What Are The Side Effects Of Cipro?

Ciprofloxacin, also known as Cipro, is a common antibiotic medication used to treat prostatitis, urinary infections, and other bacterial infections.

As with all prescription drugs, Ciprofloxacin can cause adverse side effects and should be used with care and under the advice of a doctor. That’s how we can prevent side effects and detect any severe adverse event.

Keep reading to learn what side effects Cipro (Ciprofloxacin) can cause, how long they last, and what you should be aware of when taking this antibiotic.

What is Cipro?

Cipro is an antibiotic that doctors prescribe to treat certain bacterial infections. The FDA first approved it in 1987.

Cipro is available in liquid, pill, and IV form, and you can get it in dosages of 250 mg or 500 mg. You can also get Cipro in eye and ear drops for eye and ear infections.

Common side effects of Cipro

Most medications have a long list of side effects, including Cipro. The list is not designed to discourage users from taking drugs, and they are not likely to experience all of them.

Most patients experience very mild side effects or none at all. The list helps patients and doctors determine when a new symptom is caused by Cipro.

There are rare and common side effects, depending on the proportion of patients reporting them.

The most common side effects of Ciprofloxacin include:

• Nausea: Gastrointestinal symptoms are common when using antibiotics, especially nausea. Drug-induced nausea can be very mild but may sometimes cause vomiting episodes. In some cases, it leads to treatment failure. Patients may also report loss of appetite and other gastrointestinal symptoms.
  
• Diarrhea: As with many antibiotics, Cipro can cause alterations to the gut microbiota. After destroying the healthy bacteria in the gut, it can be colonized by pathogens. Thus, talk to your doctor if you develop persistent diarrhea after using Cipro. They might recommend using probiotics to re-establish the gut microbiota. This side effect usually happens when we use a combination of antimicrobial agents or use them for extended periods of time.
  
• Dizziness and lightheadedness: This is another common side effect. It is caused by an alteration of the inner ear, which regulates the balance of the body. As such, dizziness/vertigo is common as a temporary side effect of many drugs.
  
• Yeast infections: Patients who use Ciprofloxacin repeatedly can experience an overgrowth of candida. They may appear in the oral mucosa (oral thrush) or the vagina. In some cases, the overgrowth may also appear in the gastrointestinal tract.
  
• Neurologic symptoms: In most cases, patients may only experience headaches. In other cases, their neurologic symptoms may also include insomnia and depression. Very rare cases of hallucinations, psychotic reactions, or myasthenia gravis have been described, too.

Other symptoms worth noting include:

• Tendon problems
  
• Muscle weakness
  
• Bruising or bleeding symptoms
  
• Skin rash

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.

Serious and rare side effects of Cipro

Serious side effects are not common. If you experience any of these, you should get medical help as soon as possible:

• Severe dizziness and fainting: If you feel severe dizziness and fainting, you should look for medical advice right away. Ciprofloxacin can cause changes in the electrocardiogram in susceptible patients. Some of them are very severe and cause episodes of syncope or fainting. In some cases, patients may even have a cardiac arrest and require defibrillation.
  
• Heartbeat irregularities: Ciprofloxacin and all fluoroquinolones may cause heartbeat problems. Patients may feel very rapid or irregular heartbeats. In patients with arrhythmia, Ciprofloxacin may trigger one or worsen the heart condition. Ciprofloxacin is less likely to produce severe arrhythmia compared to levofloxacin, but it is a side effect to look for in cardiac patients.
  

• Symptoms of aortic dissection: Aortic dissection is the rupture or tear of the aorta. Ciprofloxacin can cause this problem in patients with a dilated aorta. Patients with a high risk for aortic dissection or aneurysm may experience this severe side effect. Symptoms include severe and sudden pain in the chest, back, or stomach, shortness of breath, and cough.
  
• Severe allergic reactions: As it happens with medicines and foods, some people may develop allergic reactions. They are rare but are still reported by some patients. Symptoms to detect severe allergic reactions include skin rash with severe itching, shortness of breath, and swelling of the face, tongue, and throat.
  
