sensitive to sunlight. Avoid exposure to sunlight, sun lamps, or tanning beds.

What is Cipro?




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Cipro is an antibiotic in a group of drugs called fluoroquinolones. Cipro fights bacteria in the body.

Cipro is used to treat different types of bacterial infections.

Cipro may also be used for purposes other than those listed here.
What should I discuss with my healthcare provider before taking Cipro?

Before taking Cipro, tell your doctor if you have:
·
a history of allergic reaction to an antibiotic;
·
joint problems;
·
kidney disease; or
·
epilepsy or seizures.

If you have any of these conditions, you may not be able to use Cipro or you may need a dosage adjustment or special tests during treatment.

FDA pregnancy category C: This medication may be harmful to an unborn baby. Do not use Cipro without telling your doctor if you are pregnant. Tell your doctor if you become pregnant during treatment.

Cipro passes into breast milk and may harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby.

How should I take Cipro?




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Take Cipro exactly as it was prescribed for you. Do not take it in larger doses or for longer than recommended by your doctor.

Take each dose with a full glass of water (8 ounces). Drink several extra glasses of fluid each day while you are taking Cipro.

Shake the oral suspension (liquid) for at least 15 seconds just before you measure a dose. To be sure you get the correct dose, measure the liquid with a marked measuring spoon or medicine cup, not with a regular table spoon. If you do not have a dose-measuring device, ask your pharmacist for one.

When taking the oral liquid, swallow it without chewing the medicine beads you may notice in the liquid.

Do not crush, chew or break the extended-release tablet. Swallow the pill whole. It is specially made to release medicine slowly in the body. Breaking the pill would cause too much of the drug to be released at one time.

Cipro may be taken with or without food, but take it at the same time each day.

Do not take Cipro with dairy products such as milk or yogurt, or with calcium-fortified juice. You may eat or drink these products as part of a regular meal, but do not use them alone when taking Cipro. They could make the medication less effective.

Take this medication for as many days as it has been prescribed for you even if you begin to feel better. Your symptoms may get better before the infection is completely treated. Cipro will not treat a viral infection such as the common cold or flu.

Store Cipro at room temperature away from moisture and heat. Do not allow the liquid medicine to freeze.

What happens if I miss a dose?




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Take the missed dose as soon as you remember. If it is almost time for your next dose, skip the missed dose and take the medicine at the next regularly scheduled time. Do not take extra medicine to make up the missed dose.
What happens if I overdose?

Seek emergency medical attention if you think you have used too much of this medicine.

Symptoms of a Cipro overdose may include seizures, urination problems, weakness, or blue lips with pale skin.

What should I avoid while taking Cipro?




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Avoid caffeine while you are taking Cipro, because the medication can make the effects of caffeine stronger.

Avoid prolonged exposure to sunlight, sunlamps, or tanning beds. Cipro make your skin more sensitive to sunlight, and a sunburn may result. Wear protective clothing and use a sunscreen if you must be out in the sun. Call your doctor if you have severe burning, redness, itching, rash, or swelling after being in the sun.

Antibiotic medicines can cause diarrhea, which may be a sign of a new infection. If you have diarrhea that is watery or has blood in it, call your doctor. Do not use any medicine to stop the diarrhea unless your doctor has told you to.

Cipro can cause side effects that may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be awake and alert.
What are the possible side effects of Cipro?

Stop using Cipro and get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

Stop using Cipro and call your doctor at once if you have any of these serious side effects:
·
seizure (black-out or convulsions);
·
confusion, hallucinations, depression, or thoughts of hurting yourself or others;
·
sudden pain or swelling near your joints (especially in your arm or ankle);
·
nausea, stomach pain, low fever, lost appetite, dark urine, clay-colored stools, jaundice (yellowing of the skin or eyes);
·
diarrhea that is watery or bloody;
·
urinating more or less than usual;
·
numbness, tingling, or unusual pain anywhere in your body; or
·
chest pain, pounding or fast heartbeats.

