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Serious adverse reactions including tendinitis and tendon rupture, peripheral neuropathy, central nervous system effects, and exacerbation of myasthenia gravis: Fluoroquinolones, including ciprofloxacin, have been associated with disabling and potentially irreversible serious adverse reactions. Tendinitis and tendon rupture; Peripheral neuropathy; Central nervous system effects.
Discontinue ciprofloxacin immediately at the first signs or symptoms of any serious adverse reaction. In addition, avoid the use of fluoroquinolones, including ciprofloxacin, in patients who have experienced any of these serious adverse reactions associated with fluoroquinolones. Fluoroquinolones, including ciprofloxacin may exacerbate muscle weakness in patients with myasthenia gravis. Avoid ciprofloxacin in patients with known history of myasthenia gravis.
Because fluoroquinolones, including ciprofloxacin, have been associated with serious adverse reactions, reserve ciprofloxacin for use in patients who have no alternative treatment options for the following indications: Acute bacterial sinusitis, ABS; Acute bacterial exacerbation of chronic bronchitis, (ABECB); Uncomplicated urinary tract infections, UTI.
Ruptures of the shoulder, hand, Achilles tendon or other tendons that are required surgical repair or resulted in prolonged disability have been reported in patients with receiving quinolones. Post-marketing surveillance reports indicate that this risk is increased in patients taking corticosteroids, or in the elderly. Ciprofloxacin should be discontinued if the patients experience pain, inflammation, or rupture of a tendon. Patients should rest and refrain from exercise until the diagnosis of tendonitis or tendon rupture has been excluded. Tendon rupture can occur during or after therapy with quinolones, including ciprofloxacin.
Fluoroquinolones, including ciprofloxacin, have neuromuscular blocking activity and may exacerbate muscle weakness in patients with myasthenia gravis. Post marketing serious adverse reactions, including deaths and requirement for ventilator support, have been associated with fluoroquinolone use in patients with myasthenia gravis.
