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Cipro Side Effects

Generic Name: ciprofloxacin

Note: This page contains information about the side effects of ciprofloxacin. Some of the dosage forms included on this document may not apply to the brand name Cipro.

Not all side effects for Cipro may be reported. You should always consult a doctor or healthcare professional for medical advice. Side effects can be reported to the FDA here.

For the Consumer

Applies to ciprofloxacin: oral powder for suspension, oral tablet

Other dosage forms:

In addition to its needed effects, some unwanted effects may be caused by ciprofloxacin (the active ingredient contained in Cipro). In the event that any of these side effects do occur, they may require medical attention.

You should check with your doctor immediately if any of these side effects occur when taking ciprofloxacin:

More common
  • Diarrhea
  • Bloody or black, tarry stools
  • burning, crawling, itching, numbness, prickling, "pins and needles", or tingling feelings
  • changes in skin color
  • changes in urination
  • chest pain or discomfort
  • chest tightness or heaviness
  • chills or fever
  • clumsiness or unsteadiness
  • confusion
  • continuing ringing or buzzing or other unexplained noise in the ears
  • coughing or spitting up blood
  • dizziness, faintness, or lightheadedness when getting up suddenly from a lying or sitting position
  • fast, irregular, pounding, or racing heartbeat or pulse
  • headache, severe and throbbing
  • hearing loss
  • hives or welts
  • joint stiffness
  • large, hive-like swelling on the face, eyelids, lips, tongue, throat, hands, legs, feet, or sex organs
  • light-colored stools
  • muscle pain or stiffness
  • nausea and vomiting
  • nightmares
  • numbness of the hands
  • pain in the joints
  • pain or discomfort in the arms, jaw, back, or neck
  • painful, red lumps under the skin, mostly on the legs
  • pounding in the ears
  • puffiness or swelling of the eyelids or around the eyes, face, lips, or tongue
  • redness of the face, neck, arms, and occasionally, upper chest
  • seizures
  • severe abdominal or stomach pain, cramping, or burning
  • shakiness in the legs, arms, hands, or feet
  • skin rash
  • swelling of the face, feet, or lower legs
  • swollen, painful, or tender lymph glands in the neck, armpit, or groin
  • thick, white vaginal discharge with no odor or with a mild odor
  • unsteadiness, trembling, or other problems with muscle control or coordination
  • unusual drowsiness, dullness, tiredness, weakness, or feeling of sluggishness
  • white patches in the mouth and/or on the tongue
  • yellow eyes or skin
Incidence not known
  • Acid or sour stomach
  • blistering, peeling, or loosening of the skin
  • bluish-colored lips, fingernails, or palms
  • bone pain
  • diarrhea, watery and severe, which may also be bloody
  • difficulty with breathing, chewing, or talking
  • double vision
  • excessive muscle tone
  • feeling of discomfort
  • feeling, seeing, or hearing things that are not there
  • increased sensitivity to pain
  • increased sensitivity to touch
  • irregular or slow heart rate
  • mood changes
  • nosebleeds
  • rapid heart rate
  • red skin lesions, often with a purple center
  • sores, ulcers, or white spots on the lips or in the mouth
  • unusual bleeding or bruising
  • unusual excitement, nervousness, or restlessness
  • vaginal yeast infection

Some of the side effects that can occur with ciprofloxacin may not need medical attention. As your body adjusts to the medicine during treatment these side effects may go away. Your health care professional may also be able to tell you about ways to reduce or prevent some of these side effects. If any of the following side effects continue, are bothersome or if you have any questions about them, check with your health care professional:

Less common
  • Runny nose
  • sneezing
  • stuffy nose

For Healthcare Professionals

Applies to ciprofloxacin: intravenous solution, oral powder for reconstitution, oral tablet, oral tablet extended release


The most common side effects (from clinical trials of all formulations, doses, durations of therapy, and indications) were nausea, diarrhea, abnormal liver function tests, vomiting, and rash. The most common side effects reported with the IV formulation were nausea, diarrhea, vomiting, injection and infusion site reactions, rash, and increased transaminases (transient).[Ref]


Antibiotic-associated colitis with possible fatal outcome was reported very rarely.

