much more likely [1%:65 years) as compared to young adults. C max is increased 16 to 40%, and mean AUC is increased approximately 30%, which can be at least partially attributed to decreased renal clearance in the elderly. Elimination half-life is only slightly (~20%) prolonged in the elderly. These differences are not considered clinically significant [see Use in Specific Populations ( 8.5 )]. Renal Impairment In patients with reduced renal function, the half-life of ciprofloxacin is slightly prolonged. No dose adjustment is required for patients with uncomplicated UTIs receiving 500 mg Cipro XR. For cUTI and AUP, where 1000 mg is the appropriate dose, the dosage of Cipro XR should be reduced to Cipro XR 500 mg q24h in patients with creatinine clearance equal to or below 30 mL/min [see Dosage and Administration ( 2.3 )]. Hepatic Impairment In preliminary studies in patients with stable chronic cirrhosis, no significant changes in ciprofloxacin pharmacokinetics have been observed. The kinetics of ciprofloxacin in patients with acute hepatic insufficiency, however, have not been fully elucidated [see Use in Specific Populations ( 8.7 )]. Drug-Drug Interactions Antacids Concurrent administration of antacids containing magnesium hydroxide or aluminum hydroxide may reduce the bioavailability of CIPRO by as much as 90% [see Dosage and Administration ( 2.2 ) and Drug Interactions ( 7 )]. Histamine H 2 -receptor antagonists Histamine H 2 -receptor antagonists appear to have no significant effect on the bioavailability of CIPRO. Metronidazole The serum concentrations of CIPRO and metronidazole were not altered when these two drugs were given concomitantly. Tizanidine In a pharmacokinetic study, systemic exposure of tizanidine (4 mg single dose) was significantly increased (C max 7-fold, AUC 10-fold) when the drug was given concomitantly with CIPRO (500 mg twice a day for 3 days). Concomitant administration of tizanidine and Cipro XR is contraindicated due to the potentiation of hypotensive and sedative effects of tizanidine [see Contraindications ( 4.2 )] . Ropinirole In a study conducted in 12 patients with Parkinson s disease who were administered 6 mg ropinirole once daily with 500 mg CIPRO twice-daily, the mean C max and mean AUC of ropinirole were increased by 60% and 84%, respectively. Monitoring for ropinirole-related adverse reactions and appropriate dose adjustment of ropinirole is recommended during and shortly after co-administration with Cipro XR [see Warnings and Precautions ( 5.15 )]. Clozapine Following concomitant administration of 250 mg CIPRO with 304 mg clozapine for 7 days, serum concentrations of clozapine and N-desmethylclozapine were increased by 29% and 31%, respectively. Careful monitoring of clozapine associated adverse reactions and appropriate adjustment of clozapine dosage during and shortly after co-administration with Cipro XR are advised. Sildenafil Following concomitant administration of a single oral dose of 50 mg sildenafil with 500 mg CIPRO to healthy subjects, the mean C max and mean AUC of sildenafil were both increased approximately two-fold. Use sildenafil with caution when co-administered with Cipro XR due to the expected two-fold increase in the exposure of sildenafil upon co-administration of CIPRO [see Drug Interactions ( 7 )] . Duloxetine In clinical studies it was demonstrated that concomitant use of duloxetine with strong inhibitors of the CYP450 1A2 isozyme such as fluvoxamine, may result in a 5-fold increase in mean AUC and a 2.5-fold increase in mean C max of duloxetine. Lidocaine In a study conducted in 9 healthy volunteers, concomitant use of 1.5 mg/kg IV lidocaine with 500 mg ciprofloxacin twice daily resulted in an increase of lidocaine C max and AUC by 12% and 26%, respectively. Although lidocaine treatment was well tolerated at this elevated exposure, a possible interaction with Cipro XR and an increase in adverse reactions related to lidocaine may occur upon concomitant administration. Metoclopramide Metoclopramide significantly accelerates the absorption of oral ciprofloxacin resulting in a shorter time to reach maximum plasma concentrations. No significant effect was observed on the bioavailability of ciprofloxacin. Omeprazole When Cipro XR was administered as a single 1000 mg dose concomitantly with omeprazole (40 mg once daily for three days) to 18 healthy volunteers, the mean AUC and C max of ciprofloxacin were reduced by 20% and 23%, respectively. The clinical significance of this interaction has not been determined. Microbiology Mechanism of Action The bactericidal action of ciprofloxacin results from inhibition of the enzymes topoisomerase II (DNA gyrase) and topoisomerase IV (both Type II topoisomerases), which are required for bacterial DNA replication, transcription, repair, and recombination. Mechanism of Resistance The mechanism of action of fluoroquinolones, including ciprofloxacin, is different from that of other antimicrobial agents such as beta-lactams, macrolides, tetracyclines, or aminoglycosides; therefore, microorganisms resistant to these classes of drugs may be susceptible to ciprofloxacin. Resistance to fluoroquinolones occurs primarily by either mutations in the DNA gyrases, decreased outer membrane permeability, or drug efflux. In vitro resistance to ciprofloxacin develops slowly by multiple step mutations. Resistance to ciprofloxacin due to spontaneous mutations occurs at a general frequency of between] Antibiotics 101 Everything you need to know about antibiotics: List of Common Antibiotics & Types Antibiotics & Drinking Alcohol - Is it Safe? Antibiotics For UTI - What Are My Options? FEATURED: CAR-T Cell Therapy Overview Mechanism of Action KTE-C19 Studies KTE-C19 Cancer Targets Adverse Events Manufacturing Drug Status Rx Availability Prescription only C Pregnancy Category Risk cannot be ruled out N/A CSA Schedule Not a controlled drug Approval History Drug history at FDA Drug Class Quinolones Related Drugs quinolones ciprofloxacin , Levaquin , levofloxacin , moxifloxacin Urinary Tract Infection ciprofloxacin , amoxicillin , doxycycline , Augmentin , Levaquin , More... Bacterial Infection ciprofloxacin , amoxicillin , azithromycin , doxycycline , cephalexin , More... Epididymitis, Sexually Transmitted ciprofloxacin , doxycycline , Levaquin , levofloxacin , ceftriaxone , More... 39 more conditions... Cipro XR Rating No Reviews - Be the first! No Reviews - Be the first! Not Rated - Be the first! Cipro XR Images Cipro XR 500 mg (BAYER C500 QD) View larger images a fairly big
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