What are the contraindications for ciprofloxacin (fluoroquinolone antibiotic)?

Ciprofloxacin Contraindications

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, as well as in patients taking tizanidine. 1

Absolute Contraindications

1. Hypersensitivity reactions:

   • History of allergic reactions to ciprofloxacin or any quinolone antibiotic
   • Previous skin rash, anaphylaxis, or other allergic manifestations to fluoroquinolones

2. Medication interactions:

   • Concomitant administration with tizanidine (due to 7-fold increase in Cmax and 10-fold increase in AUC) 1

3. Pediatric patients:

   • Contraindicated in children and adolescents under 18 years of age except for specific FDA-approved indications (complicated UTIs, pyelonephritis due to E. coli, post-exposure treatment for inhalation anthrax) 2, 3
   • Risk of arthropathy and cartilage damage in juvenile populations 1

Relative Contraindications and Precautions

1. Pregnancy:

   • Should be avoided during pregnancy due to potential teratogenic effects 2
   • Alternative antibiotics (ampicillin, cefotaxime, ceftriaxone, or TMP-SMZ) should be used whenever possible 2

2. Breastfeeding:

   • Excreted in human milk; decision should be made whether to discontinue nursing or discontinue the drug 2

3. QT interval prolongation:

   • Avoid in patients with known QT interval prolongation or risk factors for torsades de pointes 3, 4
   • Use with caution in patients with:
     • Concomitant QT-prolonging medications
     • Hypokalemia
     • Pre-existing arrhythmias or cardiac disease 4, 5

4. CNS disorders:

   • Avoid in patients with epilepsy, cerebrovascular disease, or other CNS impairments 3
   • Risk of seizures, toxic psychosis, increased intracranial pressure 1

5. Tendinopathy risk:

   • Use with caution in:
     • Elderly patients (>60 years)
     • Non-obese patients
     • Patients on concurrent corticosteroid therapy
     • Patients with chronic renal disease 3

6. Specific infections:

   • Escherichia coli O157 (STEC) infections - may worsen risk of hemolytic uremic syndrome 6
   • Patients receiving fluoroquinolone prophylaxis should not receive oral empirical therapy with a fluoroquinolone 6

7. Renal impairment:

   • Dose adjustment required for patients with creatinine clearance <30 ml/min 7

Drug Interactions Requiring Caution

1. Medications with serious interactions:

   • Theophylline (increased serum concentrations and prolonged elimination half-life) 1
   • Warfarin and derivatives (enhanced anticoagulant effects) 1
   • Methotrexate (increased plasma levels and toxicity risk) 1
   • Caffeine (reduced clearance and prolonged half-life) 1
   • NSAIDs at high doses (increased risk of seizures) 1
   • Cyclosporine (transient elevations in serum creatinine) 1
   • Glyburide (risk of severe hypoglycemia) 1

2. Absorption interactions:

   • Multivalent cation-containing products (magnesium/aluminum antacids, sucralfate, didanosine, calcium, iron, or zinc) substantially decrease ciprofloxacin absorption 1
   • Should be taken 2 hours before or 6 hours after these products 1

Monitoring Recommendations

1. For all patients:

   • Monitor for signs of hypersensitivity reactions
   • Watch for tendon pain or inflammation
   • Observe for neurological symptoms (dizziness, seizures, confusion)

2. For high-risk patients:

   • ECG monitoring for QTc prolongation in patients with risk factors 4, 5
   • Blood glucose monitoring in diabetic patients (risk of dysglycemia) 5
   • Renal function monitoring in elderly or those with impaired kidney function

By understanding these contraindications and taking appropriate precautions, clinicians can minimize the risks associated with ciprofloxacin therapy while maintaining its effectiveness in treating appropriate infections.