Ciprofloxacin 250mg/5ml Granules And Solvent For Oral Suspension
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Ciproxin® 250mg/5ml granules and solvent for oral suspension
(ciprofloxacin)
Your medicine is available using the name Ciproxin 250mg/5ml granules and solvent for oral suspension but will be referred to as Ciproxin throughout this leaflet.
Read all of this leaflet carefully before you start taking this medicine because it contains important information for you.
■ Keep this leaflet. You may need to read it again.
■ If you have any further questions, ask your doctor or pharmacist.
■ This medicine has been prescribed for you only. Do not pass it on to others. It may harm them, even if their signs of illness are the same as yours.
■ If you get any side effects, talk to your doctor or pharmacist. This includes any possible side effects not listed in this leaflet. See section 4.
What is in this leaflet:
1. What Ciproxin is and what it is used for
2. What you need to know before you take Ciproxin
3. How to take Ciproxin
4. Possible side effects
5. How to store Ciproxin
6. Contents of the pack and other information
1. What Ciproxin is and what it is used for
Ciproxin contains the active substance ciprofloxacin. Ciprofloxacin is an antibiotic belonging to the fluoroquinolone family. Ciprofloxacin works by killing bacteria that cause infections. It only works with specific strains of bacteria.
Adults
Ciproxin is used in adults to treat the following bacterial infections:
■ respiratory tract infections
■ long lasting or recurring ear or sinus infections
■ urinary tract infections
■ genital tract infections in men and women
■ gastro-intestinal tract infections and intra-abdominal infections
■ skin and soft tissue infections
■ bone and joint infections
■ to prevent infections due to the bacterium Neisseria meningitidis
■ anthrax inhalation exposure
Ciprofloxacin may be used in the management of patients with low white blood cell counts (neutropenia) who have a fever that is suspected to be due to a bacterial infection.
If you have a severe infection or one that is caused by more than one type of bacterium, you may be given additional antibiotic treatment in addition to Ciproxin.
Children and adolescents
Ciproxin is used in children and adolescents, under specialist medical supervision, to treat the following bacterial infections:
■ lung and bronchial infections in children and adolescents suffering from cystic fibrosis
■ complicated urinary tract infections, including infections that have reached the kidneys (pyelonephritis)
■ anthrax inhalation exposure
Ciproxin may also be used to treat other specific severe infections in children and adolescents when your doctor considered this necessary.
2. What you need to know before you take Ciproxin
Do not take Ciproxin:
■ if you are allergic to the active substance, to other quinolone drugs or to any of the other ingredients of this medicine (listed in Section 6)
■ if you are taking tizanidine (see Section 2: Other medicines and Ciproxin)
Warnings and precautions
Talk to your doctor before taking Ciproxin
■ if you have ever had kidney problems because your treatment may need to be adjusted.
■ if you suffer from epilepsy or other neurological conditions.
■ if you have a history of tendon problems during previous treatment with antibiotics such as Ciproxin.
■ if you are diabetic because you may experience a risk of hypoglycaemia with ciprofloxacin.
■ if you have myasthenia gravis (a type of muscle weakness) because symptoms can be exacerbated.
■ if you have heart problems. Caution should be taken when using Ciprofloxacin, if you were born with or have family history of prolonged QT interval (seen on ECG, electrical recording of the heart), have salt imbalance in the blood (especially low level of potassium or magnesium in the blood), have a very slow heart rhythm (called 'bradycardia'), have a weak heart (heart failure), have a history of heart attack (myocardial infarction), you are female or elderly or you are taking other medicines that result in abnormal ECG changes (see section 2: Other medicines and Ciproxin).
■ if you or a member of your family is known to have a deficiency in glucose-6-phosphate dehydrogenase (G6PD), since you may experience a risk of anaemia with ciprofloxacin.
For the treatment of some genital tract infections, your doctor can prescribe another antibiotic in addition to ciprofloxacin. If there is no improvement in symptoms after 3 days of treatment, please consult your doctor.
While taking Ciproxin
Tell your doctor immediately, if any of the following occurs while taking Ciproxin. Your doctor will decide whether treatment with Ciproxin needs to be stopped.
■ Severe, sudden allergic reaction (an anaphylactic reaction/shock, angio-oedema). Even with the first dose, there is a small chance that you may experience a severe allergic reaction with the following symptoms: tightness in the chest, feeling dizzy, sick or faint, or experiencing dizziness when standing up. If this happens, stop taking Ciproxin and contact your doctor immediately.
■ Pain and swelling in the joints and tendinitis may occur occasionally, particularly if you are elderly and are also being treated with corticosteroids. Inflammation and ruptures of tendons may occur even within the first 48 hours of treatment or up to several months after discontinuation of Ciproxin therapy. At the first sign of any pain or inflammation stop taking Ciproxin and rest the painful area. Avoid any unnecessary exercise, as this might increase the risk of a tendon rupture.
■ If you suffer from epilepsy or other neurological conditions such as cerebral ischemia or stroke, you may experience side effects associated with the central nervous system. If this happens, stop taking Ciproxin and contact your doctor immediately.
