How does this medication work? What will it do for me?
Ciprofloxacin is an antibiotic that belongs to the family of medications known as quinolones. It is used to treat infections caused by certain bacteria. Ciprofloxacin extended-release (XL) is used to treat urinary tract infections such as cystitis (bladder infection) or uncomplicated pyelonephritis (kidney infection).
This medication may be available under multiple brand names and/or in several different forms. Any specific brand name of this medication may not be available in all of the forms or approved for all of the conditions discussed here. As well, some forms of this medication may not be used for all of the conditions discussed here.
Your doctor may have suggested this medication for conditions other than those listed in these drug information articles. If you have not discussed this with your doctor or are not sure why you are taking this medication, speak to your doctor. Do not stop taking this medication without consulting your doctor.
Do not give this medication to anyone else, even if they have the same symptoms as you do. It can be harmful for people to take this medication if their doctor has not prescribed it.
What form(s) does this medication come in?
Each white-to-slightly-yellow, oblong, coated tablet, debossed with "CP XL" on one side and "500" on the other, contains 500 mg of ciprofloxacin as ciprofloxacin hydrochloride (287.5 mg, calculated as ciprofloxacin on the dried basis) and ciprofloxacin (212.6 mg, calculated on the dried basis). Nonmedicinal ingredients: colloidal silicon dioxide, crospovidone, hydrogenated castor oil powder, hypromellose, magnesium stearate, microcrystalline cellulose, polyethylene glycol, succinic acid, and titanium dioxide.
How should I use this medication?
For uncomplicated urinary tract infections in women, the usual recommended adult dose of ciprofloxacin extended-release (XL) is 500 mg once a day for 3 days.
For complicated urinary tract infections and uncomplicated kidney infections, the usual recommended adult dose is 1,000 mg once a day for 7 to 14 days. For people with severely reduced kidney function, the recommended dose is 500 mg once a day for 7 to 14 days.
Ciprofloxacin extended-release should be swallowed whole. Do not split, chew, or crush the tablet. It should be taken at approximately the same time each day, with or without food. Although the medication can be taken with meals that include milk, it is best to avoid taking it with dairy products alone (e.g., yogurt) or with calcium-fortified products. (See "What other medications could interact with this medication?" below.)
Drink adequate amounts of liquids (water, juices) while you are using this medication.
Many things can affect the dose of medication that a person needs, such as body weight, other medical conditions, and other medications. If your doctor has recommended a dose different from the ones listed here, do not change the way that you are taking the medication without consulting your doctor.
Finish all of this medication, even if you begin to feel better. It is important to take this medication exactly as prescribed by your doctor. If you miss a dose, take it as soon as possible and continue on with your regular schedule. Do not take more than one dose of ciprofloxacin extended-release per day. Do not take a double dose to make up for a missed one. If you are not sure what to do after missing a dose, contact your doctor or pharmacist for advice.
Store this medication at room temperature and keep it out of the reach of children.
Do not dispose of medications in wastewater (e.g. down the sink or in the toilet) or in household garbage. Ask your pharmacist how to dispose of medications that are no longer needed or have expired.
Who should NOT take this medication?
Do not take this medication if you:
- are allergic to ciprofloxacin or any ingredients of the medication
- are allergic to other medications in the quinolone family (e.g., norfloxacin, moxifloxacin)
- are also taking a medication called tizanidine
- dizziness or lightheadedness
- general feeling of being unwell
- increased skin sensitivity to the sun
- loss of appetite
- mild diarrhea
- ringing in the ears
- stomach discomfort or gas
- trouble sleeping
- changes in sensation (things taste or smell different)
- coordination problems (unsteady walk)
- hallucinations (hearing or seeing things that aren't there)
- hearing changes
- irregular or fast heart rate
- joint pain
- memory loss
- muscle pain
- numbness or burning, tingling pain
- pain or swelling in a joint (ruptured tendon)
- severe abdominal or stomach cramps or pain
- signs of depression (e.g., poor concentration, changes in weight, changes in sleep, decreased interest in activities, thoughts of suicide)
- signs of liver problems (e.g., nausea, vomiting, diarrhea, loss of appetite, weight loss, yellowing of the skin or whites of the eyes, dark urine, pale stools)
- symptoms of high blood sugar (e.g., frequent urination, increased thirst, excessive eating, unexplained weight loss, poor wound healing, infections, fruity breath odour)
- symptoms of low blood sugar (e.g., cold sweat, cool pale skin, headache, fast heartbeat, weakness)
- symptoms of worsening myasthenia gravis (e.g., muscle weakness, drooping eyelid, vision changes, difficulty chewing and swallowing, trouble breathing)
- symptoms of a vaginal yeast infection (e.g., vaginal itching or burning, thick white odourless vaginal discharge)
