Cifran-250 Tab

Side Effects of Cifran-250 Tab

GI disturbances; headache, tremor, confusion, convulsions; rashes; joint pain; phototoxicity. Transient increases in serum creatinine. Haematological, hepatic and renal disturbances. Vasculitis, pseudomembranous colitis and tachycardia. Phototoxicity. Potentially Fatal: Anaphylactoid reaction; cardiopulmonary arrest.

Drug Interactions

Decreased absorption with concurrent sucralfate, magnesium-aluminum antacids, calcium, iron, zinc and multivitamins. Increased methotrexate and caffeine levels when taken concurrently with ciprofloxacin. Probenecid reduces renal clearance of ciprofloxacin. Potentiates oral anticoagulants and glibenclamide. Concurrent use with corticosteroids may increase tendon rupture. Concurrent use with ciclosporin may cause transient increases in serum creatinine. CNS excitation may occur with concurrent admin of quinolones and NSAIDs. Serum concentrations of theophylline are markedly elevated when co-administered with ciprofloxacin; monitor serum levels of theophylline. Potentially Fatal: Concurrent use with tizanidine can cause marked elevation in serum levels of tizanidine; avoid concurrent usage.

Contraindications

Hypersensitivity. Not to be used concurrently with tizanidine. Avoid exposure to strong sunlight or sun lamps during treatment.

Mechanism of Action

Ciprofloxacin promotes breakage of double-stranded DNA in susceptible organisms and inhibits DNA gyrase, which is essential in reproduction of bacterial DNA. Absorption: Rapidly and well absorbed from the GI tract with peak plasma concentrations after 2 hr (oral); may be delayed by the presence of food. Distribution: Bile (high concentrations), CSF (10% of those in plasma in the absence of meningitis); crosses the placenta and enters the breast milk. Protein-binding: 20-40%. Metabolism: Converted to oxociprofloxacin, sulfociprofloxacin and other active metabolites. Excretion: Mainly via the urine by active tubular secretion and glomerular filtration (as oxociprofloxacin and 15% metabolites, 40% unchanged after oral dose; 70% as unchanged, 10% as metabolites after IV dose); hepatic, biliary and transluminal secretion (non-renal excretion). Via the faeces (as sulfociprofloxacin; 35% after oral dose, 15% after IV dose); 3.5-4.5 hr (elimination half-life). Removed by haemodialysis and peritoneal dialysis (small amounts).

Special Precautions

Epilepsy, history of CNS disorders; severe renal or hepatic dysfunction; G6PD deficiency; maintain adequate hydration; myasthaenia gravis. Caution when used in patients with QT prolongation or risk factors e.g. bradycardia, pre-existing cardiac disease or uncorrected electrolyte disturbances. Discontinue treatment if patients experience tendon pain, inflammation or rupture. Avoid usage in methicillin-resistant staphylococcus aureus (MRSA) infections due to high level of resistance. May impair ability to drive or operate machinery. Safety and efficacy have not been established in pregnant and lactating women. Not to be used in children <18 yr; except where benefit clearly exceeds risk.

How to Use

Take orally with food and water, as directed by your physician.

How to Store

Keep in a cool, dry place away from sunlight and moisture.

Safety Concerns

• Alcohol: Avoid during treatment.
• Breastfeeding: Not recommended.
• Pregnancy: Contraindicated.
• Liver/Kidney: Use with caution.

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