Other less serious side effects are more likely to occur, such as:
·
nausea, vomiting;
·
dizziness or drowsiness;
·
blurred vision;
·
sleep problems (insomnia);
·
joint stiffness or muscle pain; or
·
increased sensitivity of the skin to sunlight.

Side effects other than those listed here may also occur. Talk to your doctor about any side effect that seems unusual or that is especially bothersome.

What other drugs will affect Cipro?




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Do not use Cipro if you are also taking tizanidine (Zanaflex).

Certain medicines should be taken at least 2 hours after or 6 hours before you take Cipro. This includes didanosine (Videx) chewable/buffered tablets or powder; sucralfate (Carafate); antacids that contain calcium, magnesium or aluminum (such as Tums or Rolaids); or vitamin or mineral supplements that contain calcium, iron, or zinc.

Before taking Cipro, tell your doctor if you are taking any of the following drugs:
·
didanosine (Videx, ddI);
·
theophylline (Theo-Dur, Theolair, Slo-Phyllin, Slo-Bid, Elixophyllin);
·
warfarin (Coumadin);
·
probenecid (Benemid);
·
insulin or an oral diabetes medication such as glipizide (Glucotrol), glyburide (Micronase, Diabeta, Glynase), and others;
·
a nonsteroidal anti-inflammatory drug (NSAID) such as ibuprofen (Motrin, Advil, Nuprin, others), naproxen (Aleve, Naprosyn, Anaprox), ketoprofen (Orudis KT, Orudis, Oruvail), and others;
·
phenytoin (Dilantin); or
·
cyclosporine (Neoral, Sandimmune).

There may be other drugs not listed that can affect Cipro. Tell your doctor about all the prescription and over-the-counter medications you use. This includes vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start using a new medication without telling your doctor.

Where can I get more information?




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Your pharmacist has additional information about Cipro written for health professionals that you may read.

Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medicine only for the indication prescribed.

Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.