- vision changes
- confusion or changes in thought patterns
- diarrhea (watery and severe; may also be bloody)
- signs of an aortic aneurysm (abnormal bulge in aorta) or tear in the aorta (e.g., dizziness, loss of consciousness, pulsating sensation in abdomen, sudden severe pain in the chest, abdomen or back)
- signs of a serious allergic reaction (e.g., abdominal cramps, difficulty breathing, nausea and vomiting, or swelling of the face and throat)
- signs of increased pressure in the brain (e.g., blurred or double vision, headaches, nausea)
- signs of a severe skin reaction (e.g., blistering, peeling, a rash covering a large area of the body, a rash that spreads quickly, or a rash combined with fever or discomfort)
- acetylsalicylic acid (ASA)
- amphetamines (e.g., dextroamphetamine, lisdexamfetamine)
- antacids that contain aluminum hydroxide, calcium, and magnesium hydroxide (do not take these products for at least 6 hours before or for 2 hours after ciprofloxacin)
- antipsychotics (e.g., chlorpromazine, clozapine, haloperidol, olanzapine, quetiapine, risperidone)
- BCG vaccine
- calcium supplements and multivitamins that contain calcium (do not take these products for at least 6 hours before or for 2 hours after ciprofloxacin)
- cholera vaccine
- inhaled corticosteroids (e.g., budesonide, ciclesonide, fluticasone)
- oral corticosteroids (e.g., dexamethasone, hydrocortisone, prednisone)
- diabetes medications (e.g., chlorpropamide, glyburide, insulin, metformin, rosiglitazone)
- iron supplements (e.g., ferrous fumarate, ferrous gluconate, ferrous sulfate: do not take these products for at least 6 hours before or for 2 hours after ciprofloxacin)
- magnesium supplements (e.g., magnesium hydroxide, magnesium oxide)
- multiple vitamins and minerals with Vitamin A, E
- multivitamins that contain iron (do not take these products for at least 6 hours before or for 2 hours after ciprofloxacin)
- nonsteroidal anti-inflammatory drugs (NSAIDs; e.g., ibuprofen, diclofenac, ketorolac)
- other quinolone antibiotics (e.g., norfloxacin, ofloxacin)
- sodium picosulfate
- sucralfate (do not take these products for at least 6 hours before or for 2 hours after ciprofloxacin)
- theophyllines (e.g., aminophylline, oxtryphylline, theophylline)
- thyroid replacements (e.g., desiccated thyroid, levothyroxine)
- typhoid vaccine
- tyrosine kinase inhibitors (e.g., bosutinib, dasatinib, imatinib, nilotinib, sunitinib)
- stop taking one of the medications,
- change one of the medications to another,
- change how you are taking one or both of the medications, or
- leave everything as is.
What side effects are possible with this medication?
Many medications can cause side effects. A side effect is an unwanted response to a medication when it is taken in normal doses. Side effects can be mild or severe, temporary or permanent.
The side effects listed below are not experienced by everyone who takes this medication. If you are concerned about side effects, discuss the risks and benefits of this medication with your doctor.
The following side effects have been reported by at least 1% of people taking this medication. Many of these side effects can be managed, and some may go away on their own over time.
Contact your doctor if you experience these side effects and they are severe or bothersome. Your pharmacist may be able to advise you on managing side effects.
Although most of the side effects listed below don't happen very often, they could lead to serious problems if you do not seek medical attention.
Check with your doctor as soon as possible if any of the following side effects occur:
Stop taking the medication and seek immediate medical attention if any of the following occur:
Some people may experience side effects other than those listed. Check with your doctor if you notice any symptom that worries you while you are taking this medication.
Are there any other precautions or warnings for this medication?
Before you begin using a medication, be sure to inform your doctor of any medical conditions or allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should take this medication.
HEALTH CANADA ADVISORY
January 23, 2017
Health Canada has issued restrictions concerning the use of ciprofloxacin. To read the full Health Canada Advisory, visit Health Canada's web site at www.hc-sc.gc.ca.
Antibiotic-associated colitis: This medication, like other antibiotics, may cause a potentially dangerous condition called antibiotic-associated colitis or pseudomembranous colitis. Symptoms include severe, watery diarrhea that may be bloody. If you notice these symptoms, stop taking this medication and contact your doctor as soon as possible.
Bacterial resistance: Misuse of an antibiotic such as ciprofloxacin may lead to the growth of resistant bacteria that will not be killed by the antibiotic. If this happens, the antibiotic may not work for you in the future. Although you may begin to feel better when you first start taking ciprofloxacin, you need to take all the medication exactly as directed by your doctor to finish ridding your body of the infection and to prevent resistant bacteria from taking hold. Do not take ciprofloxacin or other antibiotics to treat a viral infection such as the common cold; antibiotics do not kill viruses, and using them to treat viral infections can lead to the growth of resistant bacteria.
