What are the potential side effects of ciprofloxacin (Cipro)?

Ciprofloxacin Side Effects to Watch For

Ciprofloxacin can cause serious side effects including tendon damage, peripheral neuropathy, and central nervous system effects, requiring immediate discontinuation if symptoms develop. 1

Most Important Side Effects

• Tendinopathy and tendon rupture: Watch for pain, swelling, or inflammation in tendons, especially the Achilles tendon. This risk is higher in older adults (over 60), those taking corticosteroids, and patients with kidney, heart, or lung transplants. Stop the medication and rest at the first sign of tendon pain 1

• Peripheral neuropathy: Monitor for nerve damage symptoms in arms, hands, legs, or feet including pain, burning, tingling, numbness, or weakness. This can be permanent if the medication isn't stopped promptly 1

• Central nervous system effects: Be alert for seizures, dizziness, confusion, tremors, hallucinations, depression, or suicidal thoughts. These can occur even after the first dose 1

• Severe allergic reactions: Watch for hives, trouble breathing or swallowing, swelling of lips/tongue/face, throat tightness, rapid heartbeat, or fainting 1

Other Important Side Effects

• Photosensitivity: Avoid sunlamps and limit sun exposure as ciprofloxacin can make skin extremely sensitive to sunlight, causing severe sunburn, blisters, or swelling 1

• Liver problems: Monitor for yellowing of skin/eyes or dark urine, which can indicate liver damage 1

• Heart rhythm changes: Report any changes in heartbeat (fast or irregular) or fainting episodes. QT prolongation risk is higher in elderly patients, those with family history of QT prolongation, low potassium, or taking antiarrhythmic medications 1

• Intestinal infection (Pseudomembranous colitis): Watch for watery or bloody diarrhea with stomach cramps and fever, which can occur up to 2 months after finishing the antibiotic 1

Common Side Effects

• Gastrointestinal effects: Nausea, vomiting, diarrhea, and abdominal discomfort (occur in 2-8% of patients) 2

• Other common effects: Headache, dizziness, and vaginal yeast infection 1

Drug Interactions

• Medication interactions: Ciprofloxacin inhibits the CYP1A2 enzyme pathway, potentially causing dangerous interactions with medications like clozapine and theophylline 3, 4

• Low blood sugar: Can occur when taken with oral diabetes medications like glyburide 1

• Decreased absorption: Don't take ciprofloxacin within 2 hours of antacids or other medications containing divalent cations 1

When to Seek Immediate Medical Attention

• Stop taking ciprofloxacin and seek emergency medical help for:
  • Tendon pain or rupture 1
  • Skin rash (even after only one dose) 1
  • Signs of severe allergic reaction 1
  • Severe diarrhea or bloody stools 1
  • Nerve damage symptoms 1
  • Serious mental health changes 1

Special Considerations

• Fluoroquinolone-associated disability: In rare cases, ciprofloxacin can cause disabling and potentially permanent side effects involving multiple body systems, including tendons, muscles, joints, nerves, and central nervous system 5

• Monitoring: The American College of Physicians recommends vigilant monitoring and prompt discontinuation if concerning symptoms develop 3

• Pregnancy and breastfeeding: Safety and effectiveness in pregnant and lactating women have not been established 1