Ciprofloxacina Azevedos Uses

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What is Ciprofloxacina Azevedos?

Ciprofloxacina Azevedos is used to treat bacterial infections in many different parts of the body. Ciprofloxacina Azevedos oral liquid and tablets are also used to treat anthrax infection after inhalational exposure. Ciprofloxacina Azevedos may mask or delay the symptoms of syphilis. It is not effective against syphilis infections.

Ciprofloxacina Azevedos extended-release tablets are only used to treat urinary tract infections, including acute uncomplicated pyelonephritis.

Proquin® XR tablets are only used to treat uncomplicated or simple urinary tract infections (acute cystitis).

Ciprofloxacina Azevedos belongs to the class of drugs known as quinolone antibiotics. It works by killing bacteria or preventing their growth. However, Ciprofloxacina Azevedos will not work for colds, flu, or other virus infections.

Ciprofloxacina Azevedos is available only with your doctor's prescription.

Ciprofloxacina Azevedos indications

infoAn indication is a term used for the list of condition or symptom or illness for which the medicine is prescribed or used by the patient. For example, acetaminophen or paracetamol is used for fever by the patient, or the doctor prescribes it for a headache or body pains. Now fever, headache and body pains are the indications of paracetamol. A patient should be aware of the indications of medications used for common conditions because they can be taken over the counter in the pharmacy meaning without prescription by the Physician.
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Ciprofloxacina Azevedos tablets USP are indicated for the treatment of infections caused by susceptible isolates of the designated microorganisms in the conditions and patient populations listed below.

Urinary Tract Infections

Ciprofloxacina Azevedos tablets USP are indicated in adult patients for treatment of urinary tract infections caused by Escherichia coli, Klebsiella pneumoniae, Enterobacter cloacae, Serratia marcescens, Proteus mirabilis, Providencia rettgeri, Morganella morganii, Citrobacter koseri, Citrobacter freundii, Pseudomonas aeruginosa, methicillin-susceptible Staphylococcus epidermidis, Staphylococcus saprophyticus, or Enterococcus faecalis.

Acute Uncomplicated Cystitis

Ciprofloxacina Azevedos tablets USP are indicated in adult female patients for treatment of acute uncomplicated cystitis caused by Escherichia coli or Staphylococcus saprophyticus.

Chronic Bacterial Prostatitis

Ciprofloxacina Azevedos tablets USP are indicated in adult patients for treatment of chronic bacterial prostatitis caused by Escherichia coli or Proteus mirabilis.

Lower Respiratory Tract Infections

Ciprofloxacina Azevedos tablets USP are indicated in adult patients for treatment of lower respiratory tract infections caused by Escherichia coli, Klebsiella pneumoniae, Enterobacter cloacae, Proteus mirabilis, Pseudomonas aeruginosa, Haemophilus influenzae, Haemophilus parainfluenzae, or Streptococcus pneumoniae. Also, Ciprofloxacina Azevedos tablets USP are indicated for the treatment of acute exacerbations of chronic bronchitis caused by Moraxella catarrhalis.

Acute Sinusitis

Ciprofloxacina Azevedos tablets USP are indicated in adult patients for treatment of acute sinusitis caused by Haemophilus influenzae, Streptococcus pneumoniae, or Moraxella catarrhalis.

Skin and Skin Structure Infections

Ciprofloxacina Azevedos tablets USP are indicated in adult patients for treatment of skin and skin structure infections caused by Escherichia coli, Klebsiella pneumoniae, Enterobacter cloacae, Proteus mirabilis, Proteus vulgaris, Providencia stuartii, Morganella morganii, Citrobacter freundii, Pseudomonas aeruginosa, methicillin-susceptible Staphylococcus aureus, methicillin-susceptible Staphylococcus epidermidis, or Streptococcus pyogenes.

Bone and Joint Infections

Ciprofloxacina Azevedos tablets USP are indicated in adult patients for treatment of bone and joint infections caused by Enterobacter cloacae, Serratia marcescens, or Pseudomonas aeruginosa.

Complicated Intra-Abdominal Infections

Ciprofloxacina Azevedos tablets USP are indicated in adult patients for treatment of complicated intra-abdominal infections (used in combination with metronidazole) caused by Escherichia coli, Pseudomonas aeruginosa, Proteus mirabilis, Klebsiella pneumoniae, or Bacteroides fragilis.

Infectious Diarrhea

Ciprofloxacina Azevedos tablets USP are indicated in adult patients for treatment of infectious diarrhea caused by Escherichia coli (enterotoxigenic isolates), Campylobacter jejuni, Shigella boydii†,Shigella dysenteriae, Shigella flexneri or Shigella sonnei† when antibacterial therapy is indicated.

†Although treatment of infections due to this organism in this organ system demonstrated a clinically significant outcome, efficacy was studied in fewer than 10 patients.

Typhoid Fever (Enteric Fever)

Ciprofloxacina Azevedos tablets USP are indicated in adult patients for treatment of typhoid fever (enteric fever) caused by Salmonella typhi. The efficacy of Ciprofloxacina Azevedos in the eradication of the chronic typhoid carrier state has not been demonstrated.

Uncomplicated Cervical and Urethral Gonorrhea

Ciprofloxacina Azevedos tablets USP are indicated in adult patients for treatment of uncomplicated cervical and urethral gonorrhea due to Neisseria gonorrhoeae.

Complicated Urinary Tract Infections and Pyelonephritis

Ciprofloxacina Azevedos tablets USP are indicated in pediatric patients one to 17 years of age for treatment of complicated urinary tract infections (cUTI) and pyelonephritis due to Escherichia coli.

