Tsiprofloksatsin-Darnitsa

General characteristics. Structure:

Active ingredient: ciprofloxacin;
 1 tablet contains hydrochloride ciprofloxacin in terms of ciprofloxacin 500 mg;
excipients: potato starch, a tselyulloza microcrystallic, starch prezhelatinizirovany, croscarmellose sodium, dioxide colloid is more waterless than silicon, talc, magnesium stearate, сепифилм 752 white, a macrogoal 4000.

Indications to use:

The uncomplicated and complicated infections caused by the activators sensitive to ciprofloxacin.
• Respiratory infections: ciprofloxacin can be recommended for treatment
 the pneumonia caused by Klebsiella spp, Enterobacter spp, Proteus spp, Escherichia coli, Pseudomonas aeruginosa, Haemophilus spp, Moraxella catarrhalis, Legionella and
 stafilokokkam.
• The infections of a middle ear (average otitis) and adnexal bosoms of a nose (sinusitis), especially infections caused by gram-negative microorganisms, in particular Pseudomonas aeruginosa, or stafilokokka.
• Infections of eyes.
• Infections of kidneys and urinary tract.
• Infections of generative organs, including an adnexitis, gonorrhea and prostatitis.
• Infections of abdominal organs (infections of digestive tract, biliary tract, peritonitis).
• Infections of skin and soft tissues.
• Infections of bones and joints.
• Sepsis.
• Infections or high risk of infections (prevention) at patients with the weakened immune system (including at treatment by immunodepressants and at a neutropenia).
• Selective decontamination of intestines at treatment by immunodepressants.
• Prevention of the invasive infections caused by Neisseria meningitidis.
At appointment it is necessary to consider the existing instruction for a medical use for appropriate use of antibacterial agent.

Children.
Children can apply ciprofloxacin as drug of the second and third line to treatment of the complicated infections of the urinary tract and pyelonephritis caused by Escherichia coli (in clinical trials the age of the children receiving treatment made from 1 to 17 years), and also to treatment of the pulmonary aggravations caused by Pseudomonas
 aeruginosa at children with a mucoviscidosis of lungs (in clinical trials the age of the children receiving treatment made from 5 to 17 years).
Treatment by ciprofloxacin can be appointed only after careful assessment of a ratio risk advantage, through probability of development of side effects from joints and/or surrounding fabrics.
Treatment of children within clinical trials was carried out only according to the listed above indications. Clinical experience of use of ciprofloxacin for children according to other indications is limited.

Adults and children.
Decrease in risk of emergence or progressing to a sibirea after aerogenic contact with Bacillus anthracis.

Route of administration and doses:

Dosing mode.
If other is not appointed, the following daily doses are recommended:
For adults
 Tablets, coated
(ciprofloxacin mg)
Respiratory infections (depending on disease severity and the activator) 2 x 500 mg to 2 x 750 mg
 Infections of urinary tract:
- acute, uncomplicated;
- cystitis at women (to a menopause);
- complicated.
2 x 250 mg to 2 x 500 mg
 single dose of 500 mg
2 x 500 mg to 2 x 750 mg
 Gonorrhea:
- extragenital;
- acute uncomplicated.
2 x 250 mg
 single dose of 500 mg
 Infections of generative organs:
- uncomplicated gonorrhea (including the extragenital centers of an infection);
- adnexitis, prostatitis, orchiepididymitis.

- adnexitis, prostatitis, орхоепідидиміт.
1 x 500 mg

2 x 500 mg to 2 x 750 mg
 Diarrhea 2 x 500 mg
 Other infections (see the section "Pokazannya") 2 x 500 mg
- At especially heavy, life-threatening infections, for example at recurrent infections at patients with a mucoviscidosis;
- at infections of bones and joints, a septicaemia, peritonitis, in particular, in the presence of Pseudomonas, Staphylococcus or Streptococcus.

