From the Guidelines
Cipro tablets should not be crushed whenever possible due to potential risks of exposure to the drug and inaccuracies of drug dosing. When considering the administration of medicines through enteral feeding tubes, it is crucial to consult the relevant Summary of Product Characteristics to understand the legal position regarding individual prescriptions and dosage forms 1. Crushing medicines can lead to inaccuracies in drug dosing and exposure to the drug, which can be harmful. Some key points to consider when administering medicines through enteral feeding tubes include:
- The choice of dosage form presents practical considerations, such as the potential for tube occlusions with solid dosage forms and the risk of gut disturbances with liquid medicines containing sorbitol or high osmolality 1.
- A pharmacist can advise on the administration of medicines through enteral feeding tubes and suggest alternative medicines or patient management options 1. If crushing is necessary, it is essential to mix the crushed tablet with a small amount of soft food and consume it immediately to minimize the risks associated with crushing. However, it is recommended to explore alternative formulations, such as Cipro oral suspension, which may be easier to administer and reduce the need for crushing. Ultimately, the decision to crush Cipro tablets should be made in consultation with a healthcare provider, taking into account the individual patient's needs and the potential risks and benefits 1.
From the FDA Drug Label
Swallow the tablet whole. Do not split, crush or chew the tablet. The FDA drug label advises against crushing cipro tablets. Cipro tablets should not be crushed.
From the Research
Cipro Tablets
- Cipro tablets contain the active ingredient ciprofloxacin, a broad-spectrum fluoroquinolone antibacterial agent 2
- There is no direct evidence in the provided studies that specifically addresses whether cipro tablets can be crushed
- However, studies suggest that crushing tablets or opening capsules can have serious clinical consequences, including alteration of the drug's absorption, overdose, or underdosing 3, 4
- It is recommended to consider and research the impact of crushing a tablet or opening a capsule on the drug's effects before doing so 3
- Alternative forms of medication may exist and can be prescribed if necessary 4
Pharmacokinetics and Dosage
- Ciprofloxacin pharmacokinetics are not significantly influenced by body weight, and dosages do not need to be increased routinely in obese individuals 5
- However, soft tissue concentrations of ciprofloxacin may be lower in obese individuals, and higher dosages may be required in the treatment of infections in tissue where impaired ciprofloxacin penetration is anticipated 5
- The recommended dosage adjustments for ciprofloxacin in patients with impaired renal function vary between countries, and major adjustments are not required until the estimated creatinine clearance is < 30 ml/min/1.73m2 2
Safety and Adverse Effects
- Intravenous ciprofloxacin has been shown to be safe, with adverse events considered probably or possibly related to the drug reported in 15.8% of courses 6
- Local reactions at the site of infusion, changes in blood chemistry values, and gastrointestinal tract reactions are the most common adverse effects associated with intravenous ciprofloxacin 6