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Ciprofloxacin

Cipro, Ciprotab

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Written by R. Author | Reviewed by Uche Ruth

Updated on June 12, 2024

Overview

Ciprofloxacin, commonly known as Cipro, is a type of fluoroquinolone antibiotic. It is effective against a variety of bacterial infections, such as sinus infections and urinary tract infections (UTIs). However, due to the risk of severe side effects like tendon rupture and nerve damage, ciprofloxacin is generally reserved for more serious infections or when other safer alternatives are not available. Ciprofloxacin is administered orally, usually twice a day, and comes in both pill and liquid forms. Common side effects of this medication may include nausea and diarrhea.

What is Ciprofloxacin (Cipro) used for?

Adults only

Adults and children

How Ciprofloxacin (Cipro) works

Ciprofloxacin (Cipro) is a fluoroquinolone (or "quinolone") antibiotic. It works by blocking certain enzymes (proteins) that bacteria use to grow and repair their genetic material (DNA) in order to survive. By blocking this process, the antibiotic kills bacteria.

Pros and cons of Ciprofloxacin (Cipro)

pros and cons of ciprofloxacin
Pharmacist tips for Ciprofloxacin (Cipro)

  • Take ciprofloxacin (Cipro) exactly as prescribed. Make sure to finish your treatment course, even if you're feeling better. Stopping the medication earlier than prescribed can make your infection come back and become more difficult to treat.
  • You can take ciprofloxacin (Cipro) with or without food. If it's upsetting your stomach, try taking it with food to help. But be sure to avoid dairy products (e.g., milk, yogurt) and calcium-containing juices. Calcium can lower the amount of ciprofloxacin (Cipro) that gets absorbed into your body. Take ciprofloxacin (Cipro) at least 2 hours before or 6 hours after dairy or calcium-containing juices.
  • Make sure to stay well-hydrated by drinking enough fluids while taking ciprofloxacin (Cipro). Doing so helps prevent dehydration if you get diarrhea while taking ciprofloxacin (Cipro).
  • Ciprofloxacin (Cipro) can cause skin sensitivity to the sun. To protect your skin, make sure to wear sunscreen when going outside, wear long-sleeve clothing, and avoid being exposed to light or sun for a long time as much as possible.
  • If you develop watery or bloody diarrhea, fever, fatigue, or stomach cramps anytime during treatment or after stopping ciprofloxacin (Cipro), get medical help right away because these could be signs of a type of infectious diarrhea.
  • Limit or avoid drinking coffee or taking medications that contains caffeine, like Excedrin (acetaminophen / aspirin / caffeine) while taking ciprofloxacin (Cipro). Ciprofloxacin (Cipro) can make you more likely to feel the effects of caffeine, such as jitteriness.
  • If you have diabetes, ask your HCP if you need to check your blood sugar more often while taking ciprofloxacin (Cipro). This antibiotic can affect your blood sugar levels when taken with certain diabetes medications.
  • Speak with your healthcare team about the risks and benefits of taking ciprofloxacin (Cipro) if you're pregnant. Based on limited studies, there isn't a clear link between fluoroquinolone antibiotic use during pregnancy and harm in babies. But there's also not enough evidence to confirm that there isn't a risk to babies when taken during pregnancy.
  • Discuss with your healthcare team about the risks and benefits of breastfeeding while taking ciprofloxacin (Cipro). It's not recommended to breastfeed while taking ciprofloxacin (Cipro) and at least 2 days after the last dose because it can be passed into breastmilk. Consider feeding your baby with baby formula during this time.

More tips for the oral suspension (liquid)

  • The ciprofloxacin (Cipro) suspension is available as a 250 mg/5 mL and 500 mg/5 mL suspension. Make sure you know which strength of the suspension you have so you can measure your dose properly. Ask your pharmacist if you're not sure how much medication to measure out for your dose.
  • Shake the bottle well before using. Make sure to only use a medication dose cup or oral syringe from the pharmacy to measure out your dose. Don't use household spoons because they aren't accurate and might cause you to take the wrong dose.
  • Store the ciprofloxacin (Cipro) suspension at room temperature for up to 14 days in the original bottle you received from the pharmacy.

What are the risks and warnings for Ciprofloxacin (Cipro)?

Ciprofloxacin (Cipro) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.

