What Are The Side Effects Of Stopping Ciprofloxacin?

Ciprofloxacin, also known as Cipro, is a popular antibiotic prescribed for a number of bacterial infections, including sinus infections and urinary tract infections. 

The most commonly reported ciprofloxacin side effects include nausea, vomiting, and skin rash after sun exposure. 

However, some people may experience severe side effects, including tendon rupture, tendinitis, and peripheral neuropathy.

In this article, we’re going to take a look at some of the most common side effects of ciprofloxacin after stopping the medication. 

What is Ciprofloxacin?

Ciprofloxacin is a commonly used antibiotic. It is a prescription drug and should be used under the care of a physician. 

Ciprofloxacin belongs to a drug class known as fluoroquinolone, an antibiotic treatment option, especially against gram-negative bacteria and some gram-positive microbes.

Ciprofloxacin works by inhibiting an enzyme in bacteria known as DNA gyrase. Blocking this enzyme inhibits growth. 

Since bacteria are no longer duplicating, and the white blood cells are still active, the infection gradually improves.

Pharmacy names for ciprofloxacin include Cipro, Ciloxan, and Cetraxal, and they come in tablets, oral suspensions, eyedrops, and more.

Ciprofloxacin should not be used in children younger than 18 months old. Before using this antibiotic, tell your healthcare provider if you have kidney disease, liver disease, myasthenia gravis, tendon problems, or a history of Long QT syndrome.

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What is Ciprofloxacin used for?

Ciprofloxacin is an antibiotic used to treat infections caused by E. coli, Staphylococcus, Haemophilus influenzae, Staphylococcus aureus, and Streptococcus. 

Thus Cipro tablets with 500 mg can be used for sinus infection, bronchitis, throat infections, chancroid, or another sexually transmitted disease. Cipro uses can also be prophylactic in patients with recurrent urine infections.

Ciprofloxacin’s indication for bronchitis and pneumonia is similar to that of the stomach and urinary infection or any other condition. 

The dose is usually 500 mg every 12 hours, regardless of the disease at hand. But in severe cases, ciprofloxacin indications at a dose of 750 mg every 12 hours are preferred.

What are the side effects of Ciprofloxacin?

All drugs have side effects. But what are the most common adverse effects (or side effects) of ciprofloxacin?

If you’re experiencing side effects, they will probably be the following:

  • Nausea: It usually happens closely after swallowing the tablets. It is usually due to an upset stomach.
  • Diarrhea: When Cipro sweeps the healthy bacteria in your gut, you could end up with diarrhea.
  • A burning or stinging sensation in your eyes: This happens after applying ciprofloxacin eye drops. You may also see white specks on your eyes in these cases.

But very few patients also experience severe side effects. They are uncommon but may sometimes happen, especially with tablets or liquid form.

For instance, ciprofloxacin may cause a condition called peripheral neuropathy, which is nerve damage in the arms, hands, legs, and feet. Symptoms include pain, tingling, numbness, and weakness.

Cipro side effects may also include tendonitis and Achilles tendon rupture, especially in lung transplant recipients. 

Another population at risk is patients with kidney disease, which will probably be prescribed another drug because ciprofloxacin can be toxic to their kidneys.

Ciprofloxacin HCl, even at the usual dose of 500 mg, can have other side effects in some people. 

It may cause sleeplessness and lightheadedness in some and nervousness in others, depending on their baseline conditions. 

Ciprofloxacin may also trigger an allergic reaction with skin rashes and other skin manifestations after exposure to ultraviolet light.

Another uncommon manifestation is musculoskeletal arthropathy. It manifests as swelling and pain in your tendons and joints. 

The most affected areas are the ankle, the calf, and the shoulders, which usually happens on day two of Cipro. In some cases, these side effects can start months after stopping ciprofloxacin.

How long do you take ciprofloxacin for?

In the medication guide after buying Ciprofloxacin, you will find the indication of taking it as prescribed by your doctor. That’s because there’s not only one treatment schedule.

Ciprofloxacin tablets are usually prescribed for a few days or 1 to 3 weeks, depending on your health and the severity of your infection. 

Before you start your treatment with Cipro, your doctor will give you some patient teaching basics and advice to take the antibiotic.

The antibiotic is usually administered at 500 mg every 12 hours. The length of treatment can be 3, 5, or 7 days. In some cases, a higher dose can be administered, of up to 1 gram.

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When should I stop taking ciprofloxacin?