The onset of pseudomembranous colitis symptoms has been reported during or after antimicrobial treatment.[Ref]

Common (1% to 10%): Nausea, diarrhea, vomiting, dyspepsia
Uncommon (0.1% to 1%): Abdominal pains/discomfort, gastrointestinal (GI) pains, flatulence
Rare (0.01% to 0.1%): Elevated amylase, antibiotic-associated colitis, pancreatitis
Frequency not reported: Clostridium difficile-associated diarrhea, constipation, GI bleeding, ileus, intestinal perforation, dry mouth, oral ulceration, epigastric pain, dysphagia, elevated lipase, painful oral mucosa, heartburn, acid reflux, aggravated irritable bowel syndrome, lower abdominal pain
Postmarketing reports: GI candidiasis, oral candidiasis, pseudomembranous colitis[Ref]


Photosensitivity was seen most often when patients were exposed to intense sun (e.g., as when used to treat or prevent travelers' diarrhea).

A 27-year-old woman with mild systemic erythematosus developed toxic epidermal necrolysis (TEN) after starting a second oral course of this drug after a prior 5-day course. She developed a rash, high fever, and diarrhea after taking the 2nd dose and presented with diffuse rash, epidermal sloughing of 60% of the skin, desquamation of the lips, shock, and respiratory distress. She died on the 28th hospital day of TEN, right ventricular failure, and acute respiratory distress syndrome. As of 2003, 9 cases of TEN, including 5 fatalities, had been reported in the literature.

Erythema nodosum, Stevens-Johnson syndrome (potentially life-threatening), and TEN (potentially life-threatening) have also been reported during postmarketing experience.[Ref]

Common (1% to 10%): Rash
Uncommon (0.1% to 1%): Pruritus, urticaria
Rare (0.01% to 0.1%): Angioedema, photosensitivity reactions, sweating/hyperhidrosis, petechiae, blistering
Very rare (less than 0.01%): Erythema multiforme, erythema nodosum, Stevens-Johnson syndrome (potentially life-threatening), toxic epidermal necrolysis (potentially life-threatening)
Frequency not reported: Exfoliative dermatitis, purpura, burning, phototoxicity reaction, dry skin, maculopapular rash, skin disorder, vesiculobullous rash, erythema, hyperpigmentation, cutaneous candidiasis, bullous pemphigoid, vesicles, lobular panniculitis, photoinduced acute exanthematous pustulosis
Postmarketing reports: Acute generalized exanthematous pustulosis, fixed eruption[Ref]

Nervous system

Seizures have been reported in 2 patients given this drug and foscarnet. The temporal association between the onset of seizures and drug administration suggests a possible drug interaction; causal relationship was not established in either case. Both drugs are individually epileptogenic; concurrent use may potentiate risk of seizures.

One survey reported 11 cases of peripheral neuropathy associated with this drug. The severity ranged from mild and reversible to severe and persistent. In 1 case, a 44-year-old female developed numbness, allodynia, hypoesthesia, tremors, electrical and diffuse burning sensations, twitching, disorientation, visual impairment, nausea, temperature intolerance, rash, and palpitations; she remained disabled after 29 months.

Nystagmus, anosmia, hyperesthesia, hypoesthesia, hypertonia, intracranial hypertension, and exacerbation of myasthenia gravis have also been reported during postmarketing experience.[Ref]