Tendon inflammation and rupture

  • Risk factors: Age over 60 years | Taking corticosteroids | History of transplant(s) | High-intensity physical activity | Kidney failure | History of tendon-related problems, such as rheumatoid arthritis

Quinolone antibiotics like ciprofloxacin (Cipro) can raise your risk of inflammation in the tendon (tendonitis) or tearing of the tendon. This most often happens at the Achilles tendon, which is above your heel. But it can affect other tendons throughout your body too (e.g., shoulder, hand). Tendon damage can happen at any time after you start ciprofloxacin (Cipro) or up to several months after stopping the medication. If you experience pain or swelling in your joints or muscles, stop taking ciprofloxacin (Cipro) and contact your prescriber right away.

Effects on the brain, nerves, and mental health

  • Risk factors: History of seizures or nerve damage | Medical conditions that raise the risk of seizures | Kidney problems | Taking medications that raise the risk of seizures

Fluoroquinolone antibiotics like ciprofloxacin (Cipro) can raise your risk of seizures, dizziness, and tremors. This medication can also put you at risk for nerve damage that can happen shortly after starting treatment. Nerve damage can feel like pain, numbness, tingling, burning, weakness, and changes in sensations related to touch or temperature.

Ciprofloxacin (Cipro) can also raise your risk of depression, suicidal thoughts or behavior, aggressive behavior, psychosis, nervousness, trouble sleeping, and confusion. These changes in behavior or thoughts can happen even after just one dose of medication. If you experience any of these side effects, seek medical help right away or contact your HCP. They can help manage your treatment.

Worsening of myasthenia gravis

If you have myasthenia gravis, taking ciprofloxacin (Cipro) can worsen symptoms like muscle weakness and difficulty breathing. Ask your prescriber about using a different antibiotic if you have myasthenia gravis.

Severe allergic and skin reactions

Severe allergic reactions to ciprofloxacin (Cipro) are possible, including life-threatening reactions like facial swelling, shock, and anaphylaxis (e.g., closing of the throat). If you notice hives, rash, swelling of the lips or tongue, or difficulty breathing after taking ciprofloxacin (Cipro), get medical attention right away.

Additionally, ciprofloxacin (Cipro) can cause rare but serious skin reactions, such as Stevens-Johnson syndrome (SJS). If you notice changes in your skin, such as rash, blisters, or skin reddening or peeling, stop using ciprofloxacin (Cipro) and get medical attention as soon as possible.

Liver damage

  • Risk factors: Liver problems | Age over 55 years

Some people taking ciprofloxacin (Cipro) have had serious liver problems that can possibly lead to liver failure. Get medical attention if you notice stomach bloating or pain, yellowing of your skin or the whites of your eyes, stool changes (black, tarry, or bloody stools), or dark or brown urine. You might need to stop using the antibiotic to prevent further liver damage.

Severe damage to a major blood vessel

  • Risk factors: Age 65 years and older

In studies, there was a higher rate of severe damage to the aorta within 2 months of finishing ciprofloxacin (Cipro) treatment, especially in older adults. The aorta is the largest blood vessel in the body, and it delivers blood to the rest of your body. Damage to the aorta, such as weakening and tearing, can be severe and life-threatening. Talk with your HCP if you have a history of an aortic aneurysm since ciprofloxacin (Cipro) might not be the best medication for you. If you experience sudden pain in the chest, back, or stomach that's severe and doesn't go away, call 911 or go to the emergency room right away.

Infectious diarrhea

Ciprofloxacin (Cipro) can raise your risk of getting infected with a bacteria called Clostridioides difficile (C. diff). This infection can cause severe diarrhea. Antibiotics change the amount of normal bacteria in your stomach and intestines. This can cause C. diff to overgrow in your gut and lead to an infection. It's important to recognize the difference between diarrhea as a side effect of ciprofloxacin (Cipro) and this type of infectious diarrhea. C. diff-related diarrhea can cause rapid heart rate, foul-smelling diarrhea, fever, nausea, frequent bowel movements (even up to 15 times per day) and is an emergency. If you have any of these symptoms, get medical attention immediately so you can get tested for C. diff infection and receive treatment.

Life-threatening abnormal heart rhythm (QT prolongation)

  • Risk factors: Older age | Low blood potassium or magnesium levels | History of heart problems, slow heart rate, or other abnormal heart rhythms (arrhythmias) | Personal or family history of long QT syndrome | Taking other medications that cause QT prolongation

Ciprofloxacin (Cipro) can affect your heart rhythm, which can be serious and life-threatening. One example includes lengthening the time it takes for your heart to pump and then relax. This is known as QT prolongation. Your risk for QT prolongation is higher if you have certain factors, including abnormal electrolyte levels, heart rhythm problems, or are taking other medications that cause heart rhythm problems, such as amiodarone (Pacerone), among others. If you feel your chest pounding, have shortness of breath or chest pain, or feel faint or lightheaded while taking ciprofloxacin (Cipro), call 911 right away.

