Ciprofloxacin adverse effects

L E. Quinidine. These are the classic signs of cinchon-ism and are adverse effects of quinidine and quinine, constituents of the cinchona tree. Some of these effects could be seen as toxic effects of phenytoin. However, auditory acuity is associated with cinchonism and not with phenytoin toxicity. Nausea but not the other effects could be associated with ciprofloxacin. Excessive drowsiness would be expected if diazepam were involved. These effects would not be expected with the estrogen replacement therapy. 

PENTOXIFYLLINE ANTIBIOTICS Ciprofloxacin may t pentoxifylline levels Uncertain likely to be due to inhibition of hepatic metabolism Warn patients of the possibility of adverse effects of pentoxifylline... 

When ciprofloxacin is used in either form, a white corneal precipitate may develop in patients.This deposit, which is actually ciprofloxacin in precipitate, usually occurs at the ulcer site from 1 to 7 days after initiating treatment. Its presence makes it more difficult to evaluate the corneal ulcer and may decrease the patient s visual acuity. Anecdotal information suggests that this decrease in visual acuity may be severe enough for alternative pharmacotherapy to be chosen in a monocular patient. The white precipitate may disappear spontaneously even with continued treatment and resolves without adverse effect once ciprofloxacin therapy is discontinued. 

Corticosteroids are commonly prescribed for moderate to severe Crohn s disease with short term efficacy probably related to their effect on inflammation. Anti-bacterials are commonly used as primary therapy in Crohn s disease. Common adverse effects of metronidazole are nausea and a metallic taste, hov ever peripheral neuropathy may result from long term use. Ciprofloxacin and similar antibacterials can be beneficial in those patients intolerant to mefi onidazole. 

In contrast to ulcerative colitis, about 50% of patients with Crohn s colitis will respond to metronidazole given for up to 3 months, although adverse effects including alcohol intolerance, and peripheral neuropathy from such prolonged therapy often limit its use. The drug is also helpful in controlling perianal and small bowel disease and it decreases the incidence of anastamotic recurrence after surgery. Other antimicrobials, particularly ciprofloxacin may also be effective. 

In 75 children with typhoid fever, aged under 6 years (mean age 32 months), ciprofloxacin had no adverse effects on growth or joints (54). In another study only 2 of 219 children treated with ciprofloxacin developed arthropathy, in one case transiently (55). In a necropsy study on children treated with ciprofloxacin 20 0 mg/kg/day for an average of 148 days, there were no chondrotoxic effects however, synovial membranes showed signs of subacute synovitis, which had not been noted in life (56). 

In a Russian study of children with cystic fibrosis, the adverse effects of ciprofloxacin were chiefly gastrointestinal (nausea, stomach pain, diarrhea) and increased transaminase activity (63). One episode of arthrotoxicity was transient. There were no negative effects on growth and no chondrotoxicity. 

The withdrawal of temafloxacin in 1992, only 6 months after its introduction, followed the observation of serious adverse events that were labeled the temafloxacin syndrome (8). Adverse effects, including hemolysis, renal dysfunction, coagulopathy, and hepatic dysfunction, were estimated to occur in one in 3500 patients. For comparison, incidence rates for these adverse events were about one in 17 000 patients treated with ciprofloxacin and one in 33 000 patients treated with ofloxacin. 

Using electron spin resonance spectroscopy and spin trapping, ciprofloxacin has been shown to cause free radical production in a dose- and time-dependent manner the authors suggested that this effect may contribute to drug-related adverse effects, including phototoxicity and cartilage defects (20). 

Ciprofloxacin, an inhibitor of CYP1A2, the major enzyme whereby ropinirole is metabolized, increased the risk of ropinirole-induced adverse effects (nausea, somnolence, dizziness) (8). 

These cases of interactions of aminophylline with macro-lide antibiotics illustrate that serious, even fatal, adverse effects can occur when possible interactions are not considered. In both cases, experienced physicians prescribed appropriate antimicrobial drugs, but omitted to consider the possibility of interactions with aminophylline, and failed to reduce the dose of aminophyUme or to measure theophylline concentrations. In the first case the development of tachycardia, hypokalemia, acidosis, vomiting, and convulsions can be explained on the basis of theophylline toxicity caused by ciprofloxacin, while in the second the anxiety, tremor, and cardiac arrests could all have resulted from an interaction of aminophylline and erythromycin. These cases add to an extensive literature that emphasizes the potential for interaction between aminophylline and drugs metabolized by CYP1A2. 