■ You may experience psychiatric reactions the first time you take Ciproxin. If you suffer from depression or psychosis, your symptoms may become worse under treatment with Ciproxin. In rare cases, depression or psychosis can progress to thoughts of suicide, suicide attempts, or completed suicide. If this happens, stop taking Ciproxin and contact your doctor immediately.
■ You may experience symptoms of neuropathy such as pain, burning, tingling, numbness and/or weakness. If this happens, stop taking Ciproxin and contact your doctor immediately.
■ Hypoglycemia has been reported most often in diabetic patients, predominantly in elderly population. If this happens, contact your doctor immediately.
■ Diarrhoea may develop while you are taking antibiotics, including Ciproxin, or even several weeks after you have stopped taking them. If it becomes severe or persistent or you notice that your stool contains blood or mucus, stop taking Ciproxin immediately, as this can be life-threatening. Do not take medicines that stop or slow down bowel movements and contact your doctor.
■ Tell the doctor or laboratory staff that you are taking Ciproxin if you have to provide a blood or urine sample.
■ If you suffer from kidney problems, tell the doctor because your dose may need to be adjusted.
■ Ciproxin may cause liver damage. If you notice any symptoms such as loss of appetite, jaundice (yellowing of the skin), dark urine, itching, or tenderness of the stomach, stop taking Ciproxin and contact your doctor immediately.
■ Ciproxin may cause a reduction in the number of white blood cells and your resistance to infection may be decreased. If you experience an infection with symptoms such as fever and serious deterioration of your general condition, or fever with local infection symptoms such as sore throat/pharynx/mouth or urinary problems you should see your doctor immediately. A blood test will be taken to check possible reduction of white blood cells (agranulocytosis). It
is important to inform your doctor about your medicine.
■ Your skin becomes more sensitive to sunlight or ultraviolet (UV) light when taking Ciproxin. Avoid exposure to strong sunlight, or artificial UV light such as sunbeds.
Other medicines and Ciproxin
Tell your doctor or pharmacist if you are taking, have recently taken or might take any other medicines.
Do not take Ciproxin together with tizanidine, because this may cause side effects such as low blood pressure and sleepiness (see Section 2: Do not take Ciproxin).
The following medicines are known to interact with Ciproxin in your body. Taking Ciproxin together with these medicines can influence the therapeutic effect of those medicines. It can also increase the probability of experiencing side effects.
Tell your doctor if you are taking:
■ Vitamin K antagonists (e.g. warfarin, acenocoumarol, phenprocoumon or fluindione) or other oral anti-coagulants (to thin the blood)
■ probenecid (for gout)
■ methotrexate (for certain types of cancer, psoriasis, rheumatoid arthritis)
■ theophylline (for breathing problems)
■ tizanidine (for muscle spasticity in multiple sclerosis)
■ olanzapine (an antipsychotic)
■ clozapine (an antipsychotic)
■ ropinirole (for Parkinson's disease)
■ phenytoin (for epilepsy)
■ metoclopramide (for nausea and vomiting)
■ cyclosporin (for skin conditions, rheumatoid arthritis and in organ transplantation)
■ other medicines that can alter your heart rhythm: medicines that belong to the group of anti-arrhythmics (e.g. quinidine, hydroquinidine, disopyramide, amiodarone, sotalol, dofetilide, ibutilide), tricyclic antidepressants, some antimicrobials (that belong to the group of macrolides), some antipsychotics.
Ciproxin may increase the levels of the following medicines in your blood:
■ pentoxifylline (for circulatory disorders)
■ caffeine
■ duloxetine (for depression, diabetic nerve damage or incontinence)
■ lidocaine (for heart conditions or anaesthetic use)
■ sildenafil (e.g. for erectile dysfunction)
Some medicines reduce the effect of Ciproxin. Tell your doctor if you take or wish to take:
■ antacids
■ omeprazole
■ mineral supplements
■ sucralfate
■ a polymeric phosphate binder (e.g. sevelamer or lanthanum carbonate)
■ medicines or supplements containing calcium, magnesium, aluminium or iron
If these preparations are essential, take Ciproxin about two hours before or no sooner than four hours after them.
Ciproxin with food and drink
Unless you take Ciproxin during meals, do not eat or drink any dairy products (such as milk or yoghurt) or drinks with added calcium when you take the suspension, as they may affect the absorption of the active substance.
Pregnancy and breast-feeding
If you are pregnant or breast-feeding, think you may be pregnant or are planning to have a baby, ask your doctor or pharmacist for advice before taking this medicine.
It is preferable to avoid the use of Ciproxin during pregnancy.
Do not take Ciproxin during breast-feeding because ciprofloxacin is excreted in breast milk and can be harmful for your child.
Driving and using machines
Ciproxin may make you feel less alert. Some neurological adverse events can occur. Therefore, make sure you know how you react to Ciproxin before driving a vehicle or operating machinery. If in doubt, talk to your doctor.
Ciproxin contains sucrose
If you are sucrose intolerant, please consult your doctor before taking Ciproxin. As Ciproxin contains 1.4g sucrose per 5ml measuring spoonful, this has to be taken into consideration in terms of daily intake, particularly if you are on a diabetic diet to control your blood sugar level.
This product can be harmful to teeth.
3. How to take Ciproxin
Your doctor will explain to you exactly how much Ciproxin you will have to take as well as how often and for how long. This will depend on the type of infection you have and how bad it is.
