Cipro (Ciprofloxacin) Prescription

Generic Name: Ciprofloxacin

Common Brand Name: Cipro

Buying Ciprofloxacin Without Prescription

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• Prescription: No required.

Common medical uses:
Ciprofloxacin (Cipro) is a prescription broad-spectrum antibacterial agent with activity against a range of Gram-positive, Gram-negative, atypicals and anaerobes. Cipro is indicated for the treatment of the following infections when caused by susceptible bacteria:

• Urinary tract infections
• Acute uncomplicated cystitis in females
• Chronic bacterial prostatitis
• Lower respiratory tract infections (including acute exacerbations of chronic bronchitis)
• Acute sinusitis
• Skin and skin structure infections
• Bone and joint infections
• Complicated intra-abdominal infections (in combination with metronidazole)
• Infectious diarrhea
• Typhoid fever due to Salmonella typhi (eradication of chronic typhoid carrier state has not been proven)
• Uncomplicated cervical and urethra gonorrhea (due to N. gonorrhoeae)
• Nosocomial pneumonia
• Empirical therapy for febrile neutropenic patients (in combination with piperacillin)

Cipro dosage:

• Usual dosage ranges: Adults: 250-750 mg every 12 hours
• Anthrax:
  Inhalational (postexposure prophylaxis): 500 mg every 12 hours for 60 days
  Cutaneous (treatment, CDC guidelines): 500 mg every 12 hours for 60 days.
  Inhalational/gastrointestinal/oropharyngeal (treatment, CDC guidelines): I.V.: 400 mg every 12 hours. Note: Initial treatment should include two or more agents predicted to be effective (per CDC recommendations). Continue combined therapy for 60 days.
• Bone/joint infections: 500-750 mg twice daily for 4-6 weeks
• Chancroid (CDC guidelines): 500 mg twice daily for 3 days
• Gonococcal infections:
  Urethral/cervical gonococcal infections: 250-500 mg as a single dose (CDC recommends concomitant doxycycline or azithromycin due to possible coinfection with Chlamydia; Note: As of April 2007, the CDC no longer recommends the use of fluoroquinolones for the treatment of uncomplicated gonococcal disease.
  Disseminated gonococcal infection (CDC guidelines): 500 mg twice daily to complete 7 days of therapy (initial treatment with ceftriaxone 1 g I.M./I.V. daily for 24-48 hours after improvement begins); Note: As of April 2007, the CDC no longer recommends the use of fluoroquinolones for the treatment of more serious gonococcal disease, unless no other options exist and susceptibility can be confirmed via culture.
• Infectious diarrhea:
  Salmonella: 500 mg twice daily for 5-7 days
  Shigella: 500 mg twice daily for 3 days
  Traveler's diarrhea: Mild: 750 mg for one dose; Severe: 500 mg twice daily for 3 days
  Vibrio cholerae: 1 g for one dose
• Lower respiratory tract, skin/skin structure infections: 500-750 mg twice daily for 7-14 days
• Prostatitis (chronic, bacterial): 500 mg every 12 hours for 28 days
• Sinusitis (acute): Oral: 500 mg every 12 hours for 10 days
• Typhoid fever: Oral: 500 mg every 12 hours for 10 days
• Urinary tract infection:
  Acute uncomplicated, cystitis: 250 mg every 12 hours for 3 days
• Complicated (including pyelonephritis): 500 mg every 12 hours for 7-14 days

Cipro side effects:

• Central nervous system: restlessness, dizziness, lightheadedness, insomnia, nightmares, hallucinations, manic reaction, irritability, tremor, ataxia, convulsive seizures, lethargy, drowsiness, weakness, malaise, anorexia, phobia, depersonalization, depression, paresthesia, abnormal gait, grand mal convulsion.
• Dermatologic/Hypersensivity: rash (2%); allergic reaction, pruritus, urticaria, photosensitivity, flushing, fever, chills, angioedema, edema of the face, neck, lips, conjunctivae or hands, cutaneous candidiasis, hyperpigmentation, erythema nodosum, sweating
• Cardiovascular: palpitation, atrial flutter, ventricular ectopy, syncope, hypertension, angina pectoris, myocardial infarction, cardiopulmonary arrest, cerebral thrombosis, phlebitis, tachycardia, migraine, hypotension
• Gastrointestinal: nausea (2.5%), diarrhea (1.6%), vomiting (1%); painful oral mucosa, oral candidiasis, dysphagia, intestinal perforation, gastrointestinal bleeding, cholestatic jaundice, hepatitis.
• Genitourinary: interstitial nephritis, nephritis, renal failure, polyuria, urinary retention, urethral bleeding, vaginitis, acidosis, breast pain.
• Respiratory: dyspnea, epistaxis, laryngeal or pulmonary edema, hiccough, hemoptysis, bronchospasm, pulmonary embolism.
• Hematologic: lymphadenopathy, petechia.
• Metabolic: amylase increase, lipase increase.
• Musculoskeletal: arthralgia or back pain, joint stiffness, achiness, neck or chest pain, flare up of gout; pain, inflammation, or rupture of a tendon.
• Special sences: blurred vision, disturbed vision (change in color perception, overbrightness of lights), decreased visual acuity, diplopia, eye pain, tinnitus, hearing loss, bad taste, chromatopsia.