Inhalational Anthrax (post-exposure)

Ciprofloxacina Azevedos tablets USP are indicated in adults and pediatric patients from birth to 17 years of age for inhalational anthrax (post-exposure) to reduce the incidence or progression of disease following exposure to aerosolized Bacillus anthracis.

Ciprofloxacina Azevedos serum concentrations achieved in humans served as a surrogate endpoint reasonably likely to predict clinical benefit and provided the initial basis for approval of this indication.1 Supportive clinical information for Ciprofloxacina Azevedos for anthrax post-exposure prophylaxis was obtained during the anthrax bioterror attacks of October 2001.

Plague

Ciprofloxacina Azevedos tablets USP are indicated for treatment of plague, including pneumonic and septicemic plague, due to Yersinia pestis (Y. pestis) and prophylaxis for plague in adults and pediatric patients from birth to 17 years of age. Efficacy studies of Ciprofloxacina Azevedos could not be conducted in humans with plague for feasibility reasons. Therefore this indication is based on an efficacy study conducted in animals only.

Limitation of Use

Use in Pediatric Patients

Although effective in clinical trials, Ciprofloxacina Azevedos is not a drug of first choice in the pediatric population due to an increased incidence of adverse events compared to controls, including events related to joints and/or surrounding tissues. Ciprofloxacina Azevedos tablets USP, like other fluoroquinolones, is associated with arthropathy and histopathological changes in weight-bearing joints of juvenile animals.

Lower Respiratory Tract Infections

Ciprofloxacina Azevedos tablets USP are not a drug of first choice in the treatment of presumed or confirmed pneumonia secondary to Streptococcus pneumoniae.

Usage

To reduce the development of drug-resistant bacteria and maintain the effectiveness of Ciprofloxacina Azevedos tablets USP and other antibacterial drugs, Ciprofloxacina Azevedos tablets USP should be used only to treat or prevent infections that are proven or strongly suspected to be caused by susceptible bacteria. When culture and susceptibility information are available, they should be considered in selecting or modifying antibacterial therapy. In the absence of such data, local epidemiology and susceptibility patterns may contribute to the empiric selection of therapy.

If anaerobic organisms are suspected of contributing to the infection, appropriate therapy should be administered. Appropriate culture and susceptibility tests should be performed before treatment in order to isolate and identify organisms causing infection and to determine their susceptibility to Ciprofloxacina Azevedos. Therapy with Ciprofloxacina Azevedos tablets USP may be initiated before results of these tests are known; once results become available appropriate therapy should be continued. As with other drugs, some isolates of Pseudomonas aeruginosa may develop resistance fairly rapidly during treatment with Ciprofloxacina Azevedos. Culture and susceptibility testing performed periodically during therapy will provide information not only on the therapeutic effect of the antimicrobial agent but also on the possible emergence of bacterial resistance.

How should I use Ciprofloxacina Azevedos?

Use Ciprofloxacina Azevedos as directed by your doctor. Check the label on the medicine for exact dosing instructions.

  • Ciprofloxacina Azevedos comes with an extra patient information sheet called a Medication Guide. Read it carefully. Read it again each time you get Ciprofloxacina Azevedos refilled.
  • An extra patient leaflet may be available with Ciprofloxacina Azevedos. Talk to your pharmacist if you have questions about this information.
  • Take Ciprofloxacina Azevedos by mouth with or without food. The preferred dosing time is 2 hours after a meal.
  • Shake well before each use.
  • Use a measuring device marked for medicine dosing. Ask your pharmacist for help if you are unsure of how to measure your dose.
  • Take Ciprofloxacina Azevedos with a full glass of water (8 oz [240 mL]).
  • Drinking extra fluids while you are taking Ciprofloxacina Azevedos is recommended. Check with your doctor for instructions.
  • If you also take any products containing magnesium, aluminum, calcium, iron, or zinc (eg, antacids, quinapril, vitamins/minerals); didanosine; sucralfate; or bismuth subsalicylate, do not take them within 6 hours before or 2 hours after taking Ciprofloxacina Azevedos. Check with your doctor if you have questions.
  • If you also take sevelamer, do not take it within 4 hours before or after taking Ciprofloxacina Azevedos. Check with your doctor if you have questions.
  • Ciprofloxacina Azevedos works best if it is taken at the same time each day.
  • To clear up your infection completely, take Ciprofloxacina Azevedos for the full course of treatment. Keep taking it even if you feel better in a few days.
  • Avoid taking Ciprofloxacina Azevedos with milk or milk products (eg, calcium-enriched juice, yogurt) by themselves. However, taking Ciprofloxacina Azevedos as part of a full meal that contains milk or milk products is permitted.
  • Do not miss any doses. If you miss a dose of Ciprofloxacina Azevedos, take it as soon as possible. If it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not take 2 doses at once.

Ask your health care provider any questions you may have about how to use Ciprofloxacina Azevedos.

Uses of Ciprofloxacina Azevedos in details

infoThere are specific as well as general uses of a drug or medicine. A medicine can be used to prevent a disease, treat a disease over a period or cure a disease. It can also be used to treat the particular symptom of the disease. The drug use depends on the form the patient takes it. It may be more useful in injection form or sometimes in tablet form. The drug can be used for a single troubling symptom or a life-threatening condition. While some medications can be stopped after few days, some drugs need to be continued for prolonged period to get the benefit from it.
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Ciprofloxacina Azevedos is used to treat wide range of bacterial infections including lung or respiratory tract infections, eye infection, bladder and kidney infections, reproductive tract infections, skin and soft tissue infections and bone and joint infections.

Ciprofloxacina Azevedos description

Ciprofloxacina Azevedos: Each 250- and 500-mg tablet contains Ciprofloxacina Azevedos HCl 250 mg and 500 mg, respectively.