Abnormalities of liver, renal, and hematological parameters have been reported. As with other antibiotic regimens, pseudomembranous colitis may occur during or after treatment. Fluoroquinolones have the potential to cause adverse effects on developing cartilage and bone thus, ciprofloxacin should be used with caution in pregnant women and young children. 

I The fluoroquinones (e.g., ciprofloxacin) are nalidixic acid analogs that inhibit topoisomerase II (DNA gyrase) and topoisomerase IV. Their clinical use, the relevant drugs in this class, their biodisposition, and adverse effects are reported,... 

The newer fluoroquinolones (ciprofloxacin, norfloxacin, enoxadn, pefloxacin, gatifloxadn and moxi-floxacin) have similar toxicities and incidence of adverse effects. In general, compared to other antibiotics, these are relatively safe agents [190]. Gastrointestinal side-effects are the most common (0.8 to 6.8% of patients), followed by central nervous system manifestations (0.9 to 1.8%), and skin reactions (0.6 to 2.4%). Rare cases of increased serum creatinine levels have been reported [203]. Indeed, in a study of 133 febrile episodes in neutropenic patients comparing the effectiveness and safety of high-dose oral ciprofloxacin versus azlociUin and netilmicin, there were no renal ad-... 

There is an isolated report of red blotches developing on the face and body of a tetraplegic patient receiving ciprofloxacin 250 mg twice daily, which developed within 10 minutes of drinking 2 cans of beer containing alcohol 4.7%. He did not feel unwell or drowsy and the blotches faded over a period of 30 minutes. Previous courses of ciprofloxacin had not produced any adverse effects and the same brand of alcohol caused no... 

Rollof J, Vinge E. Neurological adverse effects during concomitant tteatment with ciprofloxacin, NSAIDS, andchloroquine possible drug interaction. AnnPharmaco er(1993)27, 1058-9. 

Information on this interaction and its clinical relevance is limited. The author of the pharmacokinetic study suggests that, if the drugs need to be used together, the dosage of pentoxifylline should be halved. In the absence of other information, if a short-course of ciprofloxacin is required in a patient taking pentoxifylline, this may be a sensible precaution. Alternatively, because the increase in AUC was minor, it may be sufficient to recommend a reduction in pentoxifylline dose only in those who experience adverse effects (e.g. nausea, headache). Note that ciprofloxacin has been used to boost pentoxifylline levels in studies investigating the possible therapeutic value of pentoxifylline s ability to inhibit various cytokines. For example, ciprofloxacin 500 mg twice daily was used with pentoxifylline 800 mg three times daily for up to one year in patients with myelod-ysplastic syndrome. ... 

Evidence from one study su ests that ciprofloxacin increases the serum levels of pentoxifylline, and may increase the incidence of adverse effects. In some clinical studies ciprofloxacin has been used to boost the levels of pentoxifylline. 

Fluvoxamine causes a very marked 33-fold increase in tizanidine levels with a consequent increase in hypotensive and sedative effects. The combination is potentially hazardous and should be avoided. Ciprofloxacin markedly increases tizanidine levels and adverse effects, and particular caution is required if this combination is considered essential Combined oral contraceptives increase tizanidine levels fourfold and might increase adverse effects. other inhibitors of CYP1A2 are predicted to interact similarly. 

A 45-year-old Japanese woman with multiple sclerosis taking tizanidine 3 mg daily had a reduction in blood pressure (from 124/88 to 102/74 mniHg) and heart rate (from 86 to 58 bpm) shortly after starting to take ciprofloxacin 400 mg daily. After 2 days she complained of drowsiness and her blood pressure was 92/54 mmHg. Retrospective analysis revealed 8 patients who had received tizanidine and ciprofloxacin concurrently. In these patients, the mean reduction in blood pressure on starting ciprofloxacin was 21.3/15.4 mmHg, and the heart rate reduction was 14.9 bpm. Adverse effects attributable to tizanidine occurred in three of the patients. ... 

For ciprofloxacin, there is a marked tenfold increase in exposure to tizanidine, with a consequent increase in adverse effects. Some authors recommend that this combination be avoided, whereas others recommend caution. The US manufacturer contraindicates the combination, whereas the UK manufacturers do not mention this potential interaction. If ciprofloxacin is considered the most appropriate antibacterial to use in a patient already taking tizanidine, anticipate the need to reduce the tizanidine dose before starting the ciprofloxacin, and closely monitor adverse effects starting ciprofloxacin may cause marked hypotension, bradycardia, and sedation. Other quinolones also inhibit CYP1A2, but to varying degrees, see Table 33.4 , (p. 1193). 

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