Consumer Drug Information

ciprofloxacin

Generic Name: ciprofloxacin (oral) (SIP roe FLOX a sin)
Brand names: Cipro, Cipro XR, Proquin XR, Cipro I.V., Cipro Cystitis Pack

What is ciprofloxacin?

Ciprofloxacin is an antibiotic in a group of drugs called fluoroquinolones (flor-o-KWIN-o-lones). Ciprofloxacin fights bacteria in the body.

Ciprofloxacin is used to treat different types of bacterial infections.

Ciprofloxacin may also be used for other purposes not listed in this medication guide.

What is the most important information I should know about ciprofloxacin?

You should not use this medication if you are taking tizanidine (Zanaflex), or if you are allergic to ciprofloxacin or similar antibiotics such as levofloxacin (Levaquin), moxifloxacin (Avelox), ofloxacin (Floxin), norfloxacin (Noroxin), lomefloxacin (Maxaquin), and others. Do not take ciprofloxacin with dairy products such as milk or yogurt, or with calcium-fortified juice. You may eat or drink dairy products or calcium-fortified juice with a regular meal, but do not use them alone when taking ciprofloxacin. They could make the medication less effective.

Before taking ciprofloxacin, tell your doctor if you have kidney or liver disease, myasthenia gravis, joint problems, diabetes, a history of seizures, low levels of potassium in your blood (hypokalemia), or a personal or family history of "Long QT syndrome."

Avoid taking antacids, vitamin or mineral supplements, sucralfate (Carafate), or didanosine (Videx) powder or chewable tablets within 6 hours before or 2 hours after you take ciprofloxacin. These other medicines can make ciprofloxacin much less effective when taken at the same time. Ciprofloxacin may cause swelling or tearing of a tendon (the fiber that connects bones to muscles in the body), especially in the Achilles' tendon of the heel. These effects may be more likely to occur if you are over 60, if you take an oral steroid medication, or if you have had a kidney, heart, or lung transplant. Stop taking ciprofloxacin and call your doctor at once if you have sudden pain, swelling, tenderness, stiffness, or movement problems in any of your joints. Rest the joint until you receive medical care or instructions.

What should I discuss with my healthcare provider before taking ciprofloxacin?

You should not use ciprofloxacin if you are also taking tizanidine (Zanaflex), or if you are allergic to ciprofloxacin or similar medications such as levofloxacin (Levaquin), lomefloxacin (Maxaquin), moxifloxacin (Avelox), ofloxacin (Floxin), norfloxacin (Noroxin), and others.

Before taking ciprofloxacin, tell your doctor if you have a heart rhythm disorder, especially if you are being treated with one of these medications: quinidine (Cardioquin, Quinidex, Quinaglute), disopyramide (Norpace), bretylium (Bretylol), procainamide (Pronestyl, Procan SR), amiodarone (Cordarone, Pacerone), or sotalol (Betapace).

If you have certain conditions, you may need a dose adjustment or special tests to safely use this medication. Before you take ciprofloxacin, tell your doctor if you have:

a history of allergic reaction to an antibiotic;
joint problems;
myasthenia gravis;
kidney or liver disease;
epilepsy or seizures;
diabetes;
low levels of potassium in your blood (hypokalemia); or
a personal or family history of "Long QT syndrome."

FDA pregnancy category C. It is not known whether ciprofloxacin is harmful to an unborn baby. Do not use ciprofloxacin without telling your doctor if you are pregnant. Tell your doctor if you become pregnant during treatment. Ciprofloxacin passes into breast milk and may harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby. Ciprofloxacin may cause swelling or tearing of a tendon (the fiber that connects bones to muscles in the body), especially in the Achilles' tendon of the heel. These effects may be more likely to occur if you are over 60, if you take an oral steroid medication, or if you have had a kidney, heart, or lung transplant. Stop taking ciprofloxacin and call your doctor at once if you have sudden pain, swelling, tenderness, stiffness, or movement problems in any of your joints. Rest the joint until you receive medical care or instructions. Do not share this medication with another person (especially a child), even if they have the same symptoms you have.

How should I take ciprofloxacin?