Each 50-, 100- and 200-mL vial of infusion solution contains Ciprofloxacina Azevedos lactate 100 mg, 200 mg and 400 mg, respectively.

Ciprofloxacina Azevedos tablet also contains microcrystalline cellulose, maize starch, crospovidone, anhydrous colloidal silica, magnesium stearate, hypromellose, macrogol 4000 and titanium dioxide (E171) while the infusion solution also contains lactic acid, sodium chloride, concentrated hydrochloric acid and water for injections.

Ciprofloxacina Azevedos XR: Each 500 mg tablet contains Ciprofloxacina Azevedos HCl monohydrate 334.8 mg and Ciprofloxacina Azevedos hydrous 253 mg, corresponding to Ciprofloxacina Azevedos 500 mg. Each 1 g tablet contains Ciprofloxacina Azevedos HCl monohydrate 669.4 mg and Ciprofloxacina Azevedos hydrate 506 mg, corresponding to Ciprofloxacina Azevedos 1000 mg.

Ciprofloxacina Azevedos XR also contains the following excipients: Crospovidone, magnesium stearate, anhydrous colloidal silica, succinic acid, hypromellose, macrogol 3350, titanium dioxide and purified water in bulk.

Ciprofloxacina Azevedos dosage

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Dosage

Ciprofloxacina Azevedos XR and Ciprofloxacina Azevedos immediate-release tablets are not interchangeable. Ciprofloxacina Azevedos XR should be administered orally once daily (Table 1).

Patients whose therapy is started with Ciprofloxacina Azevedos IV for UTIs may be switched to Ciprofloxacina Azevedos XR when clinically indicated at the discretion of the physician.

Administration

Ciprofloxacina Azevedos XR tablets should be taken whole and not split, crushed, or chewed.
Ciprofloxacina Azevedos XR should be administered at least 2 hours before or 6 hours after antacids containing magnesium or aluminum, polymeric phosphate binders (for example, sevelamer, lanthanum carbonate), as well as sucralfate, VIDEX® (didanosine) chewable/buffered tablets or pediatric powder, other highly buffered drugs, metal cations such as iron, and multivitamin preparations with zinc.
Concomitant administration of Ciprofloxacina Azevedos XR with dairy products (like milk or yogurt) or with calcium-fortified products alone should be avoided since decreased absorption is possible. A 2-hour window between substantial calcium intake (greater than 800 mg) and dosing with Ciprofloxacina Azevedos XR is recommended.

Adequate hydration of patients receiving Ciprofloxacina Azevedos XR should be maintained to prevent the formation of highly concentrated urine. Crystalluria has been reported with quinolones.

Impaired Renal Function

In patients with cUTI and acute uncomplicated pyelonephritis with a creatinine clearance of ≤ 30 mL/min, the dose of Ciprofloxacina Azevedos XR should be reduced from 1000 mg to 500 mg daily. The use of Ciprofloxacina Azevedos 1000 mg XR tablets is not recommended in this patient population.
For patients on hemodialysis or peritoneal dialysis, administer Ciprofloxacina Azevedos XR after the dialysis procedure is completed (maximum dose should be Ciprofloxacina Azevedos 500 mg XR every 24 hours). The use of Ciprofloxacina Azevedos 1000 mg XR is not recommended in this patient population.
For patients on continuous ambulatory peritoneal dialysis (CAPD), the maximum dose should be 500 mg every 24 hours.

Ciprofloxacina Azevedos interactions

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Caffeine

Some quinolones, including Ciprofloxacina Azevedos, have also been shown to interfere with the metabolism of caffeine. This may lead to reduced clearance of caffeine and a prolongation of its serum half-life.

Cyclosporine

Some quinolones, including Ciprofloxacina Azevedos, have been associated with transient elevations in serum creatinine in patients receiving cyclosporine concomitantly.

Glyburide

The concomitant administration of Ciprofloxacina Azevedos with the sulfonylurea glyburide has, on rare occasions, resulted in severe hypoglycemia.

Histamine H2-receptor antagonists

Histamine H2-receptor antagonists appear to have no significant effect on the bioavailability of Ciprofloxacina Azevedos.

Methotrexate

Renal tubular transport of methotrexate may be inhibited by concomitant administration of Ciprofloxacina Azevedos, potentially leading to increased plasma levels of methotrexate. This might increase the risk of methotrexate toxic reactions. Therefore, patients under methotrexate therapy should be carefully monitored when concomitant Ciprofloxacina Azevedos therapy is indicated.

Multivalent Cation-Containing Products

Concurrent administration of a quinolone, including Ciprofloxacina Azevedos, with multivalent cation-containing products such as magnesium or aluminum antacids, sucralfate, VIDEX chewable/buffered tablets or pediatric powder, or products containing calcium, iron, or zinc may substantially decrease the absorption of Ciprofloxacina Azevedos, resulting in serum and urine levels considerably lower than desired. Proquin XR should be administered at least 4 hours before or 2 hours after these products. This time window is different than for other oral formulations of Ciprofloxacina Azevedos, which are usually administered 2 hours before or 6 hours after antacids.

Non-steroidal anti-inflammatory drugs (but not aspirin)

These drugs in combination with very high doses of quinolones have been shown to provoke convulsions in pre-clinical studies.

Omeprazole

The rate and extent of absorption of Ciprofloxacina Azevedos was bioequivalent when Proquin XR was given alone or when Proquin XR was given 2 hours after omeprazole at the dose that maximally suppresses gastric acid secretion. Omeprazole should be taken as directed and Proquin XR should be taken with a main meal of the day, preferably the evening meal..

Phenytoin

Altered serum levels of phenytoin (increased and decreased) have been reported in patients receiving concomitant Ciprofloxacina Azevedos.

