Ciprofloxacin is not a drug of choice in suspected or established pneumonia caused by Streptococcus pneumoniae.
With simultaneous intravenous administration of ciprofloxacin and drugs for general anesthesia from the group of barbituric acid derivatives, continuous monitoring of the heart rate, blood pressure, and electrocardiogram is necessary.
To avoid the development of crystalluria, exceeding the recommended daily dose is inadmissible, adequate fluid intake and maintenance of acid urine reaction are also necessary.
Patients with epilepsy, episodes of seizures in history, vascular diseases and organic brain damage, due to the threat of development of adverse reactions from the central nervous system ciprofloxacin should be prescribed only for "vital" indications.
If a severe and prolonged diarrhea occurs during or after treatment, the diagnosis of pseudomembranous colitis should be deleted, which requires immediate discontinuation of the drug and the appointment of appropriate treatment. Contraindicated use of drugs that inhibit intestinal peristalsis.
In patients who use fluoroquinolones, including ciprofloxacin, cases of sensory and sensorimotor axonal polyneuropathy affecting small and (or) large axons are recorded, leading to paresthesia, hyposthenia, dysesthesia and weakness. Symptoms may appear soon after the onset of use and be irreversible.If a patient develops symptoms of neuropathy, including pain, burning, tingling, numbness, and (or) weakness or other sensory disturbances, including tactile, pain, temperature, vibration sensation and a feeling of use of the drug situation ciprofloxacin must be discontinued immediately.
Given that women are characterized by a large average duration of the interval QT compared to men, they are more sensitive to drugs that cause lengthening of the interval QT; Ciprofloxacin should be used with caution in combination with drugs that extend the interval QT (for example, antiarrhythmic drugs classes IA and III, tricyclic antidepressants, macrolides, neuroleptics), in patients with an increased risk of lengthening the interval QT or the development of piruet-type arrhythmias (eg, congenital lengthening syndrome QT, heart disease (heart failure, myocardial infarction, bradycardia), electrolyte imbalance (e.g., hypokalemia, hypomagnesemia)).
When ciprofloxacin was used, cases of liver necrosis and life-threatening liver failure were noted.In the presence of symptoms of liver disease, such as anorexia, jaundice, darkening of the urine, itching, abdominal tenderness, the use of ciprofloxacin should be discontinued.
Patients with severe myasthenia gravis ciprofloxacin should be used with caution, as possible exacerbation of symptoms.
When ciprofloxacin is used, cases of tendinitis and tendon rupture (predominantly Achilles tendon), sometimes bilateral, can occur within the first 48 hours after the initiation of therapy, inflammation and rupture of the tendon may occur even several months after discontinuation of ciprofloxacin treatment. In elderly patients and patients with diseases of the tendons, simultaneously receiving treatment with glucocorticosteroids, there is an increased risk of tendonopathy.
When pain occurs in the tendons or the first signs of tendovaginitis treatment should be discontinued.
When ciprofloxacin was used, cases of epileptic status were reported, ciprofloxacin, like other fluoroquinolones, can provoke cramps and reduce the threshold of convulsive readiness. In case of seizures, the drug should be discontinued.
Mental reactions may occur even after the first use of fluoroquinolones, including ciprofloxacin. In rare cases, depression or psychotic reactions can progress to suicidal thoughts and self-damaging behavior, such as suicide attempts, including those that have occurred. If a patient develops one of these reactions, stop taking the medication and tell the doctor about it.
During the treatment period, avoid direct sunlight.
In the treatment of severe infections, staphylococcal infections and infections caused by gram-positive and anaerobic bacteria, ciprofloxacin should be used in combination with appropriate antibacterial agents. For genital infections presumably caused by strains of Neisseria gonorrhoeae resistant to fluoroquinolones, local information on ciprofloxacin resistance should be taken into account and the susceptibility of the causative agent in laboratory tests should be confirmed.
In rare cases, after the first application, anaphylactic reactions may occur up to anaphylactic shock. In these cases, the use of ciprofloxacin should be stopped immediately and appropriate treatment should be given.
Ciprofloxacin is a moderate inhibitor of CYP4501A2 isoenzymes.Caution should be exercised with the simultaneous use of ciprofloxacin and drugs metabolized by these enzymes (including theophylline, methylxanthine, caffeine, duloxetine, clozapine, ropinirole, olanzapine), since an increase in the concentration of these drugs in the blood serum, due to inhibition of their metabolism by ciprofloxacin, can cause specific undesirable reactions.
Local reaction (inflammatory reaction of the skin at the injection site: edema, occurs more often if the infusion time is 30 minutes or less). The reaction quickly passes after the end of the infusion and is not a contraindication for the next administration of the drug, unless its course is complicated.
In vitro in laboratory tests ciprofloxacin suppresses the growth of Mycobacterium spp., which can lead to false-negative results in the diagnosis of this pathogen in patients taking ciprofloxacin.
Consider the sodium chloride content of the ciprofloxacin solution. in the treatment of patients who have limited sodium intake (heart failure, kidney failure, nephrotic syndrome).