 2 x 750 mg
 Prevention of the invasive infections caused by Neisseria meningitidis. 1 x 500 mg

 Additional information of rather separate groups of patients.
Children and teenagers.
• Mucoviscidosis complications.
The available clinical and pharmacokinetic data testify in favor of use of ciprofloxacin for treatment of the pulmonary aggravations caused by Pseudomonas aeruginosa in children and teenagers with a mucoviscidosis of lungs (aged from 5 up to 17 years), for treatment of complications of a mucoviscidosis of the lungs caused by Pseudomonas aeruginosa (experience of use only for children from 5 to 17 years) in a dose of 20 mg of ciprofloxacin/kg orally twice a day (the maximum daily dose – 1500 mg of ciprofloxacin) or 10 mg of ciprofloxacin/kg/body weight intravenously 3 times a day (the maximum daily dose – 1200 mg of ciprofloxacin).
• The complicated infections of urinary tract and pyelonephritis.
At the complicated infections of urinary tract and pyelonephritis the dose makes 6-10 mg of ciprofloxacin/kg/body weight intravenously each 8 hours, but no more maximum dose of 400 mg or 10-20 mg of ciprofloxacin/kg orally each 12 hours, but no more maximum dose of 750 mg.
The dosing mode for elderly patients (> 65 years).
At treatment of patients of advanced age it is necessary to apply lower doses of ciprofloxacin, depending on severity of a disease and clearance of creatinine.
The dosing mode at a renal failure or a liver.
At adults.
• Renal failure:
– At clearance of creatinine from 30 to 60 ml/hv/1,73 sq.m (a moderate renal failure) or its concentration in a blood plasma from 1,4 to 1,9 mg / 100 ml the maximum daily dose of ciprofloxacin has to make 1000 mg a day for oral administration.
– At clearance of creatinine less than 30 ml/hv/1, 73 sq.m (a heavy renal failure) or its concentration in a blood plasma are equivalent or more than 2 mg / 100 ml the maximum daily dose of ciprofloxacin has to make 500 mg for oral administration.
• Renal failure and hemodialysis:
– At clearance of creatinine from 30 to 60 ml/hv/1,73 sq.m (a moderate renal failure) or its concentration in a blood plasma from 1,4 to 1,9 mg / 100 ml the maximum daily dose of ciprofloxacin has to make 1000 mg a day for oral administration.
– At clearance of creatinine less than 30 ml/hv/1,73 or its concentration in a blood plasma are equivalent to sq.m (a heavy renal failure) or more than 2 mg / 100 ml the maximum daily dose of ciprofloxacin has to make 500 mg for oral administration.
• A renal failure and chronic peritoneal dialysis in out-patient conditions:
– Oral administration of ciprofloxacin in the form of tablets, coated, in a dose 1 tablet on 500 mg of ciprofloxacin.
• Abnormal liver function:
– Dose adjustment is not required.
• Renal failure and liver:
– At clearance of creatinine from 30 to 60 ml/hv/1,73 sq.m (a moderate renal failure) or its concentration in a blood plasma from 1,4 to 1,9 mg / 100 ml the maximum daily dose of ciprofloxacin has to make 1000 mg a day for oral administration.
– At clearance of creatinine less than 30 ml/hv/1,73 or its concentration in a blood plasma are equivalent to sq.m (a heavy renal failure) or more than 2 mg / 100 ml the maximum daily dose of ciprofloxacin has to make 500 mg for oral administration.
There is no experience of use of drug to children with a renal failure or a liver.
Route of administration.
Ciprofloxacin tablets, coated, it is necessary to swallow without chewing and to wash down with a small amount of liquid. A pill can be taken irrespective of meal.
Reception on an empty stomach accelerates digestion of active agent. In that case a pill cannot be taken along with the use of the dairy products or drinks enriched with minerals (such as milk, yogurt, orange juice enriched with calcium). However the calcium which is contained in a diet significantly does not influence ciprofloxacin absorption.
If disease severity of the patient or other reasons (for example if the patient receives an enteroalimentation) do not allow to take a ciprofloxacin pill, coated, it is recommended to pass to therapy with an intravenous dosage form of ciprofloxacin. After intravenous administration it is possible to continue treatment in the peroral way.
Treatment duration.
Duration of treatment depends on disease severity, a clinical current and a bacteriological profile. It is important to continue treatment during, at least, 3 days from the moment of disappearance of fever or clinical symptoms.
Average duration of treatment:
• 1 day at acute uncomplicated gonorrhea and cystitis;
• up to 7 days at infections of kidneys, urinary tract and abdominal organs;
• at patients with reduced immunity treatment is carried out during the entire period of a neutropenia;
• at osteomyelitis the course of treatment can make up to 2 months;
• 7-14 days at all other infections.
At the infections caused by streptococci, it is necessary to continue treatment at least 10 days for avoidance of risk of development of complications in the remote period.
At the infections caused by Chlamydia, the course of treatment also has to last at least 10 days.
Children and teenagers.
• Mucoviscidosis complications.
At complications of the mucoviscidosis of lungs caused by Pseudomonas aeruginosa at children (aged from 5 up to 17 years) duration of treatment makes 10-14 days.
• The complicated infections of urinary tract or pyelonephritis.
At the complicated infections of urinary tract or the pyelonephritis caused by Escherichia coli, the course of treatment makes 10-21 days.