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CLINICAL PHARMACOLOGY CIPRO

CLINICAL PHARMACOLOGY CIPRO Absorption Following 60-minute intravenous infusions of 200 mg and 400 mg ciprofloxacin to normal volunteers, the mean maximum serum concentrations achieved were 2.1 and 4.6 µg/mL, respectively; the concentrations at 12 hours were 0.1 and 0.2 µg/mL, respectively. Steady-state Ciprofloxacin Serum Concentrations (µg/mL) After 60-minute I.V. Infusions q 12 h. Time after starting the infusion Dose 30 min. 1 hr 3 hr 6 hr 8 hr 12 hr 200 mg 1.7 2.1 0.6 0.3 0.2 0.1 400 mg 3.7 4.6 1.3 0.7 0.5 0.2 The pharmacokinetics of ciprofloxacin are linear over the dose range of 200 to 400 mg administered intravenously. Comparison of the pharmacokinetic parameters following the 1st and 5th I.V. dose on a q 12 h regimen indicates no evidence of drug accumulation. The absolute bioavailability of oral ciprofloxacin is within a range of 70–80% with no substantial loss by first pass metabolism. An intravenous infusion of 400-mg ciprofloxacin given over 60 minutes every 12 hours has been shown to produce an area under the serum concentration time curve (AUC) equivalent to that produced by a 500-mg oral dose given every 12 hours. An intravenous infusion of 400 mg ciprofloxacin given over 60 minutes every 8 hours has been shown to produce an AUC at steady-state equivalent to that produced by a 750-mg oral dose given every 12 hours. A 400-mg I.V. dose results in a Cmax similar to that observed with a 750-mg oral dose. An infusion of 200 mg ciprofloxacin given every 12 hours produces an AUC equivalent to that produced by a 250-mg oral dose given every 12 hours. Steady-state Pharmacokinetic Parameter Following Multiple Oral and I.V. Doses Parameters 500 mg q12h, P.O. 400 mg q12h, I.V. 750 mg q12h, P.O. 400 mg q8h, I.V. AUC (µg•hr/mL) 13.7 a 12.7 a 31.6 b 32.9 c Cmax (µg/mL) 2.97 4.56 3.59 4.07 a AUC0-12h b AUC 24h=AUC0-12h Ч 2 c AUC 24h=AUC0-8h Ч 3 Distribution After intravenous administration, ciprofloxacin is present in saliva, nasal and bronchial secretions, sputum, skin blister fluid, lymph, peritoneal fluid, bile, and prostatic secretions. It has also been detected in the lung, skin, fat, muscle, cartilage, and bone. Although the drug diffuses into cerebrospinal fluid (CSF), CSF concentrations are generally less than 10% of peak serum concentrations. Levels of the drug in the aqueous and vitreous chambers of the eye are lower than in serum. Metabolism After I.V. administration, three metabolites of ciprofloxacin have been identified in human urine which together account for approximately 10% of the intravenous dose. The binding of ciprofloxacin to serum proteins is 20 to 40%. Ciprofloxacin is an inhibitor of human cytochrome P450 1A2 (CYP1A2) mediated metabolism. Coadministration of ciprofloxacin with other drugs primarily metabolized by CYP1A2 results in increased plasma concentrations of these drugs and could lead to clinically significant adverse events of the coadministered drug (see CONTRAINDICATIONS; WARNINGS; PRECAUTIONS: Drug Interactions). Excretion The serum elimination half-life is approximately 5–6 hours and the total clearance is around 35 L/hr. After intravenous administration, approximately 50% to 70% of the dose is excreted in the urine as unchanged drug. Following a 200-mg I.V. dose, concentrations in the urine usually exceed 200 µg/mL 0–2 hours after dosing and are generally greater than 15 µg/mL 8–12 hours after dosing. Following a 400-mg I.V. dose, urine concentrations generally exceed 400 µg/mL 0–2 hours after dosing and are usually greater than 30 µg/mL 8–12 hours after dosing. The renal clearance is approximately 22 L/hr. The urinary excretion of ciprofloxacin is virtually complete by 24 hours after dosing. Although bile concentrations of ciprofloxacin are several fold higher than serum concentrations after intravenous dosing, only a small amount of the administered dose (< 1%) is recovered from the bile as unchanged drug. Approximately 15% of an I.V. dose is recovered from the feces within 5 days after dosing. Special Populations Pharmacokinetic studies of the oral (single dose) and intravenous (single and multiple dose) forms of ciprofloxacin indicate that plasma concentrations of ciprofloxacin are higher in elderly subjects (> 65 years) as compared to young adults. Although the Cmax is increased 16–40%, the increase in mean AUC is approximately 30%, and can be at least partially attributed to decreased renal clearance in the elderly. Elimination half-life is only slightly (~20%) prolonged in the elderly. These differences are not considered clinically significant. (See PRECAUTIONS: Geriatric Use.) In patients with reduced renal function, the half-life of ciprofloxacin is slightly prolonged and dosage adjustments may be required. (See DOSAGE AND ADMINISTRATION.) In preliminary studies in patients with stable chronic liver cirrhosis, no significant changes in ciprofloxacin pharmacokinetics have been observed. However, the kinetics of ciprofloxacin in patients with acute hepatic insufficiency have not been fully elucidated. Following a single oral dose of 10 mg/kg ciprofloxacin suspension to 16 children ranging in age from 4 months to 7 years, the mean Cmax was 2.4 µg/mL (range: 1.5 – 3.4 µg/mL) and the mean AUC was 9.2 µg*h/mL (range: 5.8 – 14.9 µg*h/mL). There was no apparent age-dependence, and no notable increase in Cmax or AUC upon multiple dosing (10 mg/kg TID). In children with severe sepsis who were given intravenous ciprofloxacin (10 mg/kg as a 1-hour infusion), the mean Cmax was 6.1 µg/mL (range: 4.6 – 8.3 µg/mL) in 10 children less than 1 year of age; and 7.2 µg/mL (range: 4.7 – 11.8 µg/mL) in 10 children between 1 and 5 years of age. The AUC values were 17.4 µg*h/mL (range: 11.8 – 32.0 µg*h/mL) and 16.5 µg*h/mL (range: 11.0 – 23.8 µg*h/mL) in the respective age groups. These values are within the range reported for adults at therapeutic doses. Based on population pharmacokinetic analysis of pediatric patients with various infections, the predicted mean half-life in children is approximately 4 - 5 hours, and the bioavailability of the oral suspension is approximately 60%. Drug-drug Interactions The potential for pharmacokinetic drug interactions between ciprofloxacin and theophylline, caffeine, cyclosporins, phenytoin, sulfonylurea glyburide, metronidazole, warfarin, probenecid, and piperacillin sodium has been evaluated. (See PRECAUTIONS: Drug Interactions.) MICROBIOLOGY Ciprofloxacin has in vitro activity against a wide range of gram-negative and gram-positive microorganisms. The bactericidal action of ciprofloxacin results from inhibition of the enzymes topoisomerase II (DNA gyrase) and topoisomerase IV, which are required for bacterial DNA replication, transcription, repair, and recombination. The mechanism of action of fluoroquinolones, including ciprofloxacin, is different from that of penicillins, cephalosporins, aminoglycosides, macrolides, and tetracyclines; therefore, microorganisms resistant to these classes of drugs may be susceptible to ciprofloxacin and other quinolones. There is no known cross-resistance between ciprofloxacin and other classes of antimicrobials. In vitro resistance to ciprofloxacin develops slowly by multiple step mutations. Ciprofloxacin is slightly less active when tested at acidic pH. The inoculum size has little effect when tested in vitro. The minimal bactericidal concentration (MBC) generally does not exceed the minimal inhibitory concentration (MIC) by more than a factor of 2. Ciprofloxacin has been shown to be active against most strains of the following microorganisms, both in vitro and in clinical infections as described in the INDICATIONS AND USAGE section of the package insert for CIPRO I.V. (ciprofloxacin for intravenous infusion).