Take ciprofloxacin exactly as it was prescribed for you. Do not take it in larger doses or for longer than recommended by your doctor. Follow the directions on your prescription label.

Take ciprofloxacin with a full glass of water (8 ounces). Drink several extra glasses of fluid each day while you are taking ciprofloxacin. Shake the oral suspension (liquid) for at least 15 seconds just before you measure a dose. To be sure you get the correct dose, measure the liquid with a marked measuring spoon or medicine cup, not with a regular table spoon. If you do not have a dose-measuring device, ask your pharmacist for one.

When taking the oral liquid, swallow it without chewing the medicine beads you may notice in the liquid.

Do not crush, chew or break the extended-release tablet. Swallow the pill whole. It is specially made to release medicine slowly in the body. Breaking the pill would cause too much of the drug to be released at one time.

Ciprofloxacin may be taken with or without food, but take it at the same time each day.

Do not take ciprofloxacin with dairy products such as milk or yogurt, or with calcium-fortified juice. You may eat or drink these products as part of a regular meal, but do not use them alone when taking ciprofloxacin. They could make the medication less effective. Take this medication for as many days as it has been prescribed for you even if you begin to feel better. Your symptoms may get better before the infection is completely treated. Ciprofloxacin will not treat a viral infection such as the common cold or flu. Store ciprofloxacin at room temperature away from moisture and heat. Do not allow the liquid medicine to freeze.

What happens if I miss a dose?

Take the missed dose as soon as you remember. If it is almost time for your next dose, skip the missed dose and take the medicine at the next regularly scheduled time. Do not take extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention if you think you have used too much of this medicine.

Overdose symptoms may include seizures, urination problems, weakness, or blue lips with pale skin.

What should I avoid while taking ciprofloxacin?

You may be taking certain other medicines that should not be taken at the same time as ciprofloxacin. Avoid taking the following medicines within 6 hours before or 2 hours after you take ciprofloxacin. These other medicines can make ciprofloxacin much less effective when taken at the same time:

antacids that contain calcium, magnesium or aluminum (such as Tums, Mylanta, or Rolaids);
the ulcer medicine sucralfate (Carafate);
didanosine (Videx) powder or chewable tablets; or
vitamin or mineral supplements that contain calcium, iron, or zinc.

Avoid caffeine while you are taking ciprofloxacin, because the medication can make the effects of caffeine stronger.

Avoid exposure to sunlight, sunlamps, or tanning beds. Ciprofloxacin can make your skin more sensitive to sunlight, and a sunburn may result. Wear protective clothing and use a sunscreen (SPF-15 or higher) if you must be out in the sun. Call your doctor if you have severe burning, redness, itching, rash, or swelling after being in the sun.

Antibiotic medicines can cause diarrhea, which may be a sign of a new infection. If you have diarrhea that is watery or has blood in it, call your doctor. Do not use any medicine to stop the diarrhea unless your doctor has told you to.

Ciprofloxacin can cause side effects that may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be awake and alert.

Ciprofloxacin side effects

Stop using ciprofloxacin and get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat. Stop using ciprofloxacin and call your doctor at once if you have any of these serious side effects:

dizziness, fainting, fast or pounding heartbeat;
sudden pain or swelling near your joints (especially in your arm or ankle);
diarrhea that is watery or bloody;
confusion, hallucinations, depression, unusual thoughts or behavior;
seizure (convulsions);
pale or yellowed skin, dark colored urine, fever, weakness;
urinating less than usual or not at all;
easy bruising or bleeding;
numbness, tingling, or unusual pain anywhere in your body;
fever, sore throat, and headache with a severe blistering, peeling, and red skin rash; or
the first sign of any skin rash, no matter how mild.

Less serious side effects may include:

nausea, vomiting;
dizziness or drowsiness;
blurred vision;
feeling nervous, anxious, or agitated;
sleep problems (insomnia or nightmares); or
increased sensitivity of the skin to sunlight.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

Ciprofloxacin Dosing Information

Usual Adult Dose for Anthrax Prophylaxis:

Postexposure prophylaxis: 500 mg orally every 12 hours for 60 days following initial exposure

Usual Adult Dose for Cutaneous Bacillus anthracis:

500 mg orally every 12 hours for 60 days following initial exposure

Intravenous therapy with multiple drugs is recommended if there is evidence of systemic involvement, severe edema, or if head or neck lesions are present.

