Medication Guide

Read this Medication Guide before you start taking ciprofloxacin for oral suspension and each time you get a refill. There may be new information. This information does not take the place of talking to your healthcare provider about your medical condition or your treatment.

What is the most important information I should know about ciprofloxacin for oral suspension?

Ciprofloxacin, a fluoroquinolone antibacterial medicine, can cause serious side effects. Some of these serious side effects can happen at the same time and could result in death.

If you get any of the following serious side effects while you take ciprofloxacin for oral suspension, you should stop taking ciprofloxacin for oral suspension immediately and get medical help right away.

1. Tendon rupture or swelling of the tendon (tendinitis).
   • Tendon problems can happen in people of all ages who take ciprofloxacin. Tendons are tough cords of tissue that connect muscles to bones. Symptoms of tendon problems may include:
     • pain
     • swelling
     • tears and swelling of the tendons including the back of the ankle (Achilles), shoulder, hand, thumb, or other tendon sites.
   • The risk of getting tendon problems while you take ciprofloxacin is higher if you:
     • are over 60 years of age
     • are taking steroids (corticosteroids)
     • have had a kidney, heart or lung transplant.
   • Tendon problems can happen in people who do not have the above risk factors when they take ciprofloxacin.
   • Other reasons that can increase your risk of tendon problems can include:
     • physical activity or exercise
     • kidney failure
     • tendon problems in the past, such as in people with rheumatoid arthritis (RA).
   • Stop taking ciprofloxacin for oral suspension immediately and get medical help right away at the first sign of tendon pain, swelling or inflammation. The most common area of pain and swelling is the Achilles tendon at the back of your ankle. This can also happen with other tendons.
   • Tendon rupture can happen while you are taking or after you have finished taking ciprofloxacin. Tendon ruptures can happen within hours or days of taking ciprofloxacin for oral suspension and have happened up to several months after people have finished taking their fluoroquinolone.
   • Stop taking ciprofloxacin for oral suspension immediately and get medical help right away if you get any of the following signs or symptoms of a tendon rupture:
     • hear or feel a snap or pop in a tendon area
     • bruising right after an injury in a tendon area
     • unable to move the affected area or bear weight
       The tendon problems may be permanent.
2. Changes in sensation and possible nerve damage (Peripheral Neuropathy). Damage to the nerves in arms, hands, legs, or feet can happen in people who take fluoroquinolones, including ciprofloxacin. Stop taking ciprofloxacin for oral suspension immediately and talk to your healthcare provider right away if you get any of the following symptoms of peripheral neuropathy in your arms, hands, legs, or feet:
   Ciprofloxacin for oral suspension may need to be stopped to prevent permanent nerve damage.
3. Central Nervous System (CNS) effects. Mental health problems and seizures have been reported in people who take fluoroquinolone antibacterial medicines, including ciprofloxacin. Tell your healthcare provider if you have a history of seizures before you start taking ciprofloxacin for oral suspension. CNS side effects may happen as soon as after taking the first dose of ciprofloxacin. Stop taking ciprofloxacin immediately and talk to your healthcare provider right away if you get any of these side effects, or other changes in mood or behavior:
   These changes may be permanent.
4. Worsening of myasthenia gravis (a problem that causes muscle weakness). Fluoroquinolones like ciprofloxacin may cause worsening of myasthenia gravis symptoms, including muscle weakness and breathing problems. Tell your healthcare provider if you have a history of myasthenia gravis before you start taking ciprofloxacin for oral suspension. Call your healthcare provider right away if you have any worsening muscle weakness or breathing problems.

• Studies of ciprofloxacin for use in the treatment of plague and anthrax were done in animals only, because plague and anthrax could not be studied in people.
• Ciprofloxacin for oral suspension should not be used in people with acute exacerbation of chronic bronchitis, acute uncomplicated cystitis, and sinus infections, if there are other treatment options available.
• Ciprofloxacin for oral suspension should not be used as the first choice of antibacterial medicine to treat lower respiratory tract infections caused by a certain type of bacterial called Streptococcus pneumoniae.
• ciprofloxacin for oral suspension is also used in children younger than 18 years of age to treat complicated urinary tract and kidney infections or who may have breathed in anthrax germs, have plague or have been exposed to plague germs.
• Children younger than 18 years of age have a higher chance of getting bone, joint, or tendon (musculoskeletal) problems such as pain or swelling while taking ciprofloxacin for oral suspension. Ciprofloxacin for oral suspension should not be used as the first choice of antibacterial medicine in children under 18 years of age.

