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Ciprofloxacin (Ophthalmic)

Pronunciation

Pronunciation

(sip roe FLOKS a sin)

Index Terms

  • Ciprofloxacin HCl
  • Ciprofloxacin Hydrochloride

Dosage Forms

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Ointment, Ophthalmic, as hydrochloride:

Ciloxan: 0.3% (3.5 g)

Solution, Ophthalmic, as hydrochloride:

Ciloxan: 0.3% (5 mL) [contains benzalkonium chloride, edetate disodium]

Generic: 0.3% (2.5 mL, 5 mL, 10 mL)

Brand Names: U.S.

  • Ciloxan

Pharmacologic Category

  • Antibiotic, Fluoroquinolone
  • Antibiotic, Ophthalmic

Pharmacology

Inhibits DNA-gyrase in susceptible organisms; inhibits relaxation of supercoiled DNA and promotes breakage of double-stranded DNA

Absorption

Only small amounts are absorbed systemically after ophthalmic instillation

Use: Labeled Indications

Ocular infections:

US labeling:

Ointment: Treatment of superficial ocular infections (conjunctivitis) due to susceptible strains of bacteria

Solution: Treatment of superficial ocular infections (corneal ulcers, conjunctivitis) due to susceptible strains of bacteria

Canadian labeling: Ointment, solution: Treatment of superficial ocular infections (corneal ulcers, conjunctivitis) due to susceptible strains of bacteria

Contraindications

Hypersensitivity to ciprofloxacin, any component of the formulation, or other quinolones

Dosing: Adult

Bacterial conjunctivitis: Ophthalmic:

Solution: Instill 1 to 2 drops into the conjunctival sac every 2 hours while awake for 2 days and 1 to 2 drops every 4 hours while awake for the next 5 days

Ointment: Apply a 1/2 inch ribbon into the conjunctival sac 3 times/day for the first 2 days, followed by a 1/2 inch ribbon applied twice daily for the next 5 days

Corneal ulcer: Ophthalmic:

Solution: Instill 2 drops into affected eye every 15 minutes for the first 6 hours, then 2 drops into the affected eye every 30 minutes for the remainder of the first day. On day 2, instill 2 drops into the affected eye hourly. On days 3-14, instill 2 drops into affected eye every 4 hours. Treatment may continue after day 14 if re-epithelialization has not occurred.

Ointment: Canadian labeling: Apply 1/2 inch ribbon into the conjunctival sac every 1 to 2 hours around the clock on the first 2 days, then apply 1/2 inch ribbon every 4 hours for up to 12 days. Treatment may continue after day 12 if re-epithelialization has not occurred.

Dosing: Geriatric

Refer to adult dosing.

Dosing: Pediatric

Bacterial conjunctivitis: Ophthalmic:

Solution: Children ≥1 year and Adolescents: Refer to adult dosing.

Ointment: Children ≥2 years and Adolescents (US labeling) or Children >1 years and Adolescents (Canadian labeling): Refer to adult dosing.

Corneal ulcer: Ophthalmic:

Solution: Children ≥1 year and Adolescents (US labeling) or Children >12 years and Adolescents (Canadian labeling): Refer to adult dosing.

Ointment: Canadian labeling: Children >12 years and Adolescents: Refer to adult dosing.

Dosing: Renal Impairment

There are no dosage adjustments provided in the manufacturer’s labeling; however, dosage adjustment may not be necessary as systemic absorption is minimal.

Dosing: Hepatic Impairment

There are no dosage adjustments provided in the manufacturer’s labeling; however, dosage adjustment may not be necessary as systemic absorption is minimal.

Administration

Ophthalmic: For topical ophthalmic use only; avoid touching tip of applicator to eye or other surfaces. Contact lenses should be removed prior to administration.

Storage

Store at 2°C to 25°C (36°F to 77°F). Protect solution from light.

Drug Interactions

There are no known significant interactions.

Adverse Reactions

Frequency not always defined.

>10%: Ophthalmic: Crystalline eye deposits (solution:17%; white crystalline precipitate in superficial portion of corneal defect in those with corneal ulcer; reversible after completion of therapy)

1% to 10%:

Gastrointestinal: Unpleasant taste (immediately after instillation)

Ophthalmic: Corneal disease (ointment: 2%), burning sensation of eyes, conjunctival hyperemia, crusting of eyelid, eye discomfort, eye pruritus, foreign body sensation of eye

<1% (Limited to important or life-threatening): Blurred vision, corneal infiltrates, corneal staining, dermatitis, epitheliopathy, eye pain, eye irritation, eyelid edema, keratitis, keratoconjunctivitis, lacrimation, nausea, photophobia, vision loss, xerophthalmia

Warnings/Precautions

Concerns related to adverse effects:

• Delayed healing: Corneal healing may be delayed.

• Hypersensitivity reactions: Severe hypersensitivity reactions, including anaphylaxis (some fatal), have occurred with quinolone therapy (primarily with systemic use). Prompt discontinuation of drug should occur if skin rash or other symptoms arise.

• Superinfection: Prolonged use may result in fungal or bacterial superinfection. If superinfection is suspected, institute appropriate alternative therapy.

Special populations:

• Contact lens wearers: Some products contain benzalkonium chloride which may be absorbed by soft contact lenses; contact lenses should not be worn during treatment of ophthalmologic infections.

Other warnings/precautions:

• Ophthalmic use: For ophthalmic use only. Not for subconjunctival injection or for introduction into the anterior chamber of the eye. To avoid contamination, do not touch tip of container to any surface.

Pregnancy Risk Factor

C

Pregnancy Considerations

Adverse events have been observed in some animal reproduction studies. When administered orally or IV, ciprofloxacin crosses the placenta (Giamarellou 1989; Ludlam 1997). The amount of ciprofloxacin available systemically following topical application of the ophthalmic drops is significantly less in comparison to oral or IV doses. If ophthalmic agents are needed during pregnancy, the minimum effective dose should be used in combination with punctual occlusion for 3 to 5 minutes after application to decrease potential exposure to the fetus (Samples 1988).

Patient Education

• Discuss specific use of drug and side effects with patient as it relates to treatment. (HCAHPS: During this hospital stay, were you given any medicine that you had not taken before? Before giving you any new medicine, how often did hospital staff tell you what the medicine was for? How often did hospital staff describe possible side effects in a way you could understand?)

• Patient may experience blurred vision, bloodshot eyes, crusting of eyelid, sensation of foreign object in eye, or bad taste. Have patient report immediately to prescriber vision changes, eye pain, severe eye irritation, eye or eyelid edema, joint pain, joint edema, or crystalline eye deposits (HCAHPS).

• Educate patient about signs of a significant reaction (eg, wheezing; chest tightness; fever; itching; bad cough; blue skin color; seizures; or swelling of face, lips, tongue, or throat). Note: This is not a comprehensive list of all side effects. Patient should consult prescriber for additional questions.

Intended Use and Disclaimer: Should not be printed and given to patients. This information is intended to serve as a concise initial reference for healthcare professionals to use when discussing medications with a patient. You must ultimately rely on your own discretion, experience and judgment in diagnosing, treating and advising patients.

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