Features of use:

Use during pregnancy or feeding by a breast.
Pregnancy.
As safety of use of ciprofloxacin was not established to pregnant women and because data of tests for animals do not allow to exclude completely probability of injury of joint cartilages at newborns, pregnant women cannot appoint ciprofloxacin.
Tests for animals did not provide any proofs of teratogenic effects (malformation) of drug use.
Feeding period breast.
Ciprofloxacin gets into breast milk. Because of potential risk of injury of joint cartilages at newborns ciprofloxacin should not be applied during feeding by a breast.

Children.
Children can apply ciprofloxacin as drug of the second and third line to treatment of the complicated infections of the urinary tract and pyelonephritis caused by Escherichia coli (in clinical trials the age of the children receiving treatment made from 1 to 17 years), and also to treatment of the pulmonary aggravations caused by Pseudomonas aeruginosa in children with a mucoviscidosis of lungs (in clinical trials the age of the children receiving treatment made from 5 to 17 years).
Treatment by ciprofloxacin can be appointed only after careful assessment of a ratio risk advantage, because of probability of development of side effects from joints and/or surrounding fabrics.
Treatment of children within clinical trials was carried out only according to the listed above indications. Clinical experience of use of ciprofloxacin to children according to other indications is limited.
The heavy infections and/or infections caused by gram-positive or anaerobic bacteria.
For treatment of heavy infections, the infections caused by stafilokokka or anaerobic bacteria, ciprofloxacin should be applied in a combination with the appropriate antibacterial agents.
Pneumococci.
Ciprofloxacin is not recommended for treatment of pneumococcal infections because of insufficient efficiency concerning bacteria of the Streptococcus pneumoniae group.
Infections of a genital tract.
Infections of a genital tract can be caused resistant to ftorkhinolona
 Neisseria gonorrhoeae isolates. If it is suspected or it is known that infections of a genital tract are caused by N. gonorrhoeae, it is especially important to obtain information on resistance degree to ciprofloxacin and to confirm sensitivity to drug on the basis of results of laboratory researches.
Disturbance of cordial activity.
Ciprofloxacin is associated with lengthening of an interval of QT on the electrocardiogram (see.
section "Side reactions"). In general elderly patients can be more sensitive to impact of drug on QT interval. It is necessary to apply with care ciprofloxacin with the accompanying drugs which can cause prolongation of an interval of QT (for example, antiarrhytmic drugs of the class Ia or III), and in patients with risk factors concerning the specified states (for example, prolongation of QT in the anamnesis, a nekoregirovanny hypopotassemia).
Children and teenagers.
As well as other medicines of this group, it is proved that ciprofloxacin can cause an arthropathy of basic joints in young animals. The analysis of the available data on safety of use of ciprofloxacin to children, the majority of whom suffered from a mucoviscidosis, did not provide any proofs of the damage of cartilaginous tissue or joints associated with treatment. Use of ciprofloxacin according to other indications, except treatment of the pulmonary aggravations caused by Pseudomonas aeruginosa in children with a mucoviscidosis of lungs (at the age of 5-17 years), treatment of the complicated infections of the urinary tract and pyelonephritis caused by E.coli (age of 1-17 years) and a malignant anthrax after contact was not studied. Clinical experience of use of ciprofloxacin to children according to other indications is limited.
Hypersensitivity to drug.
In certain cases hypersensitivity and allergic reactions can be observed after the first reception of ciprofloxacin what it is necessary to report to the doctor immediately about.