Probenecid

Probenecid interferes with renal tubular secretion of Ciprofloxacina Azevedos and produces an increase in the level of Ciprofloxacina Azevedos in serum.

Theophylline

As with some other quinolones, concurrent administration of Ciprofloxacina Azevedos with theophylline may lead to elevated serum concentrations of theophylline and prolongation of its elimination half-life. This may result in increased risk of theophylline-related adverse reactions. If concomitant use cannot be avoided, serum levels of theophylline should be monitored and dosage adjustments made as appropriate.

Warfarin

Quinolones have been reported to enhance the effects of the oral anticoagulant warfarin or its derivatives. When these products are administered concomitantly, prothrombin time or other suitable coagulation tests should be monitored.

Ciprofloxacina Azevedos side effects

The following serious and otherwise important adverse drug reactions are discussed in greater detail in other sections of labeling:

Tendon Effects
Exacerbation of Myasthenia Gravis
Hypersensitivity Reactions
Other Serious and Sometimes Fatal Reactions
Hepatotoxicity
Serious Adverse Reactions with Concomitant Theophylline
Central Nervous System Effects
Clostridium difficile-Associated Diarrhea
Peripheral Neuropathy
Prolongation of the QT Interval
Musculoskeletal Disorders in Pediatric Patients
Photosensitivity/Phototoxicity
Development of Drug Resistant Bacteria

Clinical Trials Experience

Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared to rates in the clinical trials of another drug and may not reflect the rates observed in practice.

Adult Patients

During clinical investigations with oral and parenteral Ciprofloxacina Azevedos, 49,038 patients received courses of the drug.

The most frequently reported adverse reactions, from clinical trials of all formulations, all dosages, all drug-therapy durations, and for all indications of Ciprofloxacina Azevedos therapy were nausea (2.5%), diarrhea (1.6%), liver function tests abnormal (1.3%), vomiting (1%), and rash (1%).

In randomized, double-blind controlled clinical trials comparing Ciprofloxacina Azevedos tablets [500 mg two times daily (BID)] to cefuroxime axetil (250 mg to 500 mg BID) and to clarithromycin (500 mg BID) in patients with respiratory tract infections, Ciprofloxacina Azevedos demonstrated a CNS adverse reaction profile comparable to the control drugs.

Pediatric Patients

Short (6 weeks) and long term (1 year) musculoskeletal and neurological safety of oral/intravenous Ciprofloxacina Azevedos, was compared to a cephalosporin for treatment of cUTI or pyelonephritis in pediatric patients 1 to 17 years of age (mean age of 6 ± 4 years) in an international multicenter trial. The duration of therapy was 10 to 21 days (mean duration of treatment was 11 days with a range of 1 to 88 days). A total of 335 Ciprofloxacin- and 349 comparator-treated patients were enrolled.

An Independent Pediatric Safety Committee (IPSC) reviewed all cases of musculoskeletal adverse reactions including abnormal gait or abnormal joint exam (baseline or treatment-emergent). Within 6 weeks of treatment initiation, the rates of musculoskeletal adverse reactions were 9.3% (31/335) in the Ciprofloxacin-treated group versus 6% (21/349) in comparator-treated patients. All musculoskeletal adverse reactions occurring by 6 weeks resolved (clinical resolution of signs and symptoms), usually within 30 days of end of treatment. Radiological evaluations were not routinely used to confirm resolution of the adverse reactions. Ciprofloxacin-treated patients were more likely to report more than one adverse reaction and on more than one occasion compared to control patients. The rate of musculoskeletal adverse reactions was consistently higher in the Ciprofloxacina Azevedos group compared to the control group across all age subgroups. At the end of 1 year, the rate of these adverse reactions reported at any time during that period was 13.7% (46/335) in the Ciprofloxacin-treated group versus 9.5% (33/349) in the comparator-treated patients (Table 7).

The incidence rates of neurological adverse reactions within 6 weeks of treatment initiation were 3% (9/335) in the Ciprofloxacina Azevedos group versus 2% (7/349) in the comparator group and included dizziness, nervousness, insomnia, and somnolence.

In this trial, the overall incidence rates of adverse reactions within 6 weeks of treatment initiation were 41% (138/335) in the Ciprofloxacina Azevedos group versus 31% (109/349) in the comparator group. The most frequent adverse reactions were gastrointestinal: 15% (50/335) of Ciprofloxacina Azevedos patients compared to 9% (31/349) of comparator patients. Serious adverse reactions were seen in 7.5% (25/335) of Ciprofloxacin-treated patients compared to 5.7% (20/349) of control patients. Discontinuation of drug due to an adverse reaction was observed in 3% (10/335) of Ciprofloxacin-treated patients versus 1.4% (5/349) of comparator patients. Other adverse reactions that occurred in at least 1% of Ciprofloxacina Azevedos patients were diarrhea 4.8%, vomiting 4.8%, abdominal pain 3.3%, dyspepsia 2.7%, nausea 2.7%, fever 2.1%, asthma 1.8% and rash 1.8%.

Short-term safety data for Ciprofloxacina Azevedos was also collected in a randomized, double-blind clinical trial for the treatment of acute pulmonary exacerbations in cystic fibrosis patients (ages 5 to 17 years). Sixty seven patients received Ciprofloxacina Azevedos IV 10 mg/kg/dose every 8 hours for one week followed by Ciprofloxacina Azevedos tablets 20 mg/kg/dose every 12 hours to complete 10 to 21 days treatment and 62 patients received the combination of ceftazidime intravenous 50 mg/kg/dose every 8 hours and tobramycin intravenous 3 mg/kg/dose every 8 hours for a total of 10 to 21 days. Periodic musculoskeletal assessments were conducted by treatment-blinded examiners. Patients were followed for an average of 23 days after completing treatment (range 0 to 93 days). Musculoskeletal adverse reactions were reported in 22% of the patients in the Ciprofloxacina Azevedos group and 21% in the comparison group. Decreased range of motion was reported in 12% of the subjects in the Ciprofloxacina Azevedos group and 16% in the comparison group. Arthralgia was reported in 10% of the patients in the Ciprofloxacina Azevedos group and 11% in the comparison group. Other adverse reactions were similar in nature and frequency between treatment arms. The efficacy of Ciprofloxacina Azevedos for the treatment of acute pulmonary exacerbations in pediatric cystic fibrosis patients has not been established.