Muscle, bone, or joint problems in children

In studies, some children taking ciprofloxacin (Cipro) had problems in their muscles, bones, or joints. Because of this risk, ciprofloxacin (Cipro) should only be used in children if other antibiotics can't be used. Your child's pediatrician will decide whether ciprofloxacin (Cipro) is an appropriate antibiotic for your child.

Sun and light sensitivity

Ciprofloxacin (Cipro) makes your skin more sensitive to the sun or ultraviolet (UV) light. This means you can get sunburns more easily than usual. This can happen even during the winter and on overcast days. To lower your risk, make sure to wear sunscreen when going outside and wear long-sleeved clothing to protect your skin. Also avoid being exposed to light or sun for a long time.

Kidney problems

  • Risk factors: Dehydration (low fluids in the body)

Very rarely, ciprofloxacin (Cipro) can cause kidney problems. Make sure to stay hydrated while taking this antibiotic. Let your HCP know if you have any lower back pain; difficulty urinating; or swelling in your feet, ankles, or hands. These could be signs of kidney problems caused by ciprofloxacin (Cipro).

Strengths

Bottle of oral suspension

  • 100ml of 250mg/5ml
  • 100ml of 500mg/5ml

Tablet

  • 250mg | 14 tablets
  • 500mg

Dosages

Your healthcare team will determine your dose of ciprofloxacin (Cipro) based different factors, such as the type of infection you have and how serious it is.

General dosing for ciprofloxacin (Cipro) tablets and oral solution:

  • Skin, bone, and joint infections (adults): The typical dose ranges from 500 mg to 750 mg by mouth every 12 hours. Treatment for skin infections usually lasts 1 to 2 weeks. Treatment for bone and joint infections can take 1 to 2 months.
  • Stomach infections and infectious diarrhea (adults): The typical dose is 500 mg by mouth every 12 hours. Treatment for serious stomach infections usually last 1 to 2 weeks. Treatment for infectious diarrhea can take 5 to 7 days.
  • Sinus infections and typhoid fever (adults): The typical dose is 500 mg by mouth every 12 hours for 10 days.
  • Lower respiratory tract infection (adults): The typical dose ranges from 500 mg to 750 mg by mouth every 12 hours for 1 to 2 weeks.
  • Prostate infections (adults): The typical dose is 500 mg by mouth every 12 hours for a month.
  • Gonorrhea (adults): The typical dose is 250 mg by mouth as a single dose.
  • Urinary tract infections
    • Adults: The typical dose is 250 mg by mouth every 12 hours for 3 days. The dosing for more serious infections ranges from 250 mg to 500 mg by mouth every 12 hours for 1 to 2 weeks.
    • Children (ages 1 year and older): Your child's pediatrician will determine the dose based on your child's body weight. The typical dose ranges from 10 mg/kg to 20 mg/kg (maximum 750 mg) by mouth every 12 hours for 10 to 21 days.
  • Anthrax
    • Adults: The typical dose is 500 mg by mouth every 12 hours for 2 months.
    • Children: Your child's pediatrician will determine the dose based on your child's body weight. The typical dose is 15 mg/kg (maximum 500 mg) by mouth every 12 hours for 2 months.
  • Plague
    • Adults: The typical dose is 500 mg to 750 mg by mouth every 12 hours for 2 weeks.
    • Children: Your child's pediatrician will determine the dose based on your child's body weight. The typical dose is 15 mg/kg (maximum 500 mg) by mouth every 8 to 12 hours for 2 weeks.

Your dose might differ if you have kidney or liver problems.

Ciprofloxacin (Cipro) is also available as an injection through the veins that's given by a healthcare professional in the hospital setting.

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Interactions

Ciprofloxacin (Cipro) may interact with certain medications or supplements. Always let your doctor and pharmacist know about any other medications or supplements (including prescribed and over-the-counter medications, vitamins, and dietary or herbal supplements) that you are currently taking. The list below does not include all possible drug interactions with Ciprofloxacin (Cipro). Please note that only the generic name of each medication is listed below.