Usual Adult Dose for Inhalation Bacillus anthracis:

Treatment for confirmed cases of inhalational Bacillus anthracis infection: 400 mg IV every 12 hours plus one or two additional antibiotics with activity against the causative organism; these drugs may include rifampin, vancomycin, penicillin, ampicillin, chloramphenicol, imipenem, clindamycin, and clarithromycin

Duration: Therapy should continue for a total of 60 days following initial exposure to B anthracis. The switch from IV to oral therapy (500 mg orally every 12 hours for ciprofloxacin) may be made as soon as is clinically feasible.

Usual Adult Dose for Bacteremia:

400 mg IV every 8 to 12 hours
Therapy should be continued for about 14 days, depending on the nature and severity of the infection.

Usual Adult Dose for Bronchitis:

500 to 750 mg orally or 400 mg IV every 8 to 12 hours for 7 to 14 days

Usual Adult Dose for Chancroid:

500 mg orally twice a day for 3 days

The patient's sexual partner(s) should also be evaluated/treated.

Usual Adult Dose for Cholera:

1 g orally once, as an adjunct to fluid and electrolyte replacement

Usual Adult Dose for Cystitis:

Uncomplicated: 100 to 250 mg orally every 12 hours for 3 days or 500 mg extended-release every 24 hours for 3 days

Usual Adult Dose for Diverticulitis:

500 mg orally or 400 mg IV every 12 hours for 7 to 10 days

Usual Adult Dose for Febrile Neutropenia:

Severe: 400 mg IV every 8 hours for 7 to 14 days, in combination with piperacillin 50 mg/kg IV every 4 hours
Once the patient is stable and afebrile for at least 24 hours, and the absolute neutrophil count is greater than 500/mm3, oral antibiotics may be substituted if antibiotic therapy is to be continued.

Low-risk patient: 750 mg orally every 8 to 12 hours

Usual Adult Dose for Gonococcal Infection -- Disseminated:

400 mg IV every 12 hours for 24 to 48 hours after clinical improvement, then 500 mg orally twice a day for a total 7-day course of therapy

Due to high rates of resistance, the Centers for Disease Control and Prevention (CDC) do not recommend fluoroquinolones for treatment of gonococcal infections in the United States or for infections acquired in Asia, the Pacific Islands, England, and Wales. Antimicrobial susceptibility patterns should be monitored. The CDC recommend fluoroquinolones as alternative therapy only when culture proves susceptibility.

The CDC currently recommend initial hospitalization and injectable antimicrobials (i.e., ceftriaxone, cefotaxime, ceftizoxime) for the treatment of disseminated gonococcal infection. Twenty-four to forty-eight hours after improvement begins, the patient can be switched to oral cefixime or cefpodoxime for a total of at least 7 days of therapy.

Doxycycline therapy for 7 days (if not pregnant) or single dose azithromycin is also recommended to treat possible concurrent chlamydial infection.

The patient's sexual partner(s) should also be evaluated/treated.

Usual Adult Dose for Gonococcal Infection -- Uncomplicated:

Uncomplicated urethral/cervical/rectal/pharyngeal gonococcal infections: 500 mg orally one time

Due to high rates of resistance, the CDC do not recommend fluoroquinolones for treatment of gonococcal infections in the United States or for infections acquired in Asia, the Pacific Islands, England, and Wales. Ceftriaxone or oral cefixime are recommended as first-line treatment of gonorrhea in the United States or acquired in these areas. Antimicrobial susceptibility patterns should be monitored. The CDC recommend fluoroquinolones as alternative therapy only when culture proves susceptibility.

Doxycycline therapy for 7 days (if not pregnant) or single dose azithromycin is also recommended to treat possible concurrent chlamydial infection.

The patient's sexual partner(s) should also be evaluated/treated.