Common (1% to 10%): Headache, dizziness/lightheadedness, central nervous system disturbance
Uncommon (0.1% to 1%): Sleep disorders, taste disorders, seizures (including status epilepticus), dysesthesia, paresthesia, vertigo, hearing loss
Rare (0.01% to 0.1%): Syncope, hypoesthesia, tremor, tinnitus, migraine, olfactory nerve disorders, smell disorders, hearing impaired
Very rare (less than 0.01%): Disturbed coordination, intracranial hypertension, benign intracranial hypertension/pseudotumor cerebri, exacerbation of myasthenia gravis, hyperesthesia
Frequency not reported: Unresponsiveness, ataxia, hypertonia, anosmia, nystagmus, taste perversion/bad taste, somnolence/drowsiness, incoordination, disturbance in attention, dyskinesia, myasthenia gravis, paresis, aseptic meningitis, cerebral thrombosis, grand mal convulsion, dysphasia, lethargy
Postmarketing reports: Taste loss, peripheral neuropathy (may be irreversible), polyneuropathy[Ref]


Pancytopenia (life-threatening or fatal outcome) and bone marrow depression (life-threatening) were reported very rarely; also reported during postmarketing experience.

Increased INR was reported in patients treated with vitamin K antagonists.[Ref]

Common (1% to 10%): Eosinophilia
Uncommon (0.1% to 1%): Thrombocytopenia, thrombocythemia
Rare (0.01% to 0.1%): Leukopenia, anemia, neutropenia, leukocytosis, pancytopenia, bone marrow depression, abnormal prothrombin level
Very rare (less than 0.01%): Hemolytic anemia, agranulocytosis
Frequency not reported: Decreased hematocrit, decreased platelet counts, increased platelet counts, prolonged prothrombin time, decreased prothrombin, bleeding diathesis, decreased hemoglobin, decreased leukocyte count, increased atypical lymphocyte count, immature WBCs, increased blood monocytes, elevated sedimentation rate, elevated eosinophil counts, lymphadenopathy
Postmarketing reports: Methemoglobinemia, increased INR, prothrombin time prolonged or decreased[Ref]


Liver necrosis very rarely progressed to life-threatening hepatic failure. Liver necrosis and hepatic failure (including fatal cases) have also been reported during postmarketing experience.[Ref]

Common (1% to 10%): Abnormal liver function tests, increased transaminases
Uncommon (0.1% to 1%): Elevated bilirubin, hepatic impairment, cholestatic icterus/cholestatic jaundice, jaundice
Rare (0.01% to 0.1%): Hepatitis, liver necrosis
Very rare (less than 0.01%): Hepatic failure
Frequency not reported: Elevated AST, elevated ALT, elevated GGT[Ref]


Common (1% to 10%): Restlessness
Uncommon (0.1% to 1%): Psychomotor hyperactivity/agitation, confusion, disorientation, hallucinations
Rare (0.01% to 0.1%): Anxiety reaction, abnormal dreams, depression, psychotic reactions
Frequency not reported: Depersonalization, insomnia, manic reaction, nightmares, paranoia, phobia, toxic psychosis, nervousness, self-injurious behavior, suicidal ideations/thoughts, attempted suicide, completed suicide, catatonia
Postmarketing reports: Delirium[Ref]

Depression and psychotic reactions (both potentially culminating in self-injurious behavior such as suicidal ideations/thoughts and attempted or completed suicide) have been reported.

Agitation, confusion, and toxic psychosis have also been reported during postmarketing experience.[Ref]


Crystalluria has been reported in patients with alkaline urine and did not necessarily lead to nephrotoxicity. At physiological urinary pH, the risk of crystalluria was considered minor.

Vaginal candidiasis has also been reported during postmarketing experience.[Ref]

Common (1% to 10%): Vaginal candidiasis
Rare (0.01% to 0.1%): Hematuria, crystalluria
Frequency not reported: Albuminuria, cylindruria, frequent urination, hemorrhagic cystitis, vaginitis, dysmenorrhea, candiduria, polyuria, urethral bleeding, urinary retention, urinary tract infection, fungal vaginosis, bacterial vaginitis, dysuria, abnormal urine odor, female genital pruritus, vaginal infection, urinary frequency, micturition urgency, vaginal pruritus[Ref]


Local IV site reactions occurred more often if the infusion time was 30 minutes or less. These reactions have appeared as local skin reactions and resolved quickly when infusion was completed.

