CiprofloxacinNursing considerations

Side effects by what to assess

Sources: [1][2][3][4][5][6][7][8][9][10][11]

Blood glucose

Why

Hypoglycemia or hyperglycemia

When

In diabetes on insulin or oral agents

Act on

Stop ciprofloxacin if hypoglycemia occurs

Normal

Fasting 70 to 99 mg/dL.

Sources: [1][2]

INR (prothrombin time)

Why

Enhanced warfarin effect

When

Often during and shortly after combined use

Normal

INR 0.8 to 1.1 when not on a blood thinner. On warfarin, the usual target is 2.0 to 3.0.

Sources: [1][2]

Phenytoin level

Why

Phenytoin levels can rise or fall

When

During and shortly after combined use

Normal

Total phenytoin target 10 to 20 mcg/mL.

Sources: [1][2]

Potassium

Why

Uncorrected hypokalemia raises QT risk

When

In patients at risk for arrhythmia

Act on

Avoid ciprofloxacin with uncorrected hypokalemia

Normal

3.7 to 5.2 mEq/L.

Sources: [1][2]

Serum creatinine

Why

Renal dose adjustment

When

Before dosing and in older adults

Act on

Reduce the dose when creatinine clearance is 50 mL/min or lower

Normal

0.7 to 1.3 mg/dL in men and 0.5 to 0.95 mg/dL in women.

Sources: [1][2][3]

High-alert status

Ciprofloxacin is not on the ISMP acute care high-alert list.

Sources: [1]

Narrow therapeutic index

The label does not describe a narrow therapeutic index or direct dosing by measured blood levels of the drug.

Sources: [1]

Boxed warning

Fluoroquinolones can cause disabling, possibly permanent reactions that may occur together: tendinitis and tendon rupture, peripheral neuropathy, and CNS effects. Stop ciprofloxacin at once and avoid all fluoroquinolones after any of these. It can worsen myasthenia gravis; avoid it in patients with that history. Reserve it for patients without other options in bronchitis flares, uncomplicated cystitis, and acute sinusitis.

Sources: [1]

Antidote or reversal

No antidote. Give supportive care with good hydration, and monitor kidney function and urine pH, acidifying if needed to prevent crystalluria. Magnesium, aluminum, or calcium antacids reduce further absorption. Dialysis removes less than 10%.

Sources: [1]

Patient teaching

• Stop and call the prescriber for tendon pain or swelling, numbness or tingling, mood or thinking changes, or muscle weakness; rest the affected joint
• Get emergency care for sudden chest, stomach, or back pain
• Avoid sun and tanning beds; cover up outdoors
• Know how it affects you before driving
• If you have diabetes, check glucose and stop the drug and call if blood sugar runs low
• It can raise caffeine and theophylline effects; do not take it with tizanidine
• Watery or bloody stools, even months later, need prompt medical attention

Sources: [1]

Sound-alike and look-alike names

None listed in the ISMP list of confused drug names.

Sources: [1]

Adult dose

Urinary tract infection

250 to 500 mg every 12 hours, for 7 to 14 days.

Acute uncomplicated cystitis (only if no alternative)

250 mg every 12 hours, for 3 days.

Lower respiratory tract or skin infection

500 to 750 mg every 12 hours, for 7 to 14 days.

Bone and joint infection

500 to 750 mg every 12 hours, for 4 to 8 weeks.

Complicated intra-abdominal infection

500 mg every 12 hours with metronidazole, for 7 to 14 days.

Infectious diarrhea; typhoid fever

500 mg every 12 hours, for 5 to 7 days (diarrhea) or 10 days (typhoid).

Uncomplicated gonorrhea

250 mg as a single dose.

Chronic bacterial prostatitis

500 mg every 12 hours, for 28 days.

Acute sinusitis (only if no alternative)

500 mg every 12 hours, for 10 days.

Inhalational anthrax after exposure; plague

Anthrax: 500 mg every 12 hours, for 60 days. Plague: 500 to 750 mg every 12 hours, for 14 days.

Sources: [1]

Renal adjustment

CrCl 30 to 50 mL/min: 250 to 500 mg every 12 hours. CrCl 5 to 29: 250 to 500 mg every 18 hours. Hemodialysis or peritoneal dialysis: 250 to 500 mg every 24 hours, after dialysis.

Sources: [1][2]

Hepatic adjustment

No adjustment given. Pharmacokinetics did not change significantly in stable cirrhosis; acute hepatic insufficiency has not been studied.

Sources: [1]

Mechanism

Bactericidal. It inhibits bacterial topoisomerase II (DNA gyrase) and topoisomerase IV, enzymes needed to copy and repair bacterial DNA. It also inhibits human CYP1A2, which raises levels of drugs such as theophylline and tizanidine. Oral bioavailability is about 70%.

Sources: [1][2][3]