Usual Adult Dose for Granuloma Inguinale:

750 mg orally twice daily for at least 3 weeks

Ciprofloxacin is recommended as an alternate regimen by the CDC. Doxycycline or sulfamethoxazole-trimethoprim are considered the drugs of choice.

The patient's sexual partner(s) should also be evaluated/treated.

Usual Adult Dose for Infection Prophylaxis:

Patients with neutropenia: 500 mg orally every 12 hours; alternatively, 400 mg IV every 12 hours may be given for particularly ill patients
The duration of therapy may vary with the duration of the patient's neutropenia.

Usual Adult Dose for Infectious Diarrhea:

500 mg orally every 12 hours for 5 to 7 days

Enterotoxigenic E coli species, Aeromonas, Plesiomonas: 500 mg orally twice daily for 3 days

Usual Adult Dose for Intraabdominal Infection:

Complicated: 500 mg orally or 400 mg IV every 12 hours for 7 to 14 days, in combination with metronidazole

Usual Adult Dose for Peritonitis:

Complicated: 500 mg orally or 400 mg IV every 12 hours for 7 to 14 days, in combination with metronidazole

Usual Adult Dose for Joint Infection:

Mild to moderate: 500 mg orally or 400 mg IV every 12 hours for at least 4 to 6 weeks
Severe: 750 mg orally every 12 hours or 400 mg IV every 8 hours for at least 4 to 6 weeks

Usual Adult Dose for Osteomyelitis:

Mild to moderate: 500 mg orally or 400 mg IV every 12 hours for at least 4 to 6 weeks
Severe: 750 mg orally every 12 hours or 400 mg IV every 8 hours for at least 4 to 6 weeks

Usual Adult Dose for Meningococcal Meningitis Prophylaxis:

500 mg orally once

Usual Adult Dose for Mycobacterium avium-intracellulare -- Treatment:

400 mg IV or 750 mg orally every 12 hours, in combination with at least 3 other antimycobacterial drugs (e.g., clarithromycin or azithromycin, ethambutol, rifabutin, amikacin)

Usual Adult Dose for Nosocomial Pneumonia:

400 mg IV every 8 hours

Initial empiric treatment with broad-spectrum coverage according to the hospital's and/or ICU's antibiogram is recommended if multidrug-resistant organisms are suspected.

Duration: If the causative organism is not Pseudomonas aeruginosa, the duration of treatment should be as short as clinically possible (e.g., as little as 7 days) to reduce the risk of superinfections with resistant organisms.

Usual Adult Dose for Plague:

Treatment of plague used as a biological weapon:
Treatment, contained-casualty setting: 400 mg IV every 12 hours for 10 days; may switch to oral ciprofloxacin 500 mg twice daily when clinically indicated

The Working Group on Civilian Biodefense has recommended ciprofloxacin as an alternative to streptomycin and gentamicin if they are contraindicated, unavailable, or inactive in vitro. This use is not approved by the FDA.

Treatment, mass-casualty setting: 500 mg orally twice daily for 10 days
Postexposure prophylaxis: 500 mg orally twice daily for 7 days

The Working Group on Civilian Biodefense has recommended ciprofloxacin or doxycycline for plague treatment or postexposure prophylaxis in a mass casualty setting. This use is not approved by the FDA.

Usual Adult Dose for Pneumonia:

Mild to moderate: 500 mg orally every 12 hours for 7 to 14 days or 400 mg IV every 12 hours
Severe: 750 mg orally every 12 hours or 400 mg IV every 8 hours for 7 to 14 days

Usual Adult Dose for Prostatitis:

Chronic bacterial prostatitis: 500 mg orally every 12 hours for 28 days

Usual Adult Dose for Pyelonephritis:

Acute uncomplicated: 1000 mg extended-release every 24 hours for 7 to 14 days

Usual Adult Dose for Salmonella Enteric Fever:

500 mg orally every 12 hours for 10 days

Usual Adult Dose for Salmonella Gastroenteritis:

500 mg orally twice daily for 5 to 7 days
Up to 14 days or longer treatment may be required for immunocompromised patients.