Tell your doctor if you suffer from kidney problems because your dose may need to be adjusted.
The treatment usually lasts from 5 to 21 days, but may take longer for severe infections. Always take this medicine exactly as your doctor has told you. Check with your doctor or pharmacist if you are not sure how to take Ciproxin.
Preparing and taking the suspension
The product comes in 2 bottles. The small bottle contains granules which you add to the solvent in the larger bottle.
1. Open both bottles. Press down the child-proof cap and turn it to the left.
2. Empty the bottle containing the granules for oral suspension into the opening of the bottle of solvent. Do not add any water to the solvent.
3. Close the bottle with the solvent and added granules, turn it on its side and shake vigorously for about 15 seconds.
4. Shake it vigorously for about 15 seconds before each dose.
5. Enter the expiry date after reconstitution (= reconstitution date + 14 days) in the relevant field on the solvent bottle. The reconstituted suspension is stable for no more than 14 days even when stored in a refrigerator.
6. Do try to take the suspension at around the same time every day.
7. Always use the measuring spoon provided. The full spoon will give you a dose of 250 mg Ciproxin.
8. Do not chew the granules present in the suspension, simply swallow them.
9. A glass of water may be taken after taking the dose.
10. You can take the suspension at mealtimes or in between meals. Any calcium you take as part of a meal will not seriously affect uptake. However, do not take Ciproxin with dairy products such as milk or yoghurt or with fortified fruit-juice (e.g. calcium-fortified orange-juice).
Remember to drink plenty of fluids while you are taking this medicine.
If you take more Ciproxin than you should
If you take more than the prescribed dose, get medical help immediately. If possible, take the oral suspension or the box with you to show the doctor.
If you forget to take Ciproxin
Take the normal dose as soon as possible and then continue as prescribed. However, if it is almost time for your next dose, do not take the missed dose and continue as usual. Do not take a double dose to make up for a forgotten dose. Be sure to complete your course of treatment.
If you stop taking Ciproxin
It is important that you finish the course of treatment even if you begin to feel better after a few days. If you stop taking this medicine too soon, your infection may not be completely cured and the symptoms of the infection may return or get worse. You might also develop resistance to the antibiotic.
If you have any further questions about the use of this medicine, ask your doctor or pharmacist.
4. Possible side effects
Like all medicines, this medicine can cause side effects, although not everybody gets them.
Common:
may affect up to 1 in 10 people
■ nausea, diarrhoea
■ joint pains in children
Uncommon:
may affect up to 1 in 100 people
■ fungal superinfections
■ a high concentration of eosinophils, a type of white blood cell
■ decreased appetite
■ hyperactivity or agitation
■ headache, dizziness, sleeping problems, or taste disorders
■ vomiting, abdominal pain, digestive problems such as stomach upset (indigestion/heartburn), or wind
■ increased amounts of certain substances in the blood (transaminases and/or bilirubin)
■ rash, itching, or hives
■ joint pain in adults
■ poor kidney function
■ pains in your muscles and bones, feeling unwell (asthenia), or fever
■ increase in blood alkaline phosphatase (a certain substance in the blood)
Rare:
may affect up to 1 in 1,000 people
■ inflammation of the bowel (colitis) linked to antibiotic use (can be fatal in very rare cases) (see Section 2: Warnings and precautions)
■ changes to the blood count (leukopenia, leukocytosis, neutropenia, anaemia), increased or decreased amounts of a blood clotting factor (thrombocytes)
■ allergic reaction, swelling (oedema), or rapid swelling of the skin and mucous membranes (angio-oedema)
■ increased blood sugar (hyperglycaemia)
■ decreased blood sugar (hypoglycaemia) (see Section 2: Warnings and precautions)
■ confusion, disorientation, anxiety reactions, strange dreams, depression (potentially leading to thoughts of suicide, suicide attempts, or completed suicide), or hallucinations
■ pins and needles, unusual sensitivity to stimuli of the senses, decreased skin sensitivity, tremors, seizures (see Section 2: Warnings and precautions), or giddiness
■ eyesight problems including double vision
■ tinnitus, loss of hearing, impaired hearing
■ rapid heartbeat (tachycardia)
■ expansion of blood vessels (vasodilation), low blood pressure, or fainting
■ shortness of breath, including asthmatic symptoms
■ liver disorders, jaundice (cholestatic icterus), or hepatitis
■ sensitivity to light (see Section 2: Warnings and precautions)
■ muscle pain, inflammation of the joints, increased muscle tone, or cramp
■ kidney failure, blood or crystals in the urine (see Section 2: Warnings and precautions), urinary tract inflammation
■ fluid retention or excessive sweating
■ increased levels of the enzyme amylase
Very rare:
may affect up to 1 in 10,000 people
■ a special type of reduced red blood cell count (haemolytic anaemia); a dangerous drop in a type of white blood cells (agranulocytosis); a drop in the number of red and white blood cells and platelets (pancytopenia), which may be fatal; and bone marrow depression, which may also be fatal (see Section 2: Warnings and precautions)
■ severe allergic reactions (anaphylactic reaction or anaphylactic shock, which can be fatal - serum sickness)