In addition to the adverse reactions reported in pediatric patients in clinical trials, it should be expected that adverse reactions reported in adults during clinical trials or postmarketing experience may also occur in pediatric patients.

Postmarketing Experience

The following adverse reactions have been reported from worldwide marketing experience with fluoroquinolones, including Ciprofloxacina Azevedos. Because these reactions are reported voluntarily from a population of uncertain size, it is not always possible to reliably estimate their frequency or establish a causal relationship to drug exposure (Table 8).

Adverse Laboratory Changes

Changes in laboratory parameters while on Ciprofloxacina Azevedos are listed below:

Hepatic –Elevations of ALT (SGPT), AST (SGOT), alkaline phosphatase, LDH, serum bilirubin.

Hematologic–Eosinophilia, leukopenia, decreased blood platelets, elevated blood platelets, pancytopenia.

Renal–Elevations of serum creatinine, BUN, crystalluria, cylindruria, and hematuria have been reported.

Other changes occurring were: elevation of serum gammaglutamyl transferase, elevation of serum amylase, reduction in blood glucose, elevated uric acid, decrease in hemoglobin, anemia, bleeding diathesis, increase in blood monocytes, and leukocytosis.

Ciprofloxacina Azevedos contraindications

Caution should be taken when giving Ciprofloxacina Azevedos to epileptic patients and to those with history of central nervous system (CNS) disorders, myasthenia gravis and glucose-6-phosphate dehydrogenase deficiency. Ciprofloxacina Azevedos may exacerbate or unmask symptoms of myasthenia gravis. If tendon pain, inflammation or rupture occurs, treatment with Ciprofloxacina Azevedos should be discontinued.

Ciprofloxacina Azevedos is contraindicated in children, adolescents. It was reported to cause arthralgia and degenerative changes in joints that bear weight in young animals.

Use in pregnancy & lactation: Ciprofloxacina Azevedos is contraindicated in pregnancy. It is also excreted in breast milk. It should be used in caution when given to breastfeeding mothers as this was found to cause arthropathy in young animals.

Ciprofloxacina Azevedos pregnancy

Contraindicated in pregnancy (safety and efficacy in women during pregnancy has not been established); Ciprofloxacina Azevedos crosses the placenta, excreted in breast milk.

In experimental studies found that it causes arthropathy. In experiments on rats and mice treated with Ciprofloxacina Azevedos in doses exceeding the usual daily dose for a person 6 times, adverse effects on the fetus is not revealed. In experiments on rabbits treated with oral dose of Ciprofloxacina Azevedos 30 and 100 mg / kg, it is shown that the drug causes disruption of the gastrointestinal tract, leading to loss of body weight in females and increase the number of miscarriages but teratogenicity not found. When IV introduction to the doses of 20 mg / kg Ciprofloxacina Azevedos did not exert toxic effects on the mother and embryo, showed no teratogenicity. The use of local forms of Ciprofloxacina Azevedos in pregnancy is possible if the anticipated benefits exceed the potential risk to the fetus.

Category of the fetus by FDA - C.

Ciprofloxacina Azevedos is excreted in breast milk, so the period of lactation should decide, stop taking Ciprofloxacina Azevedos or breastfeeding based on the degree of importance of the use of drugs for the mother.

With careful use of local forms of Ciprofloxacina Azevedos in breast-feeding (not known whether Ciprofloxacina Azevedos is excreted in breast milk when applied topically).

Ciprofloxacina Azevedos overdose

In the event of acute overdosage, the patient should be carefully observed and given supportive treatment, including monitoring of renal function. Adequate hydration must be maintained. Only a small amount of Ciprofloxacina Azevedos (< 10%) is removed from the body after hemodialysis or peritoneal dialysis.

In mice, rats, rabbits and dogs, significant toxicity including tonic/clonic convulsions was observed at intravenous doses of Ciprofloxacina Azevedos between 125 and 300 mg/kg.

DOSAGE AND ADMINISTRATION

Adults

Ciprofloxacina Azevedos Injection, USP should be administered to adults by intravenous infusion over a period of 60 minutes at dosages described in the Dosage Guidelines table. Slow infusion of a dilute solution into a larger vein will minimize patient discomfort and reduce the risk of venous irritation.

The determination of dosage for any particular patient must take into consideration the severity and nature of the infection, the susceptibility of the causative microorganism, the integrity of the patient’s host-defense mechanisms, and the status of renal and hepatic function.

Ciprofloxacina Azevedos Injection, USP should be administered by intravenous infusion over a period of 60 minutes.

Conversion of I.V. to

Oral Dosing in Adults

Ciprofloxacina Azevedos Tablets and Ciprofloxacina Azevedos

Oral Suspension for oral administration are available.

Parenteral therapy may be switched to oral Ciprofloxacina Azevedos when the condition warrants, at the discretion of the physician.

Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration.

Adults with Impaired Renal Function

Ciprofloxacina Azevedos is eliminated primarily by renal excretion; however, the drug is also metabolized and partially cleared through the biliary system of the liver and through the intestine. These alternative pathways of drug elimination appear to compensate for the reduced renal excretion in patients with renal impairment. Nonetheless, some modification of dosage is recommended for patients with severe renal dysfunction. The following table provides dosage guidelines for use in patients with renal impairment:

When only the serum creatinine concentration is known, the following formula may be used to estimate creatinine clearance:

Men: Creatinine clearance (mL/min) = Weight (kg) x (140-age)

72 x serum creatinine (mg/dL)

Women: 0.85 x the value calculated for men.

The serum creatinine should represent a steady state of renal function.

For patients with changing renal function or for patients with renal impairment and hepatic insufficiency, careful monitoring is suggested.

Pediatrics

Ciprofloxacina Azevedos Injection, USP should be administered as described in the Dosage Guidelines table. An increased incidence of adverse events compared to controls, including events related to joints and/or surrounding tissues, has been observed.

Dosing and initial route of therapy (i.e., IV or oral) for complicated urinary tract infection or pyelonephritis should be determined by the severity of the infection. In the clinical trial, pediatric patients with moderate to severe infection were initiated on 6 to 10 mg/kg IV every 8 hours and allowed to switch to oral therapy (10 to 20 mg/kg every 12 hours), at the discretion of the physician.

Pediatric patients with moderate to severe renal insufficiency were excluded from the clinical trial of complicated urinary tract infection and pyelonephritis. No information is available on dosing adjustments necessary for pediatric patients with moderate to severe renal insufficiency (i.e., creatinine clearance of < 50 mL/min/1.73m2).

Preparation of Ciprofloxacina Azevedos Injection, USP for Administration

Vials (Injection Concentrate)

THIS PREPARATION MUST BE DILUTED BEFORE USE. The intravenous dose should be prepared by aseptically withdrawing the concentrate from the vial of Ciprofloxacina Azevedos Injection, USP. This should be diluted with a suitable intravenous solution to a final concentration of l-2mg/mL. The resulting solution should be infused over a period of 60 minutes by direct infusion or through a Y-type intravenous infusion set which may already be in place.

If the Y-type or "piggyback" method of administration is used, it is advisable to discontinue temporarily the administration of any other solutions during the infusion of Ciprofloxacina Azevedos Injection, USP. If the concomitant use of Ciprofloxacina Azevedos Injection, USP and another drug is necessary each drug should be given separately in accordance with the recommended dosage and route of administration for each drug.

Flexible Containers

Ciprofloxacina Azevedos Injection, USP is also available as a 0.2% premixed solution in 5% dextrose in flexible containers of 100 mL or 200 mL. The solutions in flexible containers do not need to be diluted and may be infused as described above.

Compatibility and Stability

Ciprofloxacina Azevedos Injection 1% (10 mg/mL), when diluted with the following intravenous solutions to concentrations of 0.5 to 2.0 mg/mL, is stable for up to 14 days at refrigerated or room temperature storage.

  • 0.9% Sodium Chloride Injection, USP
  • 5% Dextrose Injection, USP
  • Sterile Water for Injection
  • 10% Dextrose for Injection
  • 5% Dextrose and 0.225% Sodium Chloride for Injection
  • 5% Dextrose and 0.45% Sodium Chloride for Injection
  • Lactated Ringer’s for Injection

Ciprofloxacina Azevedos precautions

General

Crystals of Ciprofloxacina Azevedos have been observed rarely in the urine of human subjects but more frequently in the urine of laboratory animals, which is usually alkaline. Crystalluria related to Ciprofloxacina Azevedos has been reported only rarely in humans because human urine is usually acidic. Alkalinity of the urine should be avoided in patients receiving Ciprofloxacina Azevedos. Patients should be well hydrated to prevent the formation of highly concentrated urine.

Central Nervous System

Quinolones, including Ciprofloxacina Azevedos, may also cause central nervous system (CNS) events, including: nervousness, agitation, insomnia, anxiety, nightmares or paranoia.

Renal Impairment

Alteration of the dosage regimen is necessary for patients with impairment of renal function..

Photosensitivity/Phototoxicity

Moderate to severe photosensitivity/phototoxicity reactions, the latter of which may manifest as exaggerated sunburn reactions (for example, burning, erythema, exudation, vesicles, blistering, edema) involving areas exposed to light (typically the face, "V" area of the neck, extensor surfaces of the forearms, dorsa of the hands), can be associated with the use of quinolones after sun or UV light exposure. Therefore, excessive exposure to these sources of light should be avoided. Drug therapy should be discontinued if phototoxicity occurs (see.

As with any potent drug, periodic assessment of organ system functions, including renal, hepatic, and hematopoietic function, is advisable during prolonged therapy.

Prescribing Ciprofloxacina Azevedos for oral suspension in the absence of a proven or strongly suspected bacterial infection or a prophylactic indication is unlikely to provide benefit to the patient and increases the risk of the development of drug-resistant bacteria.

Information for Patients

Patients should be advised:

  • To contact their healthcare provider if they experience pain, swelling, or inflammation of a tendon, or weakness or inability to use one of their joints; rest and refrain from exercise; and discontinue Ciprofloxacina Azevedos treatment. The risk of severe tendon disorder with fluoroquinolones is higher in older patients usually over 60 years of age, in patients taking corticosteroid drugs, and in patients with kidney, heart or lung transplants.
  • That fluoroquinolones like Ciprofloxacina Azevedos may cause worsening of myasthenia gravis symptoms, including muscle weakness and breathing problems. Patients should call their healthcare provider right away if they have any worsening muscle weakness or breathing problems.
  • That antibacterial drugs including Ciprofloxacina Azevedos for oral suspension should only be used to treat bacterial infections. They do not treat viral infections (for example, the common cold). When Ciprofloxacina Azevedos for oral suspension is prescribed to treat a bacterial infection, patients should be told that although it is common to feel better early in the course of therapy, the medication should be taken exactly as directed. Skipping doses or not completing the full course of therapy may (1) decrease the effectiveness of the immediate treatment and (2) increase the likelihood that bacteria will develop resistance and will not be treatable by Ciprofloxacina Azevedos for oral suspension or other antibacterial drugs in the future.
  • That Ciprofloxacina Azevedos may be taken with or without meals and to drink fluids liberally. As with other quinolones, concurrent administration of Ciprofloxacina Azevedos with magnesium/aluminum antacids, polymeric phosphate binders (for example, sevelamer, lanthanum carbonate) or sucralfate, Videx® (didanosine) chewable/buffered tablets or pediatric powder, other highly buffered drugs, or with other products containing calcium, iron or zinc should be avoided. Ciprofloxacina Azevedos may be taken two hours before or six hours after taking these products. Ciprofloxacina Azevedos should not be taken with dairy products (like milk or yogurt) or calcium-fortified juices alone since absorption of Ciprofloxacina Azevedos may be significantly reduced; however, Ciprofloxacina Azevedos may be taken with a meal that contains these products.
  • That Ciprofloxacina Azevedos may be associated with hypersensitivity reactions, even following a single dose, and to discontinue the drug at the first sign of a skin rash or other allergic reaction.
  • That photosensitivity/phototoxicity has been reported in patients receiving quinolones. Patients should minimize or avoid exposure to natural or artificial sunlight (tanning beds or UVA/B treatment) while taking quinolones. If patients need to be outdoors while using quinolones, they should wear loose-fitting clothes that protect skin from sun exposure and discuss other sun protection measures with their physician. If a sunburn-like reaction or skin eruption occurs, patients should contact their physician.
  • That peripheral neuropathies have been associated with Ciprofloxacina Azevedos use, that symptoms may occur soon after initiation of therapy and may be irreversible. If symptoms of peripheral neuropathy including pain, burning, tingling, numbness and/or weakness develop, patients should immediately discontinue Ciprofloxacina Azevedos for oral suspension and contact their physician.
  • That Ciprofloxacina Azevedos may cause dizziness and lightheadedness; therefore, patients should know how they react to this drug before they operate an automobile or machinery or engage in activities requiring mental alertness or coordination.
  • That Ciprofloxacina Azevedos increases the effects of tizanidine (Zanaflex®). Patients should not use Ciprofloxacina Azevedos if they are already taking tizanidine.
  • That Ciprofloxacina Azevedos may increase the effects of theophylline and caffeine. There is a possibility of caffeine accumulation when products containing caffeine are consumed while taking quinolones.
  • That convulsions have been reported in patients receiving quinolones, including Ciprofloxacina Azevedos, and to notify their physician before taking this drug if there is a history of this condition.
  • That Ciprofloxacina Azevedos has been associated with an increased rate of adverse events involving joints and surrounding tissue structures (like tendons) in pediatric patients (less than 18 years of age). Parents should inform their child's physician if the child has a history of joint-related problems before taking this drug. Parents of pediatric patients should also notify their child's physician of any joint-related problems that occur during or following Ciprofloxacina Azevedos therapy..
  • That diarrhea is a common problem caused by antibiotics which usually ends when the antibiotic is discontinued. Sometimes after starting treatment with antibiotics, patients can develop watery and bloody stools (with or without stomach cramps and fever) even as late as two or more months after having taken the last dose of the antibiotic. If this occurs, patients should contact their physician as soon as possible.

Drug Interactions

Tizanidine

In a pharmacokinetic study, systemic exposure of tizanidine (4 mg single dose) was significantly increased (Cmax 7-fold, AUC 10-fold) when the drug was given concomitantly with Ciprofloxacina Azevedos (500 mg BID for 3 days). The hypotensive and sedative effects of tizanidine were also potentiated. Concomitant administration of tizanidine and Ciprofloxacina Azevedos is contraindicated.

Theophylline

As with some other quinolones, concurrent administration of Ciprofloxacina Azevedos with theophylline may lead to elevated serum concentrations of theophylline and prolongation of its elimination half-life. This may result in increased risk of theophylline-related adverse reactions. If concomitant use cannot be avoided, serum levels of theophylline should be monitored and dosage adjustments made as appropriate.

Other Xanthine Derivatives

Some quinolones, including Ciprofloxacina Azevedos, have also been shown to interfere with the metabolism of caffeine. This may lead to reduced clearance of caffeine and a prolongation of its serum half-life. On concurrent administration of Ciprofloxacina Azevedos and caffeine or pentoxifylline containing products, elevated serum concentrations of these xanthine derivatives were reported.

Chelation Complex Formation

Concurrent administration of a quinolone, including Ciprofloxacina Azevedos, with multivalent cation-containing products such as magnesium/aluminum antacids, polymeric phosphate binders (for example. sevelamer, lanthanum carbonate) sucralfate, Videx® (didanosine) chewable/buffered tablets or pediatric powder, other highly buffered drugs, or products containing calcium, iron, or zinc may substantially decrease its absorption, resulting in serum and urine levels considerably lower than desired.

Histamine H2-receptor antagonists appear to have no significant effect on the bioavailability of Ciprofloxacina Azevedos.

Omeprazole

Concomitant administration of a single tablet dose of 500 mg Ciprofloxacina Azevedos and once-daily administration of 20 mg omeprazole pretreatment for 4 days resulted in a 16%reduction of mean Cmax and mean AUC of Ciprofloxacina Azevedos

Phenytoin

Altered serum levels of phenytoin (increased and decreased) have been reported in patients receiving concomitant Ciprofloxacina Azevedos. To avoid the loss of seizure control associated with decreased phenytoin levels, and to prevent phenytoin overdose-related undesirable effects when Ciprofloxacina Azevedos is discontinued in patients receiving both agents, monitoring of phenytoin therapy, including phenytoin serum concentration measurements, is recommended during and shortly after co-administration of Ciprofloxacina Azevedos with phenytoin.

Oral Antidiabetic Agents

Hypoglycemia has been reported when Ciprofloxacina Azevedos and oral antidiabetic agents, mainly sulfonylureas (for example, glyburide, glimepiride), were co-administered, presumably by intensifying the action of the oral antidiabetic agent. The concomitant administration of Ciprofloxacina Azevedos with glyburide has, on rare occasions, resulted in severe hypoglycemia. Fatalities have been reported.

Metronidazole

The serum concentrations of Ciprofloxacina Azevedos and metronidazole were not altered when these two drugs were given concomitantly.

Cyclosporine

Some quinolones, including Ciprofloxacina Azevedos, have been associated with transient elevations in serum creatinine in patients receiving cyclosporine concomitantly.

Oral Anti-coagulants

Simultaneous administration of Ciprofloxacina Azevedos with an oral anticoagulant may augment the effect of the anticoagulant. The risk may vary with the underlying infection, age and general status of the patient so that the contribution of Ciprofloxacina Azevedos to the increase in INR (international normalized ratio) is difficult to assess. Prothrombin time and INR should be monitored frequently during and shortly after co-administration of Ciprofloxacina Azevedos with an oral anticoagulant (for example, warfarin).

Probenecid

Probenecid interferes with renal tubular secretion of Ciprofloxacina Azevedos and produces an increase in the level of Ciprofloxacina Azevedos in the serum. This should be considered if patients are receiving both drugs concomitantly.

Methotrexate

Renal tubular transport of methotrexate may be inhibited by concomitant administration of Ciprofloxacina Azevedos potentially leading to increased plasma levels of methotrexate. This might increase the risk of methotrexate associated toxic reactions. Therefore, patients under methotrexate therapy should be carefully monitored when concomitant Ciprofloxacina Azevedos therapy is indicated.

Metoclopramide

Metoclopramide significantly accelerates the absorption of oral Ciprofloxacina Azevedos resulting in shorter time to reach maximum plasma concentrations. No significant effect was observed on the bioavailability of Ciprofloxacina Azevedos.

Duloxetine

In clinical studies it was demonstrated that concomitant use of duloxetine with strong inhibitors of the CYP450 1A2 isozyme such as fluvoxamine, may result in a 5-fold increase in mean AUC and a 2.5-fold increase in mean Cmax of duloxetine. Although no clinical data are available on a possible interaction with Ciprofloxacina Azevedos, similar effects can be expected upon concomitant administration.

NSAIDs

Non-steroidal anti-inflammatory drugs (but not acetyl salicylic acid) in combination of very high doses of quinolones have been shown to provoke convulsions in pre-clinical studies.

Ropinirole

In a study conducted in 12 patients with Parkinson's disease who were administered 6 mg ropinirole once daily with 500 mg Ciprofloxacina Azevedos twice-daily, the mean Cmax and mean AUC of ropinirole were increased by 60% and 84%, respectively. Monitoring for ropinirole-related side effects and appropriate dose adjustment of ropinirole is recommended during and shortly after co-administration with Ciprofloxacina Azevedos.

Lidocaine

In a study conducted in 9 healthy volunteers, concomitant use of 1.5 mg/kg IV lidocaine with 500 mg Ciprofloxacina Azevedos twice daily, resulted in an increase of lidocaine Cmax and AUC by 12% and 26%, respectively. Although lidocaine treatment was well tolerated at this elevated exposure, a possible interaction with Ciprofloxacina Azevedos and an increase in side effects related to lidocaine may occur upon concomitant administration.

Clozapine

Following concomitant administration of 250 mg Ciprofloxacina Azevedos with 304 mg clozapine for 7 days, serum concentrations of clozapine and N-desmethylclozapine were increased by 29% and 31%, respectively. Careful monitoring of clozapine associated adverse effects and appropriate adjustment of clozapine dosage during and shortly after co-administration with Ciprofloxacina Azevedos are advised..

Sildenafil

Following concomitant administration of a single oral dose of 50 mg sildenafil with 500 mg Ciprofloxacina Azevedos to healthy subjects, the mean Cmax and mean AUC of sildenafil were both increased approximately two-fold. Therefore, sildenafil should be used with caution when co-administered with Ciprofloxacina Azevedos.

Drugs Known To Prolong QT Interval

Precaution should be taken when using Ciprofloxacina Azevedos concomitantly with drugs known to prolong the QT interval (for example, class IA or III antiarrhythmics, tricyclic antidepressants, macrolides, antipsychotics) as Ciprofloxacina Azevedos may have an additive effect on the QT interval.

CARCINOGENESIS, MUTAGENESIS & IMPAIRMENT OF FERTILITY

Eight in vitro mutagenicity tests have been conducted with Ciprofloxacina Azevedos, and the test results are listed below:

Salmonella/Microsome Test (Negative)

E. coli DNA Repair Assay (Negative)

Mouse Lymphoma Cell Forward Mutation Assay (Positive)

Chinese Hamster V79 Cell HGPRT Test (Negative)

Syrian Hamster Embryo Cell Transformation Assay (Negative)

Saccharomyces cerevisiae Point Mutation Assay (Negative)

Saccharomyces cerevisiae Mitotic Crossover and Gene Conversion Assay (Negative)

Rat Hepatocyte DNA Repair Assay (Positive)

Thus, 2 of the 8 tests were positive, but results of the following 3 in vivo test systems gave negative results:

Rat Hepatocyte DNