Major Side Effects of Ciprofloxacin (Cipro)
Ciprofloxacin (Cipro) has several serious side effects that warrant concern, most notably tendon damage, peripheral neuropathy, and central nervous system effects that can significantly impact morbidity, mortality, and quality of life.
Musculoskeletal Concerns
- Tendinitis and tendon rupture, particularly affecting the Achilles tendon, are significant risks that may require surgical repair and can occur during or even months after completing therapy 1
- The risk of tendon problems is further increased in older adults (usually over 60), patients taking corticosteroids, and those with kidney, heart, or lung transplants 1
- At the first sign of tendon pain, swelling, or inflammation, discontinue ciprofloxacin immediately and rest the affected area to prevent permanent damage 1
Neurological Effects
- Peripheral neuropathy (nerve damage) can occur in arms, hands, legs, or feet, potentially causing permanent damage if not addressed promptly 1
- Watch for symptoms including pain, burning, tingling, numbness, or weakness in extremities 1
- Central nervous system effects include seizures, increased intracranial pressure, toxic psychosis, dizziness, confusion, tremors, hallucinations, depression, and rarely, suicidal thoughts 1
- These neurological reactions can occur even after the first dose of ciprofloxacin 1
Cardiovascular Concerns
- Serious heart rhythm changes (QT prolongation and torsade de pointes) can occur, particularly in elderly patients, those with family history of QT prolongation, low blood potassium, or those taking certain heart rhythm medications 1
- Monitor for changes in heart rhythm or fainting, which require immediate medical attention 1
Gastrointestinal Issues
- Pseudomembranous colitis (intestinal infection) can develop even 2 or more months after finishing treatment 1
- Watch for watery or bloody diarrhea, stomach cramps, and fever 1
- Common but less serious gastrointestinal side effects include nausea, vomiting, diarrhea, and abdominal pain 1
Hypersensitivity Reactions
- Serious and occasionally fatal allergic reactions can occur, sometimes after just one dose 1
- Skin rash may be a sign of a more serious reaction and warrants immediate discontinuation 1
- Severe reactions may include hives, trouble breathing, swelling of lips/tongue/face, throat tightness, rapid heartbeat, or fainting 1
Special Considerations
- Ciprofloxacin can inhibit the CYP1A2 enzyme pathway, leading to potentially dangerous interactions with medications like clozapine 2
- Photosensitivity reactions can occur, making skin extremely sensitive to sunlight and UV exposure 1
- Liver problems may develop, signaled by yellowing of skin/eyes or dark urine 1
- Low blood sugar (hypoglycemia) can occur, especially in patients taking oral diabetes medications 1
High-Risk Populations
- Children under 18 years should only use ciprofloxacin for specific indicated infections due to increased risk of joint/cartilage problems 1
- Elderly patients may be at higher risk for tendon damage and CNS effects 1
- Patients with a history of seizures or CNS disorders should use ciprofloxacin with caution 1
When to Seek Immediate Medical Attention
- Tendon pain, swelling, or inflammation 1
- Signs of allergic reaction (hives, difficulty breathing, swelling, etc.) 1
- Neurological symptoms (peripheral neuropathy or CNS effects) 1
- Heart rhythm changes or fainting 1
- Severe diarrhea or bloody stools 1
- Skin rash, even after only one dose 1
Ciprofloxacin remains an effective antibiotic for many infections, but these potential side effects require vigilant monitoring and prompt discontinuation if concerning symptoms develop 3.