(see Section 2: Warnings and precautions)
■ mental disturbances (psychotic reactions potentially leading to thoughts of suicide, suicide attempts, or completed suicide) (see Section 2: Warnings and precautions)
■ migraine, disturbed coordination, unsteady walk (gait disturbance), disorder of sense of smell (olfactory disorders), pressure on the brain (intracranial pressure and pseudotumor cerebri)
■ visual colour distortions
■ inflammation of the wall of the blood vessels (vasculitis)
■ pancreatitis
■ death of liver cells (liver necrosis) very rarely leading to life-
threatening liver failure
■ small, pin-point bleeding under the skin (petechiae); various skin eruptions or rashes (for example, the potentially fatal Stevens-Johnson syndrome or toxic epidermal necrolysis)
■ muscle weakness, tendon inflammation, tendon rupture -
especially of the large tendon at the back of the ankle (Achilles tendon) (see Section 2: Warnings and precautions); worsening of the symptoms of myasthenia gravis (see Section 2: Warnings and precautions)
Not known:
frequency cannot be estimated from the available data
■ troubles associated with the nervous system such as pain, burning, tingling, numbness and/ or weakness in extremities (peripheral neuropathy and polyneuropathy)
■ abnormal fast heart rhythm, life-threatening irregular heart rhythm, alteration of the heart rhythm (called 'prolongation of QT interval', seen on ECG, electrical activity of the heart)
■ pustular rash
■ influence on blood clotting (in patients treated with Vitamin K antagonists)
Reporting of side effects
If you get any side effects, talk to your doctor or pharmacist. This includes any possible side effects not listed in this leaflet. You can also report side effects directly via the Yellow Card Scheme, Website: www.mhra.gov.uk/yellowcard. By reporting side effects, you can help provide more information on the safety of this medicine.
5. How to store Ciproxin
KEEP OUT OF THE SIGHT AND REACH OF CHILDREN.
Do not use Ciproxin after the expiry date, which is stated on the carton and bottles after "EXP". The expiry date refers to the last day of that month.
Granules:
Do not store above 25°C.
Solvent:
Do not store above 25°C.
Protect from freezing. Avoid inverted storage.
When reconstituted, the ready-to-use oral suspension is stable only for 14 days when stored either at ambient temperatures up to 30°C or in a refrigerator (2°C-8°C). After this time, the reconstituted oral suspension should not be taken. Protect the reconstituted oral suspension from freezing.
If your doctor decides to stop your treatment, return any leftover medicine to your pharmacist.
If your medicine appears to be discoloured or shows any other signs of deterioration, please return it to your pharmacist who will advise you.
Medicines should not be disposed of via wastewater or household waste. Ask your pharmacist how to dispose of medicines no longer required. These measures will help to protect the environment.
6. Contents of the pack and other information
What Ciproxin contains
The active substance is ciprofloxacin.
Each 5ml of suspension contains 250mg of ciprofloxacin after reconstitution.
Each 2.5ml of suspension (approx. 1/2 measuring spoonful) contains approx. 125mg ciprofloxacin after reconstitution.
The other ingredients are:
Granules: hypromellose, magnesium stearate, polyacrylate dispersion 30%, polysorbate 20, povidone.
Solvent: soya lecithin, medium chain triglycerides, strawberry flavour, sucrose, purified water.
What Ciproxin looks like and contents of the pack
Ciproxin consists of one amber glass bottle containing white to slightly yellow granules and white plastic bottle containing 93ml of strawberry flavoured white to slightly yellow suspension. The pack is provided with a blue plastic graduated measuring spoon.
Manufacturer
Ciproxin is manufactured by:
Bayer HealthCare Manufacturing S.r.l., Via delle Groane 126, Garbagnate Milanese, Milan, Italy.
Procured from within the EU and repackaged by: Doncaster Pharmaceuticals Group Ltd., Kirk Sandall, Doncaster, DN3 1QR.
Product Licence holder: Landmark Pharma Ltd., 7 Regents Drive, Prudhoe, Northumberland, NE42 6PX.
PL No: 21828/0490 POM
Leaflet revision and issue date: 22.05.14
Ciproxin® is a registered trademark of Bayer Aktiengesellschaft.
Advice/medical education
Antibiotics are used to cure bacterial infections. They are ineffective against viral infections.
If your doctor has prescribed antibiotics, you need them precisely for your current illness.
Despite antibiotics, some bacteria may survive or grow.
This phenomenon is called resistance: some antibiotic treatments become ineffective.
Misuse of antibiotics increases resistance. You may even help bacteria become resistant and therefore delay your cure or decrease antibiotic efficacy if you do not respect appropriate:
■ dosages
■ schedules
■ duration of treatment
Consequently, to preserve the efficacy of this drug:
1. Use antibiotics only when prescribed.
2. Strictly follow the prescription.
3. Do not re-use an antibiotic without medical prescription, even if you want to treat a similar illness.
4. Never give your antibiotic to another person; maybe it is not
adapted to her/his illness.
5. After completion of treatment, return all unused drugs to your chemist's shop to ensure they will be disposed of correctly.
PACKAGE LEAFLET: INFORMATION FOR THE USER
Ciprofloxacin 250mg/5ml granules and solvent for oral suspension
(ciprofloxacin)
Your medicine is available using the name Ciprofloxacin 250mg/5ml granules and solvent for oral suspension but will be referred to as Ciprofloxacin throughout this leaflet.