Precautions:

• Children: Do not use ciprofloxacin in children younger than 18 yr of age, except for listed indications.
• Cardiac conduction: Fluoroquinolones may prolong QTc interval; avoid use in patients with a history of QTc prolongation, uncorrected hypokalemia, hypomagnesemia, or concurrent administration of other medications known to prolong the QT interval.
• CNS stimulation: Tremor, restlessness, confusion, and very rarely hallucinations or seizures may occur.
• Crystalluria: Rarely, crystalluria has occurred. Ensure adequate hydration during therapy.
• Hypersensitivity reactions: Although quite rare, serious and occasionally fatal allergic reactions (some following the first dose) have been reported in people receiving quinolone antibiotics.
• Peripheral neuropathy: The use of quinolones has been linked to peripheral neuropathy (paresthesias, hypoesthesias, dysesthesias, weakness). Discontinue if symptoms of sensory or sensorimotor neuropathy occur.
• Phototoxicity: Avoid excessive sunlight; may cause moderate-to-severe phototoxicity reactions.
• Tendon inflammation/rupture: There have been reports of tendon inflammation (commonly Achilles, shoulder, or hand tendons) and/or rupture with quinolone antibiotics; risk is increased with concurrent corticosteroids, particularly in the elderly. Discontinue at first sign of tendon inflammation or pain.

Drug interactions

• Caffeine: may decrease the metabolism of caffeine.
• Corticosteroids: Concurrent use increases the risk of tendon rupture, particularly in elderly patients (overall incidence rare).
• CYP1A2 substrates (aminophylline, fluvoxamine, mexiletine, mirtazapine, ropinirole, tizanidine, trifluoperazine): Ciprofloxacin may increase the levels/effects of CYP1A2 substrates.
• Glyburide: Cipro may increase the effect of glyburide; monitor.
• Metal cations (aluminum, calcium, iron, magnesium, and zinc) bind Ciprofloxacin in the gastrointestinal tract and inhibit absorption. Concurrent administration of most antacids, oral electrolyte supplements, quinapril, sucralfate, some didanosine formulations should be avoided. Cipro should be administered 2 hours before or 6 hours after these agents.
• Methotrexate: Ciprofloxacin may decrease renal secretion of methotrexate; monitor.
• NSAIDs: Risk of seizures may be increased with concomitant NSAID use.
• Pentoxifylline: Monitor for headache during concomitant therapy.
• Phenytoin: may decrease phenytoin levels; monitor.
• Probenecid: May decrease renal secretion of ciprofloxacin.
• QTc-prolonging agents: may enhance the QT-prolonging effects of known QTc-prolonging agents; information based on rare case reports.
• Ropivacaine: may decrease the metabolism of ropivacaine.
• Sevelamer: may decrease absorption of oral Cipro.
• Theophylline: Serum levels may be increased by ciprofloxacin; in addition, CNS stimulation/seizures may occur at lower theophylline serum levels due to additive CNS effects.
• Tizanidine: Cipro increases serum levels of tizanidine. Concurrent administration is contraindicated.
• Typhoid vaccine: Antibiotics may decrease the therapeutic effect of live, attenuated Ty21a vaccine; delay vaccination for >24 hours after administration of antibacterial agents.
• Warfarin: The hypoprothrombinemic effect of warfarin may be enhanced by ciprofloxacin; monitor INR.

Test Interactions:

• Some quinolones may produce a false-positive urine screening result for opiates using commercially-available immunoassay kits. This has been demonstrated most consistently for levofloxacin and ofloxacin, but other quinolones have shown cross-reactivity in certain assay kits.

Pregnancy & Lactation:
Pregnancy Risk Factor: C
Cipro crosses the placenta and concentrates in amniotic fluid; maternal serum levels may be decreased during pregnancy. Reports of arthropathy (observed in immature animals and reported rarely in humans) have limited the use of fluoroquinolones in pregnancy. According to the FDA, the Teratogen Information System concluded that therapeutic doses during pregnancy are unlikely to produce substantial teratogenic risk, but data are insufficient to say that there is no risk. In general, reports of exposure have been limited to short durations of therapy in the first trimester. When considering treatment for life-threatening infection and/or prolonged duration of therapy (such as in anthrax), the potential risk to the fetus must be balanced against the severity of the potential illness.

Breast-Feeding:
Cipro is excreted in breast milk; however, the exposure to the infant is considered small and one source suggests that the decision to breast-feed be independent of the need for the antibiotic in the mother. Another source recommends the mother wait 48 hours after the last dose of Cipro to continue nursing. The manufacturer recommends to discontinue nursing or to discontinue Cipro.

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References:

• 1. U.S. Food and Drug Administration. Ciprofloxacin (Cipro) U.S. Prescribing Information available at (PDF format)