Usual Adult Dose for Shigellosis:

500 mg orally twice daily for 3 days
Up to 7 to 10 days of treatment may be required for immunocompromised patients.

A single 1 gram dose may be effective for non-dysentery shigellosis.

Usual Adult Dose for Sinusitis:

500 mg orally or 400 mg IV every 12 hours for 10 days

Usual Adult Dose for Skin or Soft Tissue Infection:

Mild to moderate: 500 mg orally every 12 hours for 7 to 14 days or 400 mg IV every 12 hours
Severe: 750 mg orally every 12 hours or 400 mg IV every 8 hours for 7 to 14 days
Vibrio vulnificus: 400 mg IV every 12 hours plus ceftazidime 1 to 2 g IV every 8 hours or cefotaxime 2 g IV every 8 hours

Usual Adult Dose for Traveler's Diarrhea:

500 mg orally every 12 hours
Therapy should be continued for about 5 to 7 days in severely ill patients. Most cases are self-limited, and prudent withholding of antibiotics in mild cases does not appear to slow recovery in most patients. However, immunocompromised patients may require longer courses of therapy.

Usual Adult Dose for Tuberculosis -- Active:

750 mg orally or 400 mg IV every 12 hours

May be given in combination with at least 3 other active drugs for treatment of multi-drug resistant TB, or when the patient is intolerant of first-line agents. AFB smear and culture should be monitored monthly.

Duration: Treatment for TB should generally continue for 18 to 24 months, or for 12 to 18 months after culture results are negative.

Usual Adult Dose for Tularemia:

Use of tularemia as a biological weapon:
Treatment, contained casualty setting: 400 mg IV twice daily for 10 days; may switch to oral ciprofloxacin 500 mg twice daily when clinically indicated
Treatment, mass casualty setting and postexposure prophylaxis: 500 mg orally twice daily for 14 days

The Working Group on Civilian Biodefense has recommended ciprofloxacin as an alternative to streptomycin and gentamicin if they are contraindicated, not available, or inactive in vitro. This use is not approved by the FDA.

Usual Adult Dose for Typhoid Fever:

500 mg orally every 12 hours for 10 days

Usual Adult Dose for Urinary Tract Infection:

Uncomplicated (cystitis): 250 mg orally every 12 hours for 3 days or 500 mg extended-release every 24 hours for 3 days
Mild to moderate: 250 mg orally every 12 hours for 7 to 14 days or 200 mg IV every 12 hours
Complicated: 500 mg orally every 12 hours or 1000 mg extended-release every 24 hours or 400 mg IV every 12 hours for 7 to 14 days

Usual Pediatric Dose for Anthrax Prophylaxis:

Prophylaxis postexposure to inhalational Bacillus anthracis:
IV: 10 mg/kg every 12 hours for 60 days following initial exposure
Maximum dose: 400 mg/dose

Oral: 15 mg/kg every 12 hours for 60 days following initial exposure
Maximum dose: 500 mg/dose

Usual Pediatric Dose for Urinary Tract Infection:

Complicated infection due to E coli:
1 to 18 years:
IV: 6 to 10 mg/kg every 8 hours for 10 to 21 days
Maximum dose: 400 mg/dose

Oral: 10 to 20 mg/kg every 12 hours for 10 to 21 days
Maximum dose: 750 mg/dose

Ciprofloxacin is not a drug of first choice due to a higher rate of adverse reactions in this population.

Usual Pediatric Dose for Pyelonephritis:

Due to E coli:
1 to 18 years:
IV: 6 to 10 mg/kg every 8 hours for 10 to 21 days
Maximum dose: 400 mg/dose

Oral: 10 to 20 mg/kg every 12 hours for 10 to 21 days
Maximum dose: 750 mg/dose

Ciprofloxacin is not a drug of first choice due to a higher rate of adverse reactions in this population.