• Kidney and liver problems: Cipro is metabolized by the liver and eliminated through the urine. As such, it may cause kidney or liver problems in susceptible patients. Talk to your doctor if you have changes in the amount of urine, pink, or stained urine. You should also report if you get a yellowish tone in the skin and eyes, stomach pain, and persistent vomiting episodes.

When do the side effects of Cipro go away?

The side effects of Ciprofloxacin can last for as long as the treatment is held. In most cases, stopping Ciprofloxacin is the best way to end the side effects listed above. After stopping the medication, it may take around one or two days for them to go away.

However, some of them may be long-lasting, and others may not go away. It depends on the side effect and the reason it was triggered in the first place.

Ciprofloxacin is never prescribed for over 3 months to prevent long-lasting side effects. 

Considerations for your diet when taking Cipro

You do need to alter your diet when taking Cipro, but this isn’t a drastic change.

Why should you avoid certain foods when taking Cipro?

The liver metabolizes antibiotic medicines through a series of enzymes. Absorption in the gastrointestinal tract may also require specific conditions.

You should be careful about what to eat and drink when taking regular meds. Otherwise, their action can be either prolonged or weakened by your dietary habits.

What are the best foods to take Cipro with?

It is recommended to take Cipro with food. And a smart move would be to eat foods that help you control your infection.

For example, if you have a urinary tract infection, you may benefit from vitamin C-rich meals. Taking your daily dose of Cipro and vitamin C helps your body combat infections.

Another recommendation is probiotic foods and supplements. Non-dairy fermented foods may contribute to your gut microbiota and prevent diarrhea. Some ideas are sauerkraut, kimchi, tempeh, miso soup, and pickled vegetables.

What foods should you avoid when you are taking Cipro?

If you’re trying to combat infections with Cipro, you should stay away from milk and dairy products.

They bind to the molecule of Ciprofloxacin and block its absorption. This is common with the majority of quinolones. Therefore, you should avoid the following foods:

• Milk
  
• Cream
  
• Yogurt
  
• Ice cream
  
• Cheese

Another recommendation is to stay away from alcoholic beverages. Alcohol will be cleared very slowly from your system if you’re taking Cipro. In some patients, drinking alcohol can trigger additional adverse reactions in the skin.

If you still have doubts about the adverse effects of Ciprofloxacin, you can also talk to your doctor or pharmacist.

Drug interactions with Ciprofloxacin

Certain drug interactions may trigger adverse reactions or increase your risks. In other cases, Ciprofloxacin prolongs the half-life of other medications, which can be dangerous sometimes (11).

Be especially careful with the following medications:

• Sotalol
  
• Quinidine
  
• Procainamide
  
• Dofetilide
  
• Amiodarone
  
• Some diuretic medications

These medications affect the heart rhythm, and using them with Cipro increases the risk of arrhythmia.

Be careful with these medications, too:

• Warfarin and any other blood-thinning drugs
  
• Theophylline
  
• Xanthines, caffeine
  
• Tizanidine
  
• Duloxetine
  

• Flibanserin
  
• Tasimelteon

In their case, Ciprofloxacin slows down their clearance from the blood. This may be dangerous in some cases, especially if you’re taking warfarin.

Drugs that impact the effectiveness of Ciprofloxacin

There’s another list of drugs that impact the effectiveness of Ciprofloxacin by reducing the bioavailability of quinolones.

In other words, they don’t allow quinolones to be absorbed or circulate freely in the blood. As such, taking these drugs along with Cipro can cause a therapeutic failure.

These drugs include:

• Sucralfate
  
• Aluminum and aluminum-containing drugs
  
• Magnesium zinc
  
• Iron and calcium supplements
  
• Antacids

What are the warnings and precautions for those taking Ciprofloxacin?

Consider the following precautions if you’re using Ciprofloxacin for a urinary tract infection or any other:

• Inform your doctor or pharmacist if you’re allergic or have had an adverse side effect after taking Cipro.
  
• Inform your doctor about irregular heartbeat problems or any other relevant medical history.
  
• Talk to your doctor if you experience a rapid heartbeat. Ciprofloxacin may trigger QT prolongation in the electrocardiogram.
  
• Talk to your doctor if you experience muscle weakness. In some cases, Cipro can cause tendon rupture or myasthenia gravis.
  