More on Ciprofloxacin (Cipro) interactions
Using this medicine with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.

Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

Side-effects

The following side effects may get better over time as your body gets used to the medication. Let your healthcare provider know immediately if you continue to experience these symptoms or if they worsen over time.

Common Side Effects

  • Nausea
  • Diarrhea
  • Vomiting
  • Rash
  • Abnormal liver blood test results

Serious Side Effects

Contact your healthcare provider immediately if you experience any of the following.

  • Achilles pain, pain or swelling at joint or muscle
  • Seizures
  • Changes in thoughts or behavior
  • Nerve damage: numbness, tingling, "pins-and-needles" feeling, burning, changes in sensations related to light touch or temperature
  • Major blood vessel damage: sudden, severe chest, back, or stomach pain; shortness of breath; pain in arms or legs
  • Infectious (C. difficile-related) diarrhea: foul-smelling diarrhea, fever, frequent bowel movements
  • Abnormal heart rhythm: chest pounding, chest pain, shortness of breath, feeling faint or lightheaded
  • Kidney problems: urinating less often than usual; swelling in your feet, ankles, or hands
  • Liver problems: stomach bloating, yellowing of your skin or the whites of your eyes, dark urine
  • Serious allergic and skin reactions: hives, blisters, skin reddening or peeling, swelling of the lips or tongue, difficulty breathing

When do Ciprofloxacin (Cipro) possible side effects begin and end?

Time passed since treatment started:

If a line continues to the right, you'll likely keep experiencing this side effect once it starts.

The following side effects have also been reported

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor immediately if any of the following side effects occur:

More common

Rare

  • Bloody or black, tarry stools
  • Burning, crawling, itching, numbness, prickling, "pins and needles", or tingling feelings
  • Changes in skin color
  • Changes in urination
  • Chest pain or discomfort
  • Chest tightness or heaviness
  • Chills
  • Clumsiness or unsteadiness
  • Confusion
  • Continuing ringing or buzzing or other unexplained noise in the ears
  • Coughing or spitting up blood
  • Dizziness, fainting, or lightheadedness when getting up suddenly from a lying or sitting position
  • Fast, irregular, pounding, or racing heartbeat or pulse
  • Fever
  • Headache, severe and throbbing
  • Hearing loss
  • Hives or welts, skin rash
  • Joint stiffness
  • Large, hive-like swelling on the face, eyelids, lips, tongue, throat, hands, legs, feet, or genitals
  • Light-colored stools
  • Muscle pain or stiffness
  • Nausea
  • Nightmares
  • Numbness of the hands
  • Pain in the joints
  • Pain or discomfort in the arms, jaw, back, or neck
  • Painful, red lumps under the skin, mostly on the legs
  • Pounding in the ears
  • Puffiness or swelling of the eyelids or around the eyes, face, lips, or tongue
  • Redness of the face, neck, arms, and occasionally, upper chest
  • Seizures
  • Severe stomach pain, cramping, or burning
  • Shakiness in the legs, arms, hands, or feet
  • Swelling of the face, feet, or lower legs
  • Swollen, painful, or tender lymph glands in the neck, armpit, or groin
  • Thick, white vaginal discharge with no odor or with a mild odor
  • Unsteadiness, trembling, or other problems with muscle control or coordination
  • Unusual drowsiness, dullness, tiredness, weakness, or feeling of sluggishness
  • Vomiting
  • White patches in the mouth or on the tongue
  • Yellow eyes or skin

Incidence not known

  • Blistering, peeling, or loosening of the skin
  • Bluish-colored lips, fingernails, or palms
  • Bone pain
  • Diarrhea, watery and severe, which may also be bloody
  • Difficulty with breathing, chewing, or talking
  • Double vision
  • Excessive muscle tone
  • Feeling of discomfort
  • Feeling, seeing, or hearing things that are not there
  • Increased sensitivity of the skin to sunlight
  • Increased sensitivity to pain or touch
  • Irregular or slow heart rate
  • Loss of sense of smell
  • Mood changes
  • Nosebleeds
  • Rapid heart rate
  • Red skin lesions, often with a purple center
  • Seeing, hearing, or feeling things that are not there
  • Sensation of skin burning
  • Severe sunburn
  • Sores, ulcers, or white spots on the lips or in the mouth
  • Uncontrolled eye movements
  • Unusual bleeding or bruising
  • Unusual excitement, nervousness, or restlessness
  • Vaginal yeast infection

Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

Less common

Common Concerns

How long it takes for ciprofloxacin (Cipro) to work can differ for each person depending on what type of infection you have and how serious it is. In general, people who take antibiotics typically begin to feel better within 1 to 3 days after starting treatment. But even if you feel better, it's important to finish the full course of ciprofloxacin (Cipro). If you stop ciprofloxacin (Cipro) too early, your infection might come back and become more challenging to treat.
Your primary care provider (PCP) will let you know how long to take ciprofloxacin (Cipro) to treat an urinary tract infection (UTI). The length of treatment for an UTI depends on different factors, such as what symptoms you have and whether you're at higher risk for any complications. If you have an uncomplicated UTI, your PCP will likely only prescribe ciprofloxacin (Cipro) for 3 days. But if you have a complicated UTI, your PCP might ask you to take ciprofloxacin (Cipro) for 1 to 2 weeks. Ask your healthcare team if you've more questions about treating UTIs.
No, ciprofloxacin (Cipro) is a fluoroquinolone (or "quinolone") antibiotic, whereas penicillin is a beta-lactam antibiotic. While the medications can be used to treat similar infections, they work differently to get rid of bacteria. Your healthcare professional (HCP) might consider ciprofloxacin (Cipro) as an option if you're allergic to penicillin and ciprofloxacin (Cipro) is able to treat your infection.
No. Ciprofloxacin (Cipro) isn't a sulfa drug; it's a quinolone antibiotic. Ciprofloxacin (Cipro) is unlikely to trigger an allergic reaction if you have a sulfa allergy.
Ciprofloxacin (Cipro) can interact with several medications. You might not need to avoid these medications completely while you're taking ciprofloxacin (Cipro). But your primary care provider (PCP) might adjust the dose of your medications, change the timing of when you take certain medications, or monitor you more closely for side effects. For example, certain supplements, like calcium or iron, can prevent your body from fully absorbing ciprofloxacin (Cipro). This means ciprofloxacin (Cipro) won't work as well in treating your infection. If you need to take one of these supplements, your PCP will recommend that you take ciprofloxacin (Cipro) at least 2 hours before or 6 hours after you take the supplements. Make sure to tell your HCP and pharmacist about all of the medications you're taking so they can help you check for interactions.
Ask your primary care provider what pain reliever you might be able to take with ciprofloxacin (Cipro). This can depend on what other medical conditions you have and your dose of ciprofloxacin (Cipro). For example, ciprofloxacin (Cipro) isn't known to interact with acetaminophen (Tylenol). You might be able to take acetaminophen (Tylenol) with ciprofloxacin (Cipro) if you don't have liver problems. But there have been rare reports of people experiencing seizures after taking higher doses of ciprofloxacin (Cipro) with non-steroidal anti-inflammatory drugs (NSAIDs). Your PCP might ask you to avoid taking NSAIDs, such as ibuprofen (Advil) or naproxen (Aleve), if you're at higher risk for seizures.
How long side effects of ciprofloxacin (Cipro) lasts can differ depending on what symptoms you're experiencing. For example, ciprofloxacin (Cipro) commonly causes nausea throughout treatment. But your healthcare team can recommend ways to ease this side effect, like taking ciprofloxacin (Cipro) with a meal or snack. Other side effects are more rare, such as pain and swelling in the tendons. While you're unlikely to experience this side effect during treatment, you're at risk for this problem even months after you stop ciprofloxacin (Cipro). Your care team might also ask you to pause certain activities, like running or jumping, for a few months after you end treatment. But if you do experience tendon pain, you need to get medical help right away. If you have a question about a specific ciprofloxacin (Cipro) side effect, talk with your care team.
No, feeling tired wasn't a reported side effect from people taking ciprofloxacin (Cipro) during clinical trials. But feeling tired might be a symptom of your infection. Contact your care team if you feel more tired than usual, especially if your tiredness doesn't get better with time; they can try to identify what might be causing it.
Yes, diarrhea is a possible side effect of ciprofloxacin (Cipro), just like most antibiotics. If you experience diarrhea, you can try following the BRAT diet for a short while to help with your stomach upset. Also, ask your prescriber if it's safe for you to take over-the-counter diarrhea medications. But call your HCP right away if you start having watery or bloody diarrhea, fever, fatigue, or stomach cramps anytime during treatment or after stopping ciprofloxacin (Cipro). These could be signs of serious infectious diarrhea called C. diff diarrhea that requires treatment.

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