Usual Pediatric Dose for Bacterial Infection:

IV: 7.5 to 10 mg/kg every 12 hours
Maximum recommended dose: 800 mg/day

Oral: 10 to 15 mg/kg every 12 hours
Maximum recommended dose: 1.5 g/day

Usual Pediatric Dose for Cutaneous Bacillus anthracis:

Treatment for confirmed cases of cutaneous Bacillus anthracis infection: 10 to 15 mg/kg (not to exceed 1 gram/24 hours) orally every 12 hours for 60 days following exposure

Usual Pediatric Dose for Inhalation Bacillus anthracis:

Treatment for confirmed cases of inhalational Bacillus anthracis infection: 10 to 15 mg/kg (not to exceed 1 gram/24 hours) IV every 12 hours, plus one or two additional antibiotics with activity against the causative organism; these drugs may include rifampin, vancomycin, penicillin, ampicillin, chloramphenicol, imipenem, clindamycin, and clarithromycin

Duration: The switch to oral antimicrobial therapy (same dose for ciprofloxacin) should occur as soon as is clinically feasible. Therapy should continue for a total of 60 days following exposure.

Usual Pediatric Dose for Pneumonia with Cystic Fibrosis:

Over 1 year:
IV: 10 mg/kg every 8 hours or 15 mg/kg every 12 hours
Maximum dose: 1.2 g/day

Oral: 20 mg/kg every 12 hours
Maximum dose: 2 g/day

Usual Pediatric Dose for Plague:

Use of plague as a biological weapon:
Treatment, contained-casualty setting: 15 mg/kg IV twice daily for 10 days (maximum 1 g/day); may switch to oral ciprofloxacin when clinically indicated

The Working Group on Civilian Biodefense has recommended ciprofloxacin as an alternative to streptomycin and gentamicin if they are contraindicated, unavailable, or inactive in vitro. This use is not approved by the FDA.

Treatment, mass casualty setting: 20 mg/kg orally twice daily for 10 days (maximum 1 g/day)
Postexposure prophylaxis: 20 mg/kg mg orally twice daily for 7 days (maximum 1 g/day)

The Working Group on Civilian Biodefense has recommended ciprofloxacin or doxycycline for plague treatment or postexposure prophylaxis in a mass casualty setting. This use is not approved by the FDA.

Usual Pediatric Dose for Tularemia:

Use of tularemia as a biological weapon:
Contained casualty setting: 15 mg/kg IV twice daily (maximum dose 1 g/day) for 10 days; may switch to oral ciprofloxacin when clinically indicated

The Working Group on Civilian Biodefense has recommended ciprofloxacin as an alternative to streptomycin and gentamicin if they are contraindicated, not available, or inactive in vitro. This use is not approved by the FDA.

Mass casualty setting and postexposure prophylaxis: 15 mg/kg mg orally twice daily (maximum dose 1 g/day) for 14 days

The Working Group on Civilian Biodefense has recommended doxycycline or ciprofloxacin for children in a mass casualty setting. This use is not approved by the FDA.

What other drugs will affect ciprofloxacin?

Do not take ciprofloxacin together with tizanidine (Zanaflex).

Before taking ciprofloxacin, tell your doctor if you are taking any of the following drugs:

a blood thinner such as warfarin (Coumadin);
clozapine (Clozaril, FazaClo);
cyclosporine (Neoral, Sandimmune);
insulin or diabetes medication you take by mouth, such as glyburide (Micronase, Diabeta, Glynase);
methotrexate (Rheumatrex, Trexall);
metoclopramide (Reglan);
phenytoin (Dilantin);
probenecid (Benemid);
ropinirole (Requip);
tacrine (Cognex);
theophylline (Theo-Dur, Theolair, Slo-Phyllin, Slo-Bid, Elixophyllin);
a nonsteroidal anti-inflammatory drug (NSAID) such as ibuprofen (Motrin, Advil, Nuprin, others), diclofenac (Cataflam, Voltaren), indomethacin (Indocin), naproxen (Aleve, Naprosyn, Anaprox), and others; or
an oral steroid medication such as prednisone and others.

This list is not complete and there may be other drugs that can interact with ciprofloxacin. Tell your doctor about all the prescription and over-the-counter medications you use. This includes vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start using a new medication without telling your doctor.

Where can I get more information?

Your pharmacist can provide more information about ciprofloxacin.

Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medicine only for the indication prescribed.
Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.