Read all of this leaflet carefully before you start taking this medicine because it contains important information for you.
■ Keep this leaflet. You may need to read it again.
■ If you have any further questions, ask your doctor or pharmacist.
■ This medicine has been prescribed for you only. Do not pass it on to others. It may harm them, even if their signs of illness are the same as yours.
■ If you get any side effects, talk to your doctor or pharmacist. This includes any possible side effects not listed in this leaflet. See section 4.
What is in this leaflet:
1. What Ciprofloxacin is and what it is used for
2. What you need to know before you take Ciprofloxacin
3. How to take Ciprofloxacin
4. Possible side effects
5. How to store Ciprofloxacin
6. Contents of the pack and other information
1. What Ciprofloxacin is and what it is used for
Ciprofloxacin contains the active substance ciprofloxacin. Ciprofloxacin is an antibiotic belonging to the fluoroquinolone family. Ciprofloxacin works by killing bacteria that cause infections. It only works with specific strains of bacteria.
Adults
Ciprofloxacin is used in adults to treat the following bacterial infections:
■ respiratory tract infections
■ long lasting or recurring ear or sinus infections
■ urinary tract infections
■ genital tract infections in men and women
■ gastro-intestinal tract infections and intra-abdominal infections
■ skin and soft tissue infections
■ bone and joint infections
■ to prevent infections due to the bacterium Neisseria meningitidis
■ anthrax inhalation exposure
Ciprofloxacin may be used in the management of patients with low white blood cell counts (neutropenia) who have a fever that is suspected to be due to a bacterial infection.
If you have a severe infection or one that is caused by more than one type of bacterium, you may be given additional antibiotic treatment in addition to Ciprofloxacin.
Children and adolescents
Ciprofloxacin is used in children and adolescents, under specialist medical supervision, to treat the following bacterial infections:
■ lung and bronchial infections in children and adolescents suffering from cystic fibrosis
■ complicated urinary tract infections, including infections that have reached the kidneys (pyelonephritis)
■ anthrax inhalation exposure
Ciprofloxacin may also be used to treat other specific severe infections in children and adolescents when your doctor considered this necessary.
2. What you need to know before you take Ciprofloxacin
Do not take Ciprofloxacin:
■ if you are allergic to the active substance, to other quinolone drugs or to any of the other ingredients of this medicine (listed in Section 6)
■ if you are taking tizanidine (see Section 2: Other medicines and Ciprofloxacin)
Warnings and precautions
Talk to your doctor before taking Ciprofloxacin
■ if you have ever had kidney problems because your treatment may need to be adjusted.
■ if you suffer from epilepsy or other neurological conditions.
■ if you have a history of tendon problems during previous treatment with antibiotics such as Ciprofloxacin.
■ if you are diabetic because you may experience a risk of hypoglycaemia with ciprofloxacin.
■ if you have myasthenia gravis (a type of muscle weakness) because symptoms can be exacerbated.
■ if you have heart problems. Caution should be taken when using Ciprofloxacin, if you were born with or have family history of prolonged QT interval (seen on ECG, electrical recording of the heart), have salt imbalance in the blood (especially low level of potassium or magnesium in the blood), have a very slow heart rhythm (called 'bradycardia'), have a weak heart (heart failure), have a history of heart attack (myocardial infarction), you are female or elderly or you are taking other medicines that result in abnormal ECG changes (see section 2: Other medicines and Ciprofloxacin).
■ if you or a member of your family is known to have a deficiency in glucose-6-phosphate dehydrogenase (G6PD), since you may experience a risk of anaemia with ciprofloxacin.
For the treatment of some genital tract infections, your doctor can prescribe another antibiotic in addition to ciprofloxacin. If there is no improvement in symptoms after 3 days of treatment, please consult your doctor.
While taking Ciprofloxacin
Tell your doctor immediately, if any of the following occurs while taking Ciprofloxacin. Your doctor will decide whether treatment with Ciprofloxacin needs to be stopped.
■ Severe, sudden allergic reaction (an anaphylactic reaction/shock, angio-oedema). Even with the first dose, there is a small chance that you may experience a severe allergic reaction with the following symptoms: tightness in the chest, feeling dizzy, sick or faint, or experiencing dizziness when standing up. If this happens, stop taking Ciprofloxacin and contact your doctor immediately.
■ Pain and swelling in the joints and tendinitis may occur occasionally, particularly if you are elderly and are also being treated with corticosteroids. Inflammation and ruptures of tendons may occur even within the first 48 hours of treatment or up to several months after discontinuation of Ciprofloxacin therapy. At the first sign of any pain or inflammation stop taking Ciprofloxacin and rest the painful area. Avoid any unnecessary exercise, as this might increase the risk of a tendon rupture.
■ If you suffer from epilepsy or other neurological conditions such as cerebral ischemia or stroke, you may experience side effects associated with the central nervous system. If this happens, stop taking Ciprofloxacin and contact your doctor immediately.
■ You may experience psychiatric reactions the first time you take Ciprofloxacin. If you suffer from depression or psychosis, your symptoms may become worse under treatment with Ciprofloxacin. In rare cases, depression or psychosis can progress to thoughts of suicide, suicide attempts, or completed suicide. If this happens, stop taking Ciprofloxacin and contact your doctor immediately.