PATIENT INFORMATION CIPRO

PATIENT INFORMATION CIPRO Patients should be advised: • that antibacterial drugs including CIPRO I.V. should only be used to treat bacterial infections. They do not treat viral infections (e.g., the common cold). When CIPRO I.V. is prescribed to treat a bacterial infection, patients should be told that although it is common to feel better early in the course of therapy, the medication should be taken exactly as directed. Skipping doses or not completing the full course of therapy may (1) decrease the effectiveness of the immediate treatment and (2) increase the likelihood that bacteria will develop resistance and will not be treatable by CIPRO I.V. or other antibacterial drugs in the future. • that ciprofloxacin may be associated with hypersensitivity reactions, even following a single dose, and to discontinue the drug at the first sign of a skin rash or other allergic reaction. • that ciprofloxacin may cause dizziness and lightheadedness; therefore, patients should know how they react to this drug before they operate an automobile or machinery or engage in activities requiring mental alertness or coordination. • that ciprofloxacin increase the effects of tizanidine (Zanaflex®). Patients should not use ciprofloxacin if they are already taking tizanidine. • that ciprofloxacin may increase the effects of theophylline and caffeine. There is a possibility of caffeine accumulation when products containing caffeine are consumed while taking ciprofloxacin. • that peripheral neuropathies have been associated with ciprofloxacin use. If symptoms of peripheral neuropathy including pain, burning, tingling, numbness and/or weakness develop, they should discontinue treatment and contact their physicians. • to discontinue treatment; rest and refrain from exercise; and inform their physician if they experience pain, inflammation, or rupture of a tendon. • that convulsions have been reported in patients taking quinolones, including ciprofloxacin, and to notify their physician before taking this drug if there is a history of this condition. • that ciprofloxacin has been associated with an increased rate of adverse events involving joints and surrounding tissue structures (like tendons) in pediatric patients (less than 18 years of age). Parents should inform their child’s physician if the child has a history of joint-related problems before taking this drug. Parents of pediatric patients should also notify their child’s physician of any joint-related problems that occur during or following ciprofloxacin therapy. (See WARNINGS, PRECAUTIONS, Pediatric Use and ADVERSE REACTIONS.)

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