Ciprofloxacin

CLINICAL USE

Antibacterial agent

DOSE IN NORMAL RENAL FUNCTION

Oral: 250–750 mg every 12 hoursIV: 100–400 mg every 12 hours

PHARMACOKINETICS

  • Molecular weight                           :331.3
  • %Protein binding                           :20–40
  • %Excreted unchanged in urine     : 40–70
  • Volume of distribution (L/kg)       :2.5
  • half-life – normal/ESRD (hrs)      :3–5/8

    DOSE IN RENAL IMPAIRMENT

    GFR (mL/MIN)

  • 20 to 50     : Dose as in normal renal function
  • 10 to 20     : 50–100% of normal dose
  • <10           : 50% of normal dose. (100% dose may be given for short periods under exceptional circumstances)

    DOSE IN PATIENTS UNDERGOING RENAL REPLACEMENT THERAPIES

  • CAPD                :Not dialysed. Oral: 250 mg every 8–12 hours. IV: 200 mg every 12 hours
  • HD                     :Not dialysed. Oral: 250–500 mg every 12 hours. IV: 200 mg every 12 hours
  • HDF/high flux   :Unknown dialysability. Oral: 250–500 mg every 12 hours. IV: 200 mg every 12 hours
  • CAV/VVHD      :Dialysed. Oral: 500–750 mg every 12 hours. IV: 200–400 mg every 12 hours

    IMPORTANT DRUG INTERACTIONS

    Potentially hazardous interactions with other drugsAnalgesics: increased risk of convulsions with NSAIDs; avoid premedication with opioid analgesicsAnticoagulants: anticoagulant effect of coumarins enhancedAntidepressants: metabolism of duloxetine inhibitedAntimalarials: manufacturer of artemether with lumefantrine advises avoid concomitant useAntipsychotics: possibly increased concentration of olanzapine and clozapineCiclosporin: variable response; no interaction seen locally; some reports of increased nephrotoxicityMuscle relaxants: tizanidine concentration increased – avoid concomitant useTacrolimus: increased levels (anecdotally) Theophylline: possibly increased risk of convulsions; increased plasma levels of theophylline

    ADMINISTRATION

    Reconstition

    –

    Route

    Oral, IV

    Rate of Administration

    Infusion: over 30–60 minutes

    Comments

    Swallow tablets whole, do not chew Do not take milk, iron preparations, indigestion remedies or phosphate binders at the same time as ciprofloxacin orally

    OTHER INFORMATION

    Intraperitoneal ciprofloxacin in

  • CAPD

    • , dose range 25 mg/L to 100 mg/LIn

  • CAPD                : peritonitis oral ciprofloxacin up to 500 mg twice daily may be administeredOral bioavailability is 70–80% Only very small amounts removed by dialysis
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