Who should not take ciprofloxacin for oral suspension?

Do not take ciprofloxacin for oral suspension if you:

• have ever had a severe allergic reaction to an antibacterial medicine known as a fluoroquinolone, or are allergic to ciprofloxacin hydrochloride or any of the ingredients in ciprofloxacin for oral suspension. See the end of this Medication Guide for a complete list of ingredients in ciprofloxacin for oral suspension.
• also take a medicine called tizanidine (Zanaflex ®).

Ask your healthcare provider if you are not sure.

What should I tell my healthcare provider before taking ciprofloxacin for oral suspension?

Before you take ciprofloxacin for oral suspension, tell your healthcare provider about all your medical conditions, including if you:

• have tendon problems. Ciprofloxacin for oral suspension should not be used in people who have a history of tendon problems.
• have a disease that causes muscle weakness (myasthenia gravis). Ciprofloxacin for oral suspension should not be used in people who have a known history of myasthenia gravis.
• have liver problems.
• have central nervous system problems (such as epilepsy).
• have nerve problems. Ciprofloxacin for oral suspension should not be used in people who have a history of a nerve problem called peripheral neuropathy have or anyone in your family has an irregular heartbeat, or heart attack, especially a condition called “QT prolongation”.
• have low blood potassium (hypokalemia) or low magnesium (hypomagnesemia).
• have or have had seizures.
• have kidney problems. You may need a lower dose of ciprofloxacin if your kidneys do not work well.
• have diabetes or problems with low blood sugar (hypoglycemia).
• have joint problems including rheumatoid arthritis (RA).
• have trouble swallowing pills.
• are pregnant or plan to become pregnant. It is not known if ciprofloxacin for oral suspension will harm your unborn baby.
• are breastfeeding or plan to breastfeed. Ciprofloxacin passes into your breast milk.
  • You should not breastfeed during treatment with ciprofloxacin for oral suspension and for 2 days after taking your last dose of ciprofloxacin for oral suspension. You may pump your breast milk and throw it away during treatment with Ciprofloxacin for oral suspension and for 2 days after taking your last dose of ciprofloxacin.
  • If you are taking ciprofloxacin for oral suspension for inhalation anthrax, you and your healthcare provider should decide whether you can continue breastfeeding while taking ciprofloxacin for oral suspension.

Tell your healthcare provider about all the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements.

• Ciprofloxacin for oral suspension and other medicines can affect each other causing side effects.
• Especially tell your healthcare provider if you take:
  • a steroid medicine.
  • an anti-psychotic medicine.
  • a tricyclic antidepressant.
  • a water pill (diuretic).
  • theophylline (such as Theo-24 ®, Elixophyllin ®, Theochron ®, Uniphyl ®, Theolair ®).
  • a medicine to control your heart rate or rhythm (antiarrhythmics).
  • an oral anti-diabetes medicine.
  • phenytoin (Fosphenytoin Sodium ®, Cerebyx ®, Dilantin-125 ®, Dilantin ®, Extended Phenytoin Sodium ®, Prompt Phenytoin Sodium ®, Phenytek ®).
  • cyclosporine (Gengraf ®, Neoral ®, Sandimmune ®, Sangcya ®).
  • a blood thinner (such as warfarin, Coumadin ®, Jantoven ®).
  • methotrexate (Trexall ®).
  • ropinirole (Requip ®).
  • clozapine (Clozaril ®, Fazaclo ® ODT ®).
  • a Non-Steroidal Anti-Inflammatory Drug (NSAID). Many common medicines for pain relief are NSAIDs. Taking an NSAID while you take ciprofloxacin or other fluoroquinolones may increase your risk of central nervous system effects and seizures.
  • sildenafil (Viagra ®, Revatio ®).
  • duloxetine.
  • products that contain caffeine.
  • probenecid (Probalan ®, Col-probenecid ®).
• Certain medicines may keep Ciprofloxacin oral suspension from working correctly. Take ciprofloxacin oral suspension either 2 hours before or 6 hours after taking these medicines, vitamins, or supplements:
  • an antacid, multivitamin, or other medicine or supplements that has magnesium, calcium, aluminum, iron, or zinc.
  • sucralfate (Carafate ®).
  • didanosine (Videx ®, Videx EC ®).

Ask your healthcare provider for a list of these medicines if you are not sure.

Know the medicines you take. Keep a list of them to show your healthcare provider and pharmacist when you get a new medicine.

How should I take ciprofloxacin for oral suspension?

• Take ciprofloxacin for oral suspension exactly as your healthcare provider tells you to take it.
• Your healthcare provider will tell you how much ciprofloxacin for oral suspension to take and when to take it.
• Ciprofloxacin for oral suspension can be taken with or without food.
• Ciprofloxacin for oral suspension should not be taken with dairy products (like milk or yogurt) or calcium-fortified juices alone but may be taken with a meal that contains these products.
• Drink plenty of fluids while taking ciprofloxacin for oral suspension.
• Do not skip any doses of ciprofloxacin for oral suspension, or stop taking it, even if you begin to feel better, until you finish your prescribed treatment unless:
  • you have tendon problems. See “What is the most important information I should know about ciprofloxacin for oral suspension?”
  • you have nerve problems. See “What is the most important information I should know about ciprofloxacin for oral suspension?”
  • you have central nervous system problems. See “What is the most important information I should know about ciprofloxacin for oral suspension?”
  • you have a serious allergic reaction. See “ What are the possible side effects of ciprofloxacin for oral suspension?”
  • your healthcare provider tells you to stop taking ciprofloxacin for oral suspension.

• Taking all of your ciprofloxacin for oral suspension doses will help make sure that all of the bacteria are killed. Taking all of your ciprofloxacin for oral suspension doses will help lower the chance that the bacteria will become resistant to ciprofloxacin. If you become resistant to ciprofloxacin, ciprofloxacin for oral suspension and other antibacterial medicines may not work for you in the future.

• If you take too much ciprofloxacin for oral suspension, call your healthcare provider or get medical help right away.
• Ciprofloxacin is supplied as a tablet, oral suspension, extended-release tablet and injection for intravenous infusion. Read and follow the instructions below for the type of ciprofloxacin your healthcare provider has prescribed for you.

Ciprofloxacin for Oral Suspension:

• Take ciprofloxacin for oral suspension in the morning and evening at about the same time each day. Shake the ciprofloxacin oral suspension bottle well each time before use for about 15 seconds to make sure the suspension is mixed well. Close the bottle completely after use.
• If you miss a dose of ciprofloxacin for oral suspension and it is:
  • 6 hours or more until your next scheduled dose, take your missed dose right away. Then take the next dose at your regular time.
  • less than 6 hours until your next scheduled dose, do not take the missed dose. Take the next dose at your regular time.
• Do not take 2 doses of ciprofloxacin for oral suspension at 1 time to make up for a missed dose. If you are not sure about when to take ciprofloxacin for oral suspension after a missed dose, ask your healthcare provider or pharmacist.

What should I avoid while taking ciprofloxacin for oral suspension?

• Ciprofloxacin for oral suspension can make you feel dizzy and lightheaded. Do not drive, operate machinery, or do other activities that require mental alertness or coordination until you know how ciprofloxacin affects you.
• Avoid sunlamps, tanning beds, and try to limit your time in the sun. Ciprofloxacin for oral suspension can make your skin sensitive to the sun (photosensitivity) and the light from sunlamps and tanning beds. You could get a severe sunburn, blisters or swelling of your skin. If you get any of these symptoms while you take ciprofloxacin for oral suspension, call your healthcare provider right away. You should use a sunscreen and wear a hat and clothes that cover your skin if you have to be in sunlight.

How should I store ciprofloxacin for oral suspension?

Ciprofloxacin for Oral Suspension

• Store granular blend and diluent at room temperature up to 77°F (25°C).
• Do not freeze.
• After your ciprofloxacin for oral suspension treatment is finished, safely throw away any unused oral suspension.

Keep ciprofloxacin for oral suspension and all medicines out of the reach of children.

General Information about the safe and effective use of ciprofloxacin for oral suspension.

Medicines are sometimes prescribed for purposes other than those listed in a Medication Guide. Do not use ciprofloxacin for oral suspension for a condition for which it is not prescribed. Do not give ciprofloxacin for oral suspension to other people, even if they have the same symptoms that you have. It may harm them.

This Medication Guide summarizes the most important information about ciprofloxacin for oral suspension. If you would like more information about ciprofloxacin for oral suspension, talk with your healthcare provider. You can ask your healthcare provider or pharmacist for information about ciprofloxacin for oral suspension that is written for health professionals.