Ciprofloxacin IV Concentrate Rx
Generic Name and Formulations:
Ciprofloxacin 10mg/mL; soln for IV infusion after dilution.
Various generic manufacturers
Indications for Ciprofloxacin IV Concentrate:
Susceptible infections, including lower respiratory tract, acute exacerbations of chronic bronchitis (AECB), skin and skin structures, bone and joint, acute sinusitis, complicated intraabdominal (w. metronidazole), UTIs, chronic bacterial prostatitis, acute uncomplicated cystitis in females. Postexposure prophylaxis and treatment of anthrax. Infectious diarrhea, typhoid fever, uncomplicated cervical and urethral gonorrhea: oral form only. Nosocomial pneumonia, empiric therapy in febrile neutropenia: IV form only. For AECB, acute sinusitis, and acute uncomplicated cystitis: reserve for those who have no alternative treatment options.
See full labeling. Infuse over 60 mins. Switch to oral form when appropriate. ≥18yrs: Lower respiratory tract, skin and skin structure: 400mg every 8–12hrs for 7–14 days. Nosocomial pneumonia: 400mg every 8hrs for 10–14 days. Intraabdominal (w. metronidazole): 400mg every 12hrs for 7–14 days. Bone and joint: 400mg every 8–12hrs for 4–8 weeks. Acute sinusitis: 400mg every 12hrs for 10 days. UTIs: 200–400mg every 8–12hrs for 7–14 days. Prostatitis: 400mg every 12hrs for 28 days. Febrile neutropenia: 400mg every 8hrs (+ piperacillin sodium 50mg/kg IV every 4hrs; max 24g/day) for 7–14 days. Postexposure prophylaxis of inhalational anthrax: 400mg every 12hrs for 60 days (start as soon as possible after exposure). Treatment of inhalational, GI, or oropharyngeal anthrax, or cutaneous anthrax with systemic involvement, extensive edema, or head/neck lesions: see CDC recommendations. Renal dysfunction (CrCl 5–29mL/min): 200–400mg every 18–24hrs.
<18yrs: usually not recommended. See full labeling. Infuse over 60 mins. Switch to oral form when appropriate. 1–17yrs: Complicated UTIs or pyelonephritis: 6–10mg/kg (max 400mg) IV every 8hrs for 10–21 days (see full labeling). Postexposure prophylaxis of inhalational anthrax: 10mg/kg (max 400mg/dose) every 12hrs for 60 days (start as soon as possible after exposure). Treatment of inhalational, GI, cutaneous, or oropharyngeal anthrax: see CDC recommendations.
Tendinitis and tendon rupture. Peripheral neuropathy. CNS effects. Exacerbation of myasthenia gravis.
XR not interchangeable with other forms. Increased risk of disabling and potentially irreversible adverse reactions (including tendinitis/tendon rupture [esp. in patients >60yrs, or those with kidney, heart or lung transplants], peripheral neuropathy, or CNS effects); discontinue immediately if signs/symptoms occur. CNS disorders (eg, cerebral arteriosclerosis, epilepsy) that increase seizure risk. History of myasthenia gravis; avoid. Renal (except XR tabs for uncomplicated UTIs) or hepatic dysfunction: reduce dose. History of QT prolongation, ventricular arrhythmias, proarrhythmic conditions (eg, bradycardia, acute myocardial ischemia), hypokalemia, or hypomagnesemia; avoid. Discontinue at 1st sign of skin rash, jaundice, any other hypersensitivity, phototoxicity, or hepatitis. History of joint-related disorders (esp. children). Maintain adequate hydration, avoid alkaline urine to avoid crystalluria. May mask symptoms of syphilis; test for syphilis before treating gonorrhea, then follow-up after 3 months. Monitor blood, renal, hepatic function in prolonged use. Avoid excessive sun and UV light. Elderly. Pregnancy (Cat.C). Nursing mothers: not recommended.
See Contraindications. Potentiates hypotensive and sedative effects of tizanidine. Avoid theophylline (increases theophylline levels), duloxetine, zolpidem; oral forms with antacids, multivalent cations, calcium, iron, zinc, sucralfate, buffered forms of didanosine, other highly buffered drugs (may give ciprofloxacin 2hrs before or 6hrs after); high ciprofloxacin doses with NSAIDs (increases seizure risk). Potentiates caffeine/xanthine derivatives. Potentiated by probenecid. Severe hypoglycemia with oral antidiabetics (eg, glyburide, glimepiride). Increased serum creatinine with cyclosporine. Monitor methotrexate, oral anticoagulants (potentiation), phenytoin (variable effects), clozapine and ropinirole (potentiation). Increased risk of tendinitis/tendon rupture with corticosteroids. Caution with sildenafil, other drugs that lower seizure threshold. Increased risk of QT prolongation with Class IA or III antiarrhythmics, TCAs, macrolides, antipsychotics. Reduced absorption with omeprazole (XR).
Nausea, diarrhea, vomiting, headache, CNS disturbances (eg, convulsions, dizziness, nervousness, insomnia, nightmares, paranoia), rash, eosinophilia, elevated liver enzymes, photosensitivity, Stevens-Johnson syndrome, myalgia, tendinitis/tendon rupture, joint-related disorders (children), local reactions (inj); rare: increased intracranial pressure, toxic psychosis; peripheral neuropathy (may be irreversible), torsades de pointes, C. difficile-associated diarrhea.
Tabs—100; Oral Susp—100mL (w. graduated teaspoon); IV premixed (100mL, 200mL)—1; XR Tabs—50, 100; IV conc—contact supplier