■ You may experience symptoms of neuropathy such as pain, burning, tingling, numbness and/or weakness. If this happens, stop taking Ciprofloxacin and contact your doctor immediately.
■ Hypoglycemia has been reported most often in diabetic patients, predominantly in elderly population. If this happens, contact your doctor immediately.
■ Diarrhoea may develop while you are taking antibiotics, including Ciprofloxacin, or even several weeks after you have stopped taking them. If it becomes severe or persistent or you notice that your stool contains blood or mucus, stop taking Ciprofloxacin immediately, as this can be life-threatening. Do not take medicines that stop or slow down bowel movements and contact your doctor.
■ Tell the doctor or laboratory staff that you are taking Ciprofloxacin if you have to provide a blood or urine sample.
■ If you suffer from kidney problems, tell the doctor because your dose may need to be adjusted.
■ Ciprofloxacin may cause liver damage. If you notice any symptoms such as loss of appetite, jaundice (yellowing of the skin), dark urine, itching, or tenderness of the stomach, stop taking Ciprofloxacin and contact your doctor immediately.
■ Ciprofloxacin may cause a reduction in the number of white blood cells and your resistance to infection may be decreased. If you experience an infection with symptoms such as fever and serious deterioration of your general condition, or fever with local infection symptoms such as sore throat/pharynx/mouth or urinary problems you should see your doctor immediately. A blood test will be taken to check possible reduction of white blood cells (agranulocytosis). It is important to inform your doctor about your medicine.
■ Your skin becomes more sensitive to sunlight or
ultraviolet (UV) light when taking Ciprofloxacin. Avoid exposure to strong sunlight, or artificial UV light such as sunbeds.
Other medicines and Ciprofloxacin
Tell your doctor or pharmacist if you are taking, have recently taken or might take any other medicines.
Do not take Ciprofloxacin together with tizanidine, because this may cause side effects such as low blood pressure and sleepiness (see Section 2: Do not take Ciprofloxacin).
The following medicines are known to interact with Ciprofloxacin in your body. Taking Ciprofloxacin together with these medicines can influence the therapeutic effect of those medicines. It can also increase the probability of experiencing side effects.
Tell your doctor if you are taking:
■ Vitamin K antagonists (e.g. warfarin, acenocoumarol, phenprocoumon or fluindione) or other oral anti-coagulants (to thin the blood)
■ probenecid (for gout)
■ methotrexate (for certain types of cancer, psoriasis, rheumatoid arthritis)
■ theophylline (for breathing problems)
■ tizanidine (for muscle spasticity in multiple sclerosis)
■ olanzapine (an antipsychotic)
■ clozapine (an antipsychotic)
■ ropinirole (for Parkinson's disease)
■ phenytoin (for epilepsy)
■ metoclopramide (for nausea and vomiting)
■ cyclosporin (for skin conditions, rheumatoid arthritis and in organ transplantation)
■ other medicines that can alter your heart rhythm: medicines that belong to the group of anti-arrhythmics (e.g. quinidine, hydroquinidine, disopyramide, amiodarone, sotalol, dofetilide, ibutilide), tricyclic antidepressants, some antimicrobials (that belong to the group of macrolides), some antipsychotics.
Ciprofloxacin may increase the levels of the following medicines in your blood:
■ pentoxifylline (for circulatory disorders)
■ caffeine
■ duloxetine (for depression, diabetic nerve damage or incontinence)
■ lidocaine (for heart conditions or anaesthetic use)
■ sildenafil (e.g. for erectile dysfunction)
Some medicines reduce the effect of Ciprofloxacin. Tell your doctor if you take or wish to take:
■ antacids
■ omeprazole
■ mineral supplements
■ sucralfate
■ a polymeric phosphate binder (e.g. sevelamer or lanthanum
carbonate)
■ medicines or supplements containing calcium, magnesium,
aluminium or iron
If these preparations are essential, take Ciprofloxacin about two hours before or no sooner than four hours after them.
Ciprofloxacin with food and drink
Unless you take Ciprofloxacin during meals, do not eat or drink any dairy products (such as milk or yoghurt) or drinks with added calcium when you take the suspension, as they may affect the absorption of the active substance.
Pregnancy and breast-feeding
If you are pregnant or breast-feeding, think you may be pregnant or are planning to have a baby, ask your doctor or pharmacist for advice before taking this medicine.
It is preferable to avoid the use of Ciprofloxacin during pregnancy. Do not take Ciprofloxacin during breast-feeding because ciprofloxacin is excreted in breast milk and can be harmful for your child.
Driving and using machines
Ciprofloxacin may make you feel less alert. Some neurological adverse events can occur. Therefore, make sure you know how you react to Ciprofloxacin before driving a vehicle or operating machinery. If in doubt, talk to your doctor.
Ciprofloxacin contains sucrose
If you are sucrose intolerant, please consult your doctor before taking Ciprofloxacin. As Ciprofloxacin contains 1.4g sucrose per 5ml measuring spoonful, this has to be taken into consideration in terms of daily intake, particularly if you are on a diabetic diet to control your blood sugar level.
This product can be harmful to teeth.
3. How to take Ciprofloxacin
Your doctor will explain to you exactly how much Ciprofloxacin you will have to take as well as how often and for how long. This will depend on the type of infection you have and how bad it is.
Tell your doctor if you suffer from kidney problems because your dose may need to be adjusted.
The treatment usually lasts from 5 to 21 days, but may take longer for severe infections. Always take this medicine exactly as your doctor has told you. Check with your doctor or pharmacist if you are not sure how to take Ciprofloxacin.
Preparing and taking the suspension
The product comes in 2 bottles. The small bottle contains granules which you add to the solvent in the larger bottle.
1. Open both bottles. Press down the child-proof cap and turn it to the left.
2. Empty the bottle containing the granules for oral suspension into the opening of the bottle of solvent. Do not add any water to the solvent.
3. Close the bottle with the solvent and added granules, turn it on its side and shake vigorously for about 15 seconds.
4. Shake it vigorously for about 15 seconds before each dose.
5. Enter the expiry date after reconstitution (= reconstitution date + 14 days) in the relevant field on the solvent bottle. The reconstituted suspension is stable for no more than 14 days even when stored in a refrigerator.
6. Do try to take the suspension at around the same time every day.
7. Always use the measuring spoon provided. The full spoon will give you a dose of 250 mg Ciprofloxacin.
8. Do not chew the granules present in the suspension, simply swallow them.
9. A glass of water may be taken after taking the dose.
10. You can take the suspension at mealtimes or in between meals. Any calcium you take as part of a meal will not seriously affect uptake. However, do not take Ciprofloxacin with dairy products such as milk or yoghurt or with fortified fruit-juice (e.g. calcium-fortified orange-juice). Remember to drink plenty of fluids while you are taking this medicine.
If you take more Ciprofloxacin than you should
If you take more than the prescribed dose, get medical help immediately. If possible, take the oral suspension or the box with you to show the doctor.
If you forget to take Ciprofloxacin
Take the normal dose as soon as possible and then continue as prescribed. However, if it is almost time for your next dose, do not take the missed dose and continue as usual. Do not take a double dose to make up for a forgotten dose. Be sure to complete your course of treatment.
If you stop taking Ciprofloxacin
It is important that you finish the course of treatment even if you begin to feel better after a few days. If you stop taking this medicine too soon, your infection may not be completely cured and the symptoms of the infection may return or get worse. You might also develop resistance to the antibiotic.
If you have any further questions about the use of this medicine, ask your doctor or pharmacist.
4. Possible side effects
Like all medicines, this medicine can cause side effects, although not everybody gets them.
Common:
may affect up to 1 in 10 people
■ nausea, diarrhoea
■ joint pains in children
Uncommon:
may affect up to 1 in 100 people
■ fungal superinfections
■ a high concentration of eosinophils, a type of white blood cell
■ decreased appetite
■ hyperactivity or agitation
■ headache, dizziness, sleeping problems, or taste disorders
■ vomiting, abdominal pain, digestive problems such as stomach upset (indigestion/heartburn), or wind
■ increased amounts of certain substances in the blood (transaminases and/or bilirubin)
■ rash, itching, or hives
■ joint pain in adults
■ poor kidney function
■ pains in your muscles and bones, feeling unwell (asthenia), or fever
■ increase in blood alkaline phosphatase (a certain substance in the blood)
Rare:
may affect up to 1 in 1,000 people
■ inflammation of the bowel (colitis) linked to antibiotic use (can be fatal in very rare cases) (see Section 2: Warnings and precautions)
■ changes to the blood count (leukopenia, leukocytosis, neutropenia, anaemia), increased or decreased amounts of a blood clotting factor (thrombocytes)
■ allergic reaction, swelling (oedema), or rapid swelling of the skin and mucous membranes (angio-oedema)
■ increased blood sugar (hyperglycaemia)
■ decreased blood sugar (hypoglycaemia) (see Section 2: Warnings and precautions)
■ confusion, disorientation, anxiety reactions, strange dreams, depression (potentially leading to thoughts of suicide, suicide attempts, or completed suicide), or hallucinations
■ pins and needles, unusual sensitivity to stimuli of the senses, decreased skin sensitivity, tremors, seizures (see Section 2: Warnings and precautions), or giddiness
■ eyesight problems including double vision
■ tinnitus, loss of hearing, impaired hearing
■ rapid heartbeat (tachycardia)
■ expansion of blood vessels (vasodilation), low blood pressure, or fainting
■ shortness of breath, including asthmatic symptoms
■ liver disorders, jaundice (cholestatic icterus), or hepatitis
■ sensitivity to light (see Section 2: Warnings and precautions)
■ muscle pain, inflammation of the joints, increased muscle tone, or cramp
■ kidney failure, blood or crystals in the urine (see Section 2: Warnings and precautions), urinary tract inflammation
■ fluid retention or excessive sweating
■ increased levels of the enzyme amylase
Very rare:
may affect up to 1 in 10,000 people
■ a special type of reduced red blood cell count (haemolytic anaemia); a dangerous drop in a type of white blood cells (agranulocytosis); a drop in the number of red and white blood cells and platelets (pancytopenia), which may be fatal; and bone marrow depression, which may also be fatal (see Section 2: Warnings and precautions)