Behaviour and nervous system: Rarely, ciprofloxacin extended-release may affect behaviour and the nervous system. If you experience confusion, tremors, nerve pain, tingling or weakness, depression (including thoughts of harming yourself), hallucinations (hearing, seeing, or feeling things that are not actually there), agitation, anxiety, difficulty sleeping, nightmares, or any other behaviour changes while taking this medication, contact your doctor.
Blood glucose: Ciprofloxacin, like other medications in this family, may cause changes in blood sugar levels (may cause a loss of blood glucose control) and glucose tolerance may change. People with diabetes may find it necessary to monitor their blood sugar more frequently while using this medication.
If you experience symptoms of low blood sugar (e.g., cold sweat, cool pale skin, headache, fast heartbeat, weakness) or symptoms of high blood sugar (e.g., frequent urination, increased thirst, excessive eating, unexplained weight loss, poor wound healing, infections, fruity breath odour), talk to your doctor.
Drowsiness/reduced alertness: Ciprofloxacin may cause dizziness, affecting your ability to drive or operate machinery. Avoid these and other hazardous tasks until you have determined how this medication affects you.
Hypersensitivity syndrome: A severe allergic reaction called hypersensitivity syndrome has occurred for some people taking ciprofloxacin. This reaction involves a number of organs in the body and may be fatal if not treated quickly. Stop taking the medication and get immediate medical attention if you have symptoms of a severe allergic reaction, including fever, swollen glands, yellowing of the skin or eyes, or flu-like symptoms with skin rash or blistering.
Kidney function: Kidney disease or reduced kidney function may cause this medication to build up in the body, causing side effects, since ciprofloxacin is removed from the body mostly by the kidneys. If you have reduced kidney function or kidney disease, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.
Liver function: Ciprofloxacin may reduce liver function and can cause liver failure. If you have liver problems, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.
If you experience symptoms of liver problems such as fatigue, feeling unwell, loss of appetite, nausea, yellowing of the skin or whites of the eyes, dark urine, pale stools, abdominal pain or swelling, and itchy skin, contact your doctor immediately.
Neuromuscular disorders: Ciprofloxacin may cause increased muscle weakness for people with myasthenia gravis (an autoimmune disorder that causes muscle weakness). If you have myasthenia gravis, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.
Other infections: Use of ciprofloxacin extended-release for a long time may cause other infections, especially by yeast or fungi. If you notice symptoms of an infection (e.g., vaginal yeast infection symptoms such as thick white discharge and itchiness), contact your doctor.
QT prolongation: This medication can lengthen heartbeat as shown on an electrocardiogram test, also known as QT prolongation. Very rare cases of abnormal heartbeat have been reported by people taking ciprofloxacin extended-release, but these reports generally involved people who had conditions that predisposed them to abnormal heartbeat, or who had been taking other medications that can increase the risk of developing an abnormal heartbeat.
If you have heart disease and abnormal heart rhythms, or are taking certain medications (e.g., verapamil, atazanavir), discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed. If you develop heart palpitations (fast or irregular heartbeat) or experience fainting spells, stop taking your medication and contact your doctor immediately.
Seizures: Rarely, seizures have been reported with this medication. If you have a history of epilepsy or medical conditions that increase the risk of seizures, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed. If you have a seizure while taking this medication, stop taking it and get immediate medical attention.
Sun sensitivity: Ciprofloxacin extended-release can increase the sensitivity of the skin to sun and increase the chance of sunburn. Avoid the sun, use sunscreen, and avoid sun beds while taking this medication. If you must spend time in the sun, use sunblock with minimum SPF 15. Contact your doctor if severe sun sensitivity occurs (e.g., sunburn).
Tendonitis: Ciprofloxacin extended-release may increase the chance of tendon injury. Injury occurs more commonly for seniors who are also taking, or have recently taken, corticosteroid medications (e.g., prednisone, dexamethasone), however it can happen to anyone who takes ciprofloxacin. If you experience any new pain in the tendons, stop taking ciprofloxacin extended-release, avoid physical exercise, and contact your doctor.
Pregnancy: This medication should not be used during pregnancy unless the benefits outweigh the risks. If you become pregnant while taking this medication, contact your doctor immediately.
Breast-feeding: This medication passes into breast milk. If you are a breast-feeding mother and are taking ciprofloxacin extended-release, it may affect your baby. Talk to your doctor about whether you should continue breast-feeding.
Children: The safety and effectiveness of ciprofloxacin extended-release has not been established for children and adolescents less than 18 years of age.
Seniors: Seniors may require lower doses of this medication due to age-related decreases in kidney function.
What other drugs could interact with this medication?
There may be an interaction between ciprofloxacin extended-release and any of the following:
If you are taking any of these medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:
An interaction between two medications does not always mean that you must stop taking one of them. Speak to your doctor about how any drug interactions are being managed or should be managed.
Medications other than those listed above may interact with this medication. Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications that you are taking. Also tell them about any supplements you take. Since caffeine, alcohol, the nicotine from cigarettes, or street drugs can affect the action of many medications, you should let your prescriber know if you use them.
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