Ciprofloxacin is very effective, but it is also known for causing various side effects, as mentioned above. 

These side effects can lead to severe complications, including tendon ruptures and kidney failure. Therefore, it is essential that you know when to stop taking ciprofloxacin to prevent these side effects.

Before taking ciprofloxacin, you should consult your doctor to know what to avoid when taking Cipro, and in some cases, they will perform liver function tests or consider drug effects and interactions if you’re taking multiple medications. 

For example, you may need to stop Cipro if you’re taking or need to start taking antipsychotics (clozapine) or antidepressants (duloxetine). 

Other medications that increase your risk of side effects are corticosteroids, which increase the risk of tendon injuries. 

Doctors can instruct you on how much ciprofloxacin to take and when to stop taking it.

Doctors can sometimes have you stop taking it at least a week before musculoskeletal surgery. This will ensure that your kidneys and tendons have time to heal and reduce your risk of complications.

Inform your healthcare provider in advance if you’re allergic to ciprofloxacin or a medication that sounds similar to it (levofloxacin, gemifloxacin, and other fluoroquinolones). 

And if you start experiencing severe side effects, stop taking it and consult your doctor as soon as possible.

Since Ciprofloxacin has peripheral nervous system effects, you might need to stop ciprofloxacin if you have or develop myasthenia gravis or optic neuropathy. 

Another contraindication is Marfan syndrome, and having this diagnosis is enough reason to stop ciprofloxacin.

What are the side effects of stopping Ciprofloxacin?

The European Medicines Agency issued a press release in 2018 talking about disabling and potentially permanent side effects of ciprofloxacin. 

Some of the side effects can start during Cipro treatment, and others may start after stopping taking ciprofloxacin. 

These are not common, but the possibility of having them is enough to consider other treatment options when possible and take extra precautions in elderly patients and transplant recipients.

Ciprofloxacin does not cause tolerance or dependency. It won’t cause withdrawal syndrome, either. Thus, there are no direct side effects of stopping ciprofloxacin. 

Still, some patients can experience prolonged side effects that continue after stopping. Others can have late side effects of the treatment that manifest themselves days or weeks after stopping. These include:

  • Tendon problems: Tendons can be inflamed or torn after treatment with Cipro and any other fluoroquinolone.
  • Nervous system effects: Patients can experience different neuropathy symptoms that remain after stopping Cipro. For instance, the sensation of burning pain or pins and needles. In some cases, it manifests as muscle weakness or muscle pain.
  • Mental health issues: In some cases, the use of this drug has been associated with tiredness, depression, memory, and sleeping problems that may remain after treatment.

How long after stopping Ciprofloxacin do side effects stop?

Cipro rash and allergy to ciprofloxacin are acute manifestations of the medication. They stop as soon as you stop taking it. 

It may take a few hours or one day before the effects of Cipro wear out and you’re completely healed from skin rash and other skin manifestations.

More severe side effects, such as tendon and nerve damage, can have more profound implications. Some central nervous system effects can also last for longer. 

According to the information laid down in the press release by the European Medicines Agency, these severe side effects can take months or years to heal fully.

But most side effects are transient and can be handled with over-the-counter medication. 

For instance, what can I take for a headache while on ciprofloxacin or after stopping? Ibuprofen or even acetaminophen can solve the problem. 

But in the case of severe adverse events is not as easy, and if they stay after stopping the medication, it is better to talk to your healthcare provider about that.

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How long does Ciprofloxacin stay in your system after stopping?

An individual with normal renal function will need around 6 hours to clear ciprofloxacin out of their system. This is the half-life of the medication. 

But when you take several doses for a few days, the medication builds up in your blood, and it may take 22 hours to clear it out of your system entirely. 

These numbers may vary depending on the dosing schedule and whether you’re consuming an extended-release drug.

In the majority of cases, the side effects start to subside 24 hours after stopping Ciprofloxacin. Most adverse events begin to go away within 24 hours and are gone completely within seven days.

Below is a list of common side effects and what to expect of them:

  • Diarrhea: It can occur for 1-3 days after treatment. It is usually mild and resolves quickly on its own unless you take a very large dose and for a very long time. In such cases, the side effects may require medical treatment to reestablish the gut microbiota.
  • Nausea: It typically only lasts a few hours or one day but can be severe in rare cases.
  • Dizziness: It usually goes away after the first dose.
  • Headache: They usually go away within 24 hours.
  • Ciprofloxacin allergy and skin rash: In most cases, it starts to go away after a few hours. In severe cases, antibiotic allergy can take up to 2 weeks to fade away.