In extremely exceptional cases anaphylactic/anaphylactoid reactions can progress to state of shock, the life-threatening patient. In certain cases they are observed after the first reception of ciprofloxacin. In these cases reception of ciprofloxacin needs to be suspended and to immediately carry out drug treatment (treatment of an acute anaphylaxis).
Digestive tract.
In case of emergence during or after treatment of heavy and persistent diarrhea it is necessary to report about it to the doctor as this symptom can mask a serious gastrointestinal illness (for example, pseudomembranous colitis can threaten life with a possible lethal outcome), which demands immediate treatment. In such cases reception of ciprofloxacin it is necessary to stop and begin use of the corresponding therapy (for example, Vancomycinum orally 4 x 250 mg/days). The medicines inhibiting a peristaltics are contraindicated.
Passing increase in activity of transaminases, alkaline phosphatase or cholestatic jaundice, especially at patients with the previous injury of a liver can be observed.
Musculoskeletal system.
At any signs of a tendinitis (for example, a painful swelling, an inflammation) it is necessary to report about it to the doctor and to stop treatment by an antibiotic. At the same time it is necessary to keep the affected extremity in rest and to avoid an inappropriate exercise stress (as the risk of a rupture of a sinew can increase).
The rupture of sinews (preferential Achilles) was observed preferential at drug use to elderly people or in connection with the previous treatment by glucocorticoids.
Ciprofloxacin should be applied with care to patients with the disturbances from sinews in the anamnesis associated with treatment of a hinolonama.
Nervous system.
Patients with epilepsy and the patients having in the anamnesis of dysfunction of the central nervous system (for example, decrease in a convulsive threshold, a spasm in the anamnesis, decrease in a blood-groove in vessels of a brain, change in structure of a brain or a stroke), can accept ciprofloxacin only in case of dominance of the expected advantage over possible risk as such patients treat risk group because of possible side reactions from the central nervous system.
In certain cases side reactions from the central nervous system are observed after the first reception of ciprofloxacin. Seldom the depression or psychosis can progress to the life-threatening patient of a state. In such cases reception of ciprofloxacin needs to be stopped and to immediately tell the doctor.
Skin and hypodermic cellulose.
It was proved that ciprofloxacin causes emergence of reactions of photosensitivity therefore the patients accepting ciprofloxacin have to avoid an intensive sunlight or ultra-violet radiation. At emergence of reactions of photosensitivity (for example, similar sunblisters) ciprofloxacin should stop therapy.
P450 cytochrome.
It is known that ciprofloxacin is moderate inhibitor of enzymes 1A2 of P450 cytochrome. It is necessary to be careful at the simultaneous use of ciprofloxacin and drugs which are metabolized in the similar fermental way (such as theophylline, methylxanthine, caffeine, дулоксетин, clozapine). Increase in concentration of these drugs in blood serum is connected with inhibition of their metabolic clearance ciprofloxacin, can cause specific side effects.
Influence on results of laboratory analyses.
In vitro ciprofloxacin can influence results of crops on Mycobacterium spp flora. by oppression of growth in culture of mycobacteria, resulting in false-negative results of the analysis of crops from the patients accepting ciprofloxacin.

Ability to influence speed of response at control of motor transport or work with other mechanisms.
Ftorkhinolona to which ciprofloxacin belongs can influence ability of the patient to drive the car and work with mechanisms because of reaction from the central nervous system (see the section "Side reactions"). It is especially characteristic at administration of drug in parallel with alcohol.

Side effects:

Side reactions, information on which is given below, are classified by bodies and systems and for the frequency of their emergence: often (≥ 1/100, <1/10); not widespread (≥ 1/1000, <1/100); seldom widespread (≥ 1/10000, <1/1000), very seldom widespread (<1/10 000); frequency which cannot be estimated due to the lack of data.
Infections and invasions: not widespread – fungal superinfections; seldom widespread – antibiotikoassotsiirovanny colitis (it is very rare with a possible lethal outcome).
From the hemopoietic system: not widespread – an eosinophilia, seldom widespread – a leukopenia, anemia, a neutropenia, a leukocytosis, thrombocytopenia, a thrombocytosis; very seldom widespread – hemolitic anemia, an agranulocytosis, a pancytopenia (such that threatens life) and a marrow depression (such that threatens life).
From the alimentary system: extended – nausea, diarrhea; not widespread – vomiting, pain in a stomach and intestines, the dispepsichesky frustration, a meteorism very seldom widespread – pancreatitis.
From immune system: not widespread – the allergic reactions, an allergic/Quincke's disease very seldom widespread – anaphylactic reactions, an acute anaphylaxis (such that threatens life) and reactions, similar to a serum disease.
Metabolic disturbances: not widespread – anorexia, seldom widespread – a hyperglycemia.
Mental disorders: not widespread – psychomotor excitement / uneasiness; seldom widespread – confusion of consciousness and a disorientation, concern, the increased drowsiness, a depression, the hallucinations very seldom widespread – psychoses.
From a nervous system: not widespread – a headache, dizziness, frustration of a dream, taste disturbance; seldom widespread – paresthesias, a dizesteziya, a hypesthesia, a hyperesthesia, a tremor, spasms, вертиго; very seldom widespread – migraine, an incoordination, disturbance of sense of smell, intracranial hypertensia, thrombosis of cerebral arteries; it is unknown – peripheral neuropathy and polyneuropathy.
From an organ of sight: seldom widespread – a vision disorder; very seldom widespread – disturbance of color perception.
From an acoustic organ: seldom widespread – a ring in ears, temporary deafness, very seldom widespread – a persistent hearing disorder.
From cardiovascular system: not widespread – tachycardia; seldom widespread – a vazodilatation, a lowering of arterial pressure, a faint; very seldom widespread – vasculites; it is unknown – prolongation of an interval of QT, ventricular arrhythmia, bidirectional ventricular тахикардия*.
From respiratory system: seldom widespread – диспноэ (including asthmatic states).
From a liver and biliary tract: not widespread – quickly passing increase in level of transaminases, a hyperbilirubinemia seldom widespread – a short-term abnormal liver function, jaundice, hepatitis (noninfectious); very seldom widespread – a liver necrosis (very seldom progresses to a liver failure which threatens life).
From skin and hypodermic cellulose: not widespread – the rash, an itch, urticaria seldom widespread – the reactions of a photosensitization, emergence of nonspecific bubbles very seldom widespread – petechias, a multiformny erythema, a knotty erythema, Stephens-Johnson's syndrome (with potential threat of life) and a toxic epidermal necrolysis with potential threat of life (Lyell's disease).
From a musculoskeletal system: not widespread – arthralgias; seldom widespread – mialgiya, arthritises, increase in a muscle tone and myotonia; very seldom widespread – muscular weakness, a tendinitis, a rupture of sinews (preferential Achilles), an aggravation of symptoms of a myasthenia.
From an urinary system: not widespread – a renal failure; seldom widespread – tubulointerstitsialny nephrite, a renal failure, a hamaturia, a crystalluria.
General disturbances: not widespread – the nonspecific pain syndrome, an indisposition, fever seldom widespread – the hypostases, perspiration (hyperhidrosis) very seldom widespread – walking disturbance.
Laboratory indicators: not widespread – short-term increase in level of an alkaline phosphatase in blood; seldom widespread – an aberration of level of a prothrombin and increase in level of amylase.
 * These reactions were fixed in the post-marketing period and observed preferential at patients with accessory factors of risk of prolongation of an interval of QT (see the section "Features of Use").
The following undesirable by-effects belong to the category of the increased rate in subgroups of the patients receiving drug intravenously or consistently (after intravenous maintaining – the peroral mode):

Table 1.
Frequent Vomiting, tranzitorny increase in activity of transaminases, rash.

