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

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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

See how to identify renal failure stages according to GFR calculation

See how to diagnose irreversible renal disease

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