Alternatives to Ciprofloxacin

Doctors may try different alternatives to ciprofloxacin in case of hypersensitivity reactions or severe side effects. It depends on the type of infection you need to solve. 

For instance, Cipro is the first choice treatment for acute pyelonephritis, typhoid and paratyphoid fever, prostatitis, low-risk neutropenia, and infectious gastroenteritis or colitis.

  • In acute pyelonephritis, patients may receive ceftriaxone or cefotaxime when Cipro cannot be used. These are third-generation cephalosporins.
  • In typhoid and paratyphoid fever cases, the first choice treatment can be Cipro but ceftriaxone and azithromycin. The latter belongs to the antibiotic group of macrolides.
  • In the case of prostatitis and other inflammatory diseases of the prostate, ceftriaxone and cefotaxime are considered the second option in mild to moderate cases and the first option in severe cases.
  • In infectious gastroenteritis or colitis, Cipro is only used when the pathogen bacteria has not been identified. In such cases, there are many alternatives to ciprofloxacin, including ceftriaxone, azithromycin, and sulfamethoxazole + trimethoprim, which is a bacteriostatic sulfonamide.

Ciprofloxacin can also be considered the first choice for patients with allergies to penicillin and other first-choice drugs. 

Even in such cases, there is a long list of alternatives doctors can consider depending on each case.

There are also natural antibiotics in plants and herbs such as garlic, oregano, onions, clove, and ginger. Their phytonutrients and other components are active against various microbes. 

However, the list of sensitive bacteria is not the same as ciprofloxacin, and the effectiveness is not the same. Thus, they may serve as adjunctive therapy but do not replace antibiotic treatment when a doctor recommends it.

Conclusion

Ciprofloxacin is a fluoroquinolone, a type of wide-spectrum antibiotic that impairs bacteria’s growth and cell division. 

The drug is highly effective against many gram-negative bacteria and some gram-positive microbes. Thus, it has been used to treat many bacterial infections.

The U.S. Food and Drug Administration (FDA) approved ciprofloxacin to treat severe bacterial infections like pneumonia, urinary tract infections, gonorrhea, and other illnesses. 

This drug is also used to treat chlamydia infections and is the first option for pyelonephritis, prostatitis, typhoid fever, and other ailments.

The most common side effects of ciprofloxacin are nausea and diarrhea. Still, some patients can experience other adverse events, including lightheadedness, skin rash upon ultraviolet exposure, and severe manifestations such as tendon rupture and persistent neuropathy.

Most side effects of Cipro go away after discontinuing the medication. But others may stay longer, even after ciprofloxacin is no longer in the system.

 This is not the most common, but it may happen in elderly patients, organ transplant recipients, and children. 

That’s why ciprofloxacin is rarely the first choice treatment in these patients, and alternative options should be explored when the risk of side effects is high.

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Sources

  1. Thai, T., Salisbury, B. H., & Zito, P. M. (2021). Ciprofloxacin. In StatPearls [Internet]. StatPearls Publishing.
  2. Rahm, V. I. M. A. L. A., & Schacht, P. E. T. E. R. (1989). Safety of ciprofloxacin. A review. Scand J Infect Dis Suppl, 60, 120-8.
  3. Chhajed, P. N., Plit, M. L., Hopkins, P. M., Malouf, M. A., & Glanville, A. R. (2002). Achilles tendon disease in lung transplant recipients: association with ciprofloxacin. European Respiratory Journal, 19(3), 469-471.
  4. Hajji, M., Jebali, H., Mrad, A., Blel, Y., Brahmi, N., Kheder, R., … & Zouaghi, M. K. (2018). Nephrotoxicity of ciprofloxacin: five cases and a review of the literature. Drug Safety-Case Reports, 5(1), 1-5.
  5. Vance-Bryan, K., Guay, D. R., & Rotschafer, J. C. (1990). Clinical pharmacokinetics of ciprofloxacin. Clinical pharmacokinetics, 19(6), 434-461.
  6. European Medicines Association. (2019). Disabling and potentially permanent side effects lead to suspension or restrictions of quinolone of fluoroquinolone antibiotics. European Medicines Association, Amsterdam, The Netherlands. European Medicines Association, Amsterdam, The Netherlands.

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