• Inform your doctor if you have episodes of diarrhea or vomiting. They may reduce your levels of magnesium and potassium in the blood and trigger heartbeat problems.
  
• If you have diabetes, check your blood sugar regularly.
  
• Limit your sun exposure and use sunscreen and protective clothing.

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Alternative antibiotics to Cipro

Some patients may need to take an alternative antibiotic to Cipro if they have a Cipro allergy or the bacteria they’re trying to fight is resistant.

Luckily, Cipro has many alternatives, which can be prescribed for different reasons.

Levofloxacin (Levaquin)

One of the best alternatives to Cipro in the case of bacteria resistance is levofloxacin (Levaquin). It is another quinolone, very similar to Cipro. 

However, keep in mind that levofloxacin is a potent antibiotic. That’s why it is administered in fewer doses than Cipro.

According to studies, levofloxacin can be as effective as Ciprofloxacin for bacterial prostatitis treatment, respiratory infections, and urinary tract infections. And the adverse events are almost the same as Cipro.

Trimethoprim/Sulfamethoxazole

This non-quinolone antibiotic is a useful alternative to Cipro in patients with urinary infections. When the urinary tract infection has complicated to pyelonephritis, we can use gentamicin or trimethoprim/sulfamethoxazole.

Fosfomycin

Another non-quinolone antibiotic, fosfomycin can be useful in cases of uncomplicated urinary tract infection. Especially if there are culture results to make sure the bacteria is sensitive.

Ceftriaxone

Ceftriaxone is another non-quinolone antibiotic. When a urinary infection becomes a major problem, we can use ceftriaxone. It is recommended as an option in patients with sepsis of urinary origin. In uncomplicated urinary tract infections, Cefpodoxime is the second choice after Cipro.

How does Cipro compare to other antibiotics?

• Cipro vs. Metronidazole: Metronidazole can be used to treat gastrointestinal infections. Sometimes it is used in combination with Cipro. However, Ciprofloxacin is better because it is tolerated with fewer side effects. And some studies show that Cipro is more effective than Metronidazole.
  
• Cipro vs. Cefpodoxime: Cefpodoxime is a third-generation cephalosporin. But it has been used too much, and some bacteria have developed resistance. According to a study, Cipro has 4% resistance to urinary tract bacteria, and Cefpodoxime has 8%.
  
• Cipro vs. erythromycin: They are both used to treat patients with chancroid, a sexually-transmitted disease. But studies show that Cipro is equally effective with fewer adverse effects. 

So, if you want to know why Cipro is prescribed instead of other antibiotics, it is because it is better tolerated. Side effects are less common in Cipro compared to others. Additionally, more bacteria are still sensitive to Ciprofloxacin.

Why is Cipro considered a strong antibiotic?

Ciprofloxacin is considered a strong antibiotic because it has a low level of resistance. As mentioned above, bacteria are still sensitive to Cipro. In other words, Cipro is still able to clear the infection.

However, this is an ever-changing situation because a potent antibiotic may become weak in the future. That’s because bacteria create resistance when we use an antibiotic too much.

Thus, patients are encouraged not to take Ciprofloxacin without a prescription. If they have a prescription, it should be followed strictly. Otherwise, the bacteria may create resistance against the antibiotic.

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, also known as Cipro, is a very useful antimicrobial agent. It is a quinolone, similar to levofloxacin. 

Cipro works by slowing down the replication of the bacteria and inducing DNA breaks. It is a strong antibiotic with a very wide spectrum and works for different types of infections.

However, Cipro has various side effects that include rare and severe adverse events and more common and mild problems. Common Cipro side effects include nausea, headaches, diarrhea, and other gastrointestinal complaints.

Rare and severe side effects of Cipro include myasthenia gravis and other neuronal problems, arrhythmia, and prolongation of the QT interval in electrocardiograms and others. Some patients may also develop allergies to fluoroquinolones, but this is not very common.

When taking Ciprofloxacin, we should also consider not drinking alcohol, milk, or dairy products. Ciprofloxacin will also interact with drugs that prolong QT interval or make it less effective. Thus, inform your doctor if you’re taking medications or have any chronic conditions.

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