Infrequent Thrombocytopenia, thrombocytosis, confusion of consciousness and disorientation, hallucinations, paresthesias, dizesteziya, spasms, вертиго, dizzinesses, vision disorder, hearing disorder, tachycardia, vazodilatation, decrease in the ABP, tranzitorny liver failure, jaundice, renal failure, hypostasis.
Rare Pancytopenia, oppression of marrow, acute anaphylaxis, psychotic reactions, migraine, disturbances of sense of smell, hearing disorder, vasculitis, pancreatitis, necrosis of a liver, petechia, rupture of a sinew.

Use to children.
The frequency of cases of an arthropathy stated above is based on the data obtained at researches of adult patients. At children the arthropathy is observed often (see the section "Features of Use").

Interaction with other medicines:

Antiarrhytmic drugs of the class Ia or III.
It is necessary to be careful at simultaneous use of ciprofloxacin and antiarrhytmic drugs of the class Ia or III as ciprofloxacin can strengthen prolongation of an interval of QT (see the section "Features of Use").
Formation of chelate complexes.
At simultaneous use of ciprofloxacin (inside) and the medicines containing multivalent cations, mineral additives (for example, calcium, magnesium, aluminum, iron), fosfatsvyazyvayushchy polymers (for example, a sevelamer, lanthanum a carbonate), сукральфат or antacids, and also the drugs with a big buffer capacity (for example, tablets диданозин) containing magnesium, aluminum or calcium ciprofloxacin absorption decreases. In this regard ciprofloxacin should be accepted or in 1-2 hours prior to or at least in 4 hours after reception of these drugs.
This restriction does not concern the antacids belonging to a class of blockers H2 receptors.
Food, in particular dairy products.
It is necessary to avoid a concomitant use of ciprofloxacin and the milk or enriched with minerals products (for example, milk, yogurt, orange juice with the increased content of calcium). Other products with the content of calcium considerably do not influence ciprofloxacin absorption.
Probenetsid.
Probenetsid slows down removal of ciprofloxacin with bile. Simultaneous use of the medicines containing пробенецид and ciprofloxacin leads to increase in level of concentration of ciprofloxacin in a blood plasma.
Metoclopramidum.
Metoclopramidum accelerates ciprofloxacin absorption (at peroral introduction) that leads to reduction of time of achievement of the maximum concentration in a blood plasma. On bioavailability of ciprofloxacin no influence was observed.
Omeprazol.
Simultaneous use of ciprofloxacin and the medicines containing омепразол leads to insignificant decrease in Cmax and reduction of an indicator "the area under a ratio curve concentration time" (AUC) of ciprofloxacin.
Tizanidin.
During clinical trial with participation of healthy volunteers at simultaneous use of ciprofloxacin and a tizanidin increase in concentration of a tizanidin in a blood plasma is revealed (increase in Cmax by 7 times, range – 4-21 times, increase in an indicator of AUC – by 10 times, range – 6-24 times). Hypotensive and sedative by-effects are associated with increase in concentration of a tizanidin in blood serum. Therefore simultaneous use of ciprofloxacin and the medicines containing тизанидин is contraindicated (see the section "Contraindications").
Theophylline.
Combined use of ciprofloxacin and the medicines containing theophylline can lead to undesirable increase in concentration of theophylline in a blood plasma that in turn, can cause development of side effects. In rare instances such side effects can threaten life or have fatal result. If simultaneous use of these drugs cannot be avoided, it is necessary to control concentration of theophylline in blood serum and adequately to reduce its dose (see the section "Features of Use").
Other derivatives of xanthine.
After the simultaneous use of ciprofloxacin and means containing caffeine or пентоксифиллин (окспентифиллин) it was reported about increase in concentration of these xanthines in blood serum.
Methotrexate.
At co-administration of ciprofloxacin delay of tubular transport (renal metabolism) of a methotrexate is possible that can lead to increase in concentration of a methotrexate in a blood plasma. At the same time the probability of emergence of the side toxic reactions caused by a methotrexate can increase. In this regard for the patients receiving a combination therapy a methotrexate and ciprofloxacin it is necessary to carry out careful observation.