Injection site irritation and induration have been reported with IV infusion time 30 minutes or less (instead of the recommended 1 hour) or when a small vein in the back of the hand was used.[Ref]

Common (1% to 10%): Local IV site reactions, injection and infusion site reactions (e.g., phlebitis, thrombophlebitis)
Frequency not reported: Injection site irritation and induration with IV infusion[Ref]


Uncommon (0.1% to 1%): Musculoskeletal pain (e.g., extremity pain, back pain, chest pain), arthralgia
Rare (0.01% to 0.1%): Myalgia, arthritis, increased muscle tone and cramping, tendon rupture (mainly Achilles tendon)
Very rare (less than 0.01%): Tendinitis, muscular weakness
Frequency not reported: Arthropathy (including suspected reversible cases), joint stiffness, elevated serum creatine phosphokinase, abnormal joint exam, joint sprains, arthrosis, bone pain, decreased range of motion in a joint (knee, elbow, ankle, hip, wrist, shoulder), jaw pain, neck pain, gout flare-up, joint swelling, muscle spasms, night cramps, knee inflammation
Postmarketing reports: Myoclonus, myasthenia, twitching[Ref]

Arthropathy has primarily been a concern in pediatric patients; however, at least 1 case was described in an adult cystic fibrosis patient receiving this drug. Although cystic fibrosis arthropathy and hypertrophic pulmonary osteoarthropathy typically occur in 7% to 8% of cystic fibrosis adults and adolescents, the arthropathy exhibited in this patient did not resemble either. Several elements in its presentation strongly supported the diagnosis of ciprofloxacin-induced arthropathy, such as: a consistent time of onset with other reported cases of suspected quinolone-induced arthropathy (usually 3 weeks after starting therapy); a lack of history of arthralgia in the patient; reoccurrence upon rechallenge; and resolution of symptoms upon discontinuation of therapy (usually 2 weeks after therapy stopped).

Tendinitis with subsequent tendon rupture has been documented in numerous case reports. One patient with chronic renal failure developed bilateral Achilles tendon rupture after 4 days of ciprofloxacin therapy. Although renal transplant patients and those with end-stage renal disease tend to have an increased risk of Achilles tendinitis and rupture over the general population, quinolone use has been shown to further increase that risk (12% in quinolone-treated patients versus 7% in nonquinolone-treated patients).

As of October 1994, 25 cases of Achilles tendon rupture had been reported to the US FDA. Some ruptures have also occurred in the hand or shoulder. Other risk factors identified included age and corticosteroid use.

There had been 23 reports of tendonitis submitted to the Australian Adverse Drug Reactions Committee (ADRAC) between 2006 and 2008, including reports of Achilles tendonitis, tendon rupture, and tendon pain and swelling. The reports were primarily in male patients (15 cases) older than 56 years who used this drug for 2 to 14 days. In 19 of the reported cases, a fluoroquinolone (generally ciprofloxacin) was the primary suspect; however, details of concomitant serious medical conditions were not documented in most of the reports.

Musculoskeletal side effects reported in pediatric patients included arthralgia, abnormal gait, abnormal joint exam, joint sprains, leg pain, back pain, arthrosis, bone pain, pain, myalgia, arm pain, and decreased range of motion in a joint (knee, elbow, ankle, hip, wrist, shoulder).

Myalgia, tendinitis, and tendon rupture have also been reported during postmarketing experience.[Ref]


Uncommon (0.1% to 1%): Tachycardia, vasodilatation, hypotension
Rare (0.01% to 0.1%): Vasculitis
Frequency not reported: Angina pectoris, cardiopulmonary arrest, myocardial infarction, hypertension, palpitation, bradycardia, arrhythmia, atrial flutter, cardiac murmur, cardiovascular collapse, ventricular ectopy, ventricular bigeminy, abdominal aortic bruit, postural hypotension
Postmarketing reports: QT prolongation/ECG QT prolonged, torsade de pointes, ventricular arrhythmia[Ref]

Torsade de pointes was reported mainly in patients with risk factors for QT prolongation.

