From the Guidelines
Ciprofloxacin is contraindicated in patients with a history of hypersensitivity to ciprofloxacin or other quinolones, as well as in patients with tendon damage, pregnancy, breastfeeding, and children, due to the risk of arthropathy and other adverse effects. When considering the use of ciprofloxacin, it is essential to evaluate the potential risks and benefits, particularly in patients with certain medical conditions.
- The use of ciprofloxacin is contraindicated in patients with a history of hypersensitivity to ciprofloxacin or other quinolones, as this can cause severe allergic reactions 1.
- Patients with tendon damage or a history of tendon disorders should avoid ciprofloxacin, as it can increase the risk of tendon rupture, particularly in those over 60 years old or taking concomitant corticosteroids 1.
- Ciprofloxacin is also contraindicated in pregnancy and breastfeeding, as animal studies have shown that quinolones can cause arthropathy in the developing fetus or infant 1.
- Additionally, ciprofloxacin should not be used in children, as it can cause arthropathy in weight-bearing joints, and its use is contraindicated in the UK for children or growing adolescents 1.
- Other contraindications for ciprofloxacin include cardiovascular conditions such as congenital or documented acquired QT prolongation, clinically relevant bradycardia, or heart failure with reduced left ventricular ejection fraction, as well as liver disease, particularly chronic liver disease with a Child-Pugh severity score C or transaminase levels fivefold greater than the upper limit of normal 1.
- Concurrent use with other drugs that prolong the QT interval is also contraindicated, and patients with kidney disease may require dose adjustments 1.
From the FDA Drug Label
Ciprofloxacin is contraindicated in persons with a history of hypersensitivity to ciprofloxacin, any member of the quinolone class of antimicrobial agents, or any of the product components. Concomitant administration with tizanidine is contraindicated. The contraindications to ciprofloxacin are:
- A history of hypersensitivity to ciprofloxacin
- A history of hypersensitivity to any member of the quinolone class of antimicrobial agents
- A history of hypersensitivity to any of the product components
- Concomitant administration with tizanidine 2
From the Research
Contraindications to Ciprofloxacin
The following are contraindications to ciprofloxacin:
- Known prolongation of the QT interval 3, 4
- Uncorrected hypokalaemia or hypomagnesaemia 3, 4
- Patients receiving class IA (e.g. quinidine, procainamide) or class III (e.g. amiodarone, sotalol) antiarrhythmic agents 3, 4
- Myasthenia gravis, as fluoroquinolones can exacerbate the condition 5, 6
- Patients with a history of anaphylactoid reactions to ciprofloxacin or other fluoroquinolones 7
- CNS disorders that predispose to seizures (e.g. severe cerebral arteriosclerosis or epilepsy), as fluoroquinolones can cause CNS excitatory effects 3, 4
Special Considerations
- Elderly patients with impairments of the CNS should be treated with fluoroquinolones only under close supervision 3
- Patients with chronic renal diseases, concomitant use of corticosteroids, and age over 60 years are at increased risk of fluoroquinolone-induced tendon disorders 3, 4
- Patients with known or suspected CNS disorders that predispose to seizures should be treated with caution 3, 4