What are the side effects of Cipro (ciprofloxacin)?

Side Effects of Ciprofloxacin

Ciprofloxacin has numerous potentially serious side effects including tendinitis/tendon rupture, peripheral neuropathy, CNS effects, and QT prolongation, which require immediate discontinuation if symptoms develop. 1

Common Side Effects

• Gastrointestinal effects (4.9-5%): nausea, vomiting, diarrhea, and abdominal discomfort 2, 3
• Central nervous system effects (1.5-1.6%): dizziness, confusion, tremors, headache 2, 3
• Skin reactions (1.1-1.4%): rash, photosensitivity 2, 3
• Metabolic/nutritional effects (4.4-4.6%) 2, 3

Serious Side Effects

Musculoskeletal Effects

• Tendinopathy and tendon rupture: Most frequently involves the Achilles tendon, but can affect rotator cuff, hand, biceps, and thumb tendons 1
• Risk factors: age over 60 years, concurrent corticosteroid use, kidney/heart/lung transplants, strenuous physical activity, renal failure, and previous tendon disorders 1
• Arthropathy: Reported in children with rates of musculoskeletal adverse events of 9.3% compared to 6.0% in control patients 4

Neurological Effects

• Peripheral neuropathy: Can cause permanent nerve damage with symptoms including pain, burning, tingling, numbness, and weakness in arms, hands, legs, or feet 1
• Central nervous system effects: Convulsions, increased intracranial pressure, toxic psychosis, dizziness, confusion, tremors, hallucinations, depression, and rarely suicidal thoughts 1

Cardiovascular Effects

• QT prolongation and torsade de pointes: Can cause abnormal heart rhythm, particularly in elderly patients, those with family history of QT prolongation, low potassium levels, or taking antiarrhythmic medications 1

Gastrointestinal Effects

• Pseudomembranous colitis (C. difficile-associated diarrhea): Can occur during or up to 2 months after treatment, presenting with watery or bloody diarrhea, stomach cramps, and fever 1

Hypersensitivity Reactions

• Serious and occasionally fatal anaphylactic reactions can occur even after the first dose 1
• Symptoms include cardiovascular collapse, loss of consciousness, tingling, pharyngeal/facial edema, dyspnea, urticaria, and itching 1
• Other severe reactions: toxic epidermal necrolysis, Stevens-Johnson syndrome, vasculitis, arthralgia, myalgia, serum sickness, allergic pneumonitis 1

Hepatic Effects

• Liver problems: Yellowing of skin or eyes, dark urine 1
• Cases of severe hepatitis have been reported 5

Hematologic Effects

• Blood disorders: Anemia (including hemolytic and aplastic), thrombocytopenia, leukopenia, agranulocytosis, pancytopenia 1, 6

Drug Interactions

• Inhibits CYP1A2 enzyme pathway, leading to potentially dangerous interactions with medications like clozapine 7, 1
• Theophylline: Serious and fatal reactions including cardiac arrest, seizure, status epilepticus, and respiratory failure have been reported 1
• Antacids containing magnesium, aluminum, calcium, or other divalent/trivalent cations can reduce absorption 1
• Oral anti-diabetes medications: Can cause hypoglycemia when used with glyburide 1

Precautions

• Photosensitivity: Avoid sunlamps, tanning beds, and limit sun exposure; use sunscreen and protective clothing 1
• Pregnancy: Safety and effectiveness in pregnant women have not been established 1
• Pediatric use: Should be used in children only for specific indicated infections due to increased risk of musculoskeletal adverse events 1
• Do not drive or operate machinery until effects on mental alertness are known 1

When to Stop Ciprofloxacin

• At first sign of tendinitis or tendon rupture: pain, swelling, inflammation of a tendon 1
• At first sign of skin rash 1
• If experiencing symptoms of peripheral neuropathy 1
• If experiencing serious allergic reactions 1

The overall incidence of side effects is approximately 9-10%, with most being mild to moderate in intensity and reversible. Serious side effects requiring discontinuation occur in approximately 1.5% of patients 2, 3.