Vasculitis has also been reported during postmarketing experience.[Ref]


Elevated serum theophylline has been reported in patients receiving theophylline concomitantly.

Gait disturbance and elevated serum potassium have also been reported during postmarketing experience.[Ref]

Uncommon (0.1% to 1%): Candida infections, mycotic superinfections, pain, fever, malaise/feeling unwell, asthenia, edema
Very rare (less than 0.01%): Gait disturbance/abnormal gait
Frequency not reported: Irritability, flushing, thirst, elevated serum calcium, elevated serum potassium, decreased serum albumin, decreased serum potassium, decreased total serum protein, elevated serum theophylline, serum phenytoin altered, chills, swelling, breast pain, achiness, weakness, fatigue, suprapubic pain, rigors, tenderness, fungal infection, increased body temperature[Ref]


Quinolone class antibiotics have been associated with symptomatic hypoglycemia.[Ref]

Uncommon (0.1% to 1%): Elevated blood alkaline phosphatase, decreased appetite/anorexia, decreased food intake
Rare (0.01% to 0.1%): Hyperglycemia, hypoglycemia
Frequency not reported: Elevated LDH, elevated uric acid, elevated blood glucose, elevated triglycerides, decreased uric acid, decreased blood glucose, acidosis, symptomatic hypoglycemia
Postmarketing reports: Elevated serum cholesterol[Ref]


Uncommon (0.1% to 1%): Renal impairment, renal failure
Rare (0.01% to 0.1%): Tubulointerstitial nephritis
Frequency not reported: Elevated serum creatinine, renal calculi, elevated BUN, decreased BUN, abnormal kidney function, allergic interstitial nephritis, nephritis, myoglobin-associated acute kidney injury/failure[Ref]

Allergic interstitial nephritis resulting in nonoliguric renal failure has been described in numerous case reports. Several cases included symptoms of rash, fever, and arthralgia and were accompanied by eosinophilia and eosinophiluria. Cases of allergic interstitial nephritis often responded to short courses of corticosteroid therapy.[Ref]


Uncommon (0.1% to 1%): Visual disturbances (e.g., chromatopsia, diplopia, photopsia)
Very rare (less than 0.01%): Visual color distortions
Frequency not reported: Decreased visual acuity, blurred vision, cataracts, multiple punctate lenticular opacities, eye pain[Ref]

Quinolone class antibiotics have been associated with cataracts and multiple punctate lenticular opacities.[Ref]


Rare (0.01% to 0.1%): Allergic reactions, anaphylactic shock (life-threatening), allergic edema
Very rare (less than 0.01%): Anaphylactic reaction, serum sickness-like reaction
Frequency not reported: Anaphylactoid reactions, necrotizing vasculitis, cutaneous vasculitis[Ref]

Allergic reactions ranged from urticaria to anaphylactic reactions, including life-threatening anaphylactic shock.

At least 2 cases have been reported of patients developing a cutaneous vasculitis related to use of this drug. The vasculitis resolved without medical intervention after the drug was discontinued.

Serum sickness-like reaction and anaphylactic shock (life-threatening) have also been reported during postmarketing experience.[Ref]


Rare (0.01% to 0.1%): Dyspnea (including asthmatic condition)
Frequency not reported: Bronchospasm, hemoptysis, laryngeal edema, respiratory arrest, epistaxis, hiccough, pulmonary edema, pleural effusion, pulmonary embolism, respiratory distress, wheeze, cough, upper respiratory tract infection, pharyngitis, nasopharyngitis[Ref]


Frequency not reported: Gynecomastia[Ref]


Frequency not reported: Jarisch-Herxheimer reaction[Ref]

Oral ciprofloxacin has been associated with a case of Jarisch-Herxheimer reaction (characterized by hypotension, tachycardia, and disseminated intravascular coagulation) in a 14-year-old female with tickborne relapsing fever.[Ref]


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