Non-steroidal anti-inflammatory drugs.
Researches on animals showed that the combined use of very high doses of hinolon (giraza inhibitors) and some non-steroidal anti-inflammatory drugs (excepting acetylsalicylic acid) can provoke spasms.
Cyclosporine.
At simultaneous use of ciprofloxacin and cyclosporine tranzitorny increase in concentration of serumal creatinine was observed. Therefore frequent control of an indicator of concentration of serumal creatinine is necessary for such patients (twice a week).
Antagonists of vitamin K.
At simultaneous use of ciprofloxacin and the antagonist of vitamin K anticoagulating effect of ciprofloxacin can amplify. The risk can vary depending on an infection, age, the general condition of the patient therefore it is difficult to estimate exact influence of ciprofloxacin on increase in value of the International normalized relation (INR). It is necessary to exercise regular control of INR in time and right after joint administration of ciprofloxacin and the antagonist of vitamin K (for example, warfarin, an atsenokumarol, a fenprokumon or a fluindion).
Glibenclamidum.
In some cases simultaneous use of ciprofloxacin and the medicines containing Glibenclamidum can increase intensity of effect of glibenclamide (hypoglycemia).
Duloksetin.
During clinical trials it was revealed that simultaneous use of a duloksetin and powerful inhibitors of SUR450 1A2 isoenzyme (such as флювоксамин) can lead to increase in AUC and Cmax of a duloksetin. Despite the absence of clinical data on interaction with ciprofloxacin, it is possible to provide a possibility of interaction at simultaneous use of ciprofloxacin and a duloksetin (see the section "Features of Use").
Ropinirol.
During clinical trials it was revealed that simultaneous use of a ropinirol with the ciprofloxacin moderated by inhibitor of SUR450 1A2 isoenzyme leads to increase in AUC and Cmax of a ropinirol by 60% and 84% respectively. Monitoring of side effects of a ropinirol and the corresponding correcting of a dose is recommended in time and right after joint introduction with ciprofloxacin (see the section "Features of Use").
Lidocaine.
The research with participation of healthy volunteers was shown that simultaneous use of the medicines containing lidocaine and ciprofloxacin, moderate inhibitor of SUR450 1A2 isoenzyme, reduces clearance of the lidocaine entered intravenously by 22%. Though treatment with lidocaine was well transferred, after simultaneous use with ciprofloxacin a certain interaction which can be followed by side reactions can be observed.
Clozapine.
After simultaneous use of 250 mg of ciprofloxacin with clozapine a current of 7 days serumal concentration of clozapine and N-desmetilklozapina were increased for 29% and 31% respectively. Clinical supervision and the corresponding correcting of a dose of clozapine is recommended in time and right after joint introduction with ciprofloxacin (see the section "Features of Use").
Sildenafil.
The research with participation of healthy volunteers was shown by increase in Cmax and AUC of a sildenafil approximately twice after oral administration of 50 mg along with 500 mg of ciprofloxacin. Therefore it is necessary to appoint with care simultaneous use of ciprofloxacin with sildenafily, carefully weighing risk and advantage.

Contraindications:

Ciprofloxacin it is not necessary to use at hypersensitivity to active agent drug or to other drugs of group of ftorkhinolon, or to any of drug excipients.
Simultaneous use of ciprofloxacin and tizanidin contraindicated because of clinically significant side effects (arterial hypotension, drowsiness) connected with increase in concentration of a tizanidin in a blood plasma.

Overdose:

Owing to acute overdose at oral administration in some cases it was noted reversible toxic action on a parenchyma of kidneys.
Therefore in case of overdose, except holding ordinary actions, it is also recommended to control function of kidneys and to accept the antacids containing magnesium and calcium which reduce ciprofloxacin absorption.
By means of a hemodialysis or peritoneal dialysis only a small amount of ciprofloxacin is removed (<10%).

Issue conditions:

According to the recipe