■ severe allergic reactions (anaphylactic reaction or anaphylactic shock, which can be fatal - serum sickness)
(see Section 2: Warnings and precautions)
■ mental disturbances (psychotic reactions potentially leading to thoughts of suicide, suicide attempts, or completed suicide) (see Section 2: Warnings and precautions)
■ migraine, disturbed coordination, unsteady walk (gait disturbance), disorder of sense of smell (olfactory disorders), pressure on the brain (intracranial pressure and pseudotumor cerebri)
■ visual colour distortions
■ inflammation of the wall of the blood vessels (vasculitis)
■ pancreatitis
■ death of liver cells (liver necrosis) very rarely leading to life-threatening liver failure
■ small, pin-point bleeding under the skin (petechiae); various skin eruptions or rashes (for example, the potentially fatal Stevens-Johnson syndrome or toxic epidermal necrolysis)
■ muscle weakness, tendon inflammation, tendon rupture -especially of the large tendon at the back of the ankle (Achilles tendon) (see Section 2: Warnings and precautions); worsening of the symptoms of myasthenia gravis (see Section 2: Warnings and precautions)
Not known:
frequency cannot be estimated from the available data
■ troubles associated with the nervous system such as pain, burning, tingling, numbness and/ or weakness in extremities (peripheral neuropathy and polyneuropathy)
■ abnormal fast heart rhythm, life-threatening irregular heart rhythm, alteration of the heart rhythm (called 'prolongation of QT interval', seen on ECG, electrical activity of the heart)
■ pustular rash
■ influence on blood clotting (in patients treated with Vitamin K antagonists)
Reporting of side effects
If you get any side effects, talk to your doctor or pharmacist. This includes any possible side effects not listed in this leaflet. You can also report side effects directly via the Yellow Card Scheme, Website: www.mhra.gov.uk/yellowcard. By reporting side effects, you can help provide more information on the safety of this medicine.
5. How to store Ciprofloxacin
KEEP OUT OF THE SIGHT AND REACH OF CHILDREN.
Do not use Ciprofloxacin after the expiry date, which is stated on the carton and bottles after "EXP". The expiry date refers to the last day of that month.
Granules:
Do not store above 25°C.
Solvent:
Do not store above 25°C.
Protect from freezing. Avoid inverted storage.
When reconstituted, the ready-to-use oral suspension is stable only for 14 days when stored either at ambient temperatures up to 30°C or in a refrigerator (2°C-8°C). After this time, the reconstituted oral suspension should not be taken. Protect the reconstituted oral suspension from freezing.
If your doctor decides to stop your treatment, return any leftover medicine to your pharmacist.
If your medicine appears to be discoloured or shows any other signs of deterioration, please return it to your pharmacist who will advise you.
Medicines should not be disposed of via wastewater or household waste. Ask your pharmacist how to dispose of medicines no longer required. These measures will help to protect the environment.
6. Contents of the pack and other information
What Ciprofloxacin contains
The active substance is ciprofloxacin.
Each 5ml of suspension contains 250mg of ciprofloxacin after reconstitution.
Each 2.5ml of suspension (approx. 1/2 measuring spoonful) contains approx. 125mg ciprofloxacin after reconstitution.
The other ingredients are:
Granules: hypromellose, magnesium stearate, polyacrylate dispersion 30%, polysorbate 20, povidone.
Solvent: soya lecithin, medium chain triglycerides, strawberry flavour, sucrose, purified water.
What Ciprofloxacin looks like and contents of the pack
Ciprofloxacin consists of one amber glass bottle containing white to slightly yellow granules and white plastic bottle containing 93ml of strawberry flavoured white to slightly yellow suspension. The pack is provided with a blue plastic graduated measuring spoon.
Manufacturer
Ciprofloxacin is manufactured by:
Bayer HealthCare Manufacturing S.r.l., Via delle Groane 126, Garbagnate Milanese, Milan, Italy.
Procured from within the EU and repackaged by: Doncaster Pharmaceuticals Group Ltd., Kirk Sandall, Doncaster, DN3 1QR.
Product Licence holder: Landmark Pharma Ltd., 7 Regents Drive, Prudhoe, Northumberland, NE42 6PX.
PL No: 21828/0490 I POM I
Leaflet revision and issue date: 22.05.14
Advice/medical education
Antibiotics are used to cure bacterial infections.
They are ineffective against viral infections.
If your doctor has prescribed antibiotics, you need them precisely for your current illness.
Despite antibiotics, some bacteria may survive or grow.
This phenomenon is called resistance: some antibiotic treatments become ineffective.
Misuse of antibiotics increases resistance. You may even help bacteria become resistant and therefore delay your cure or decrease antibiotic efficacy if you do not respect appropriate:
■ dosages
■ schedules
■ duration of treatment
Consequently, to preserve the efficacy of this drug:
1. Use antibiotics only when prescribed.
2. Strictly follow the prescription.
3. Do not re-use an antibiotic without medical prescription, even if you want to treat a similar illness.
4. Never give your antibiotic to another person; maybe it is not
adapted to her/his illness.
5. After completion of treatment, return all unused drugs to your chemist's shop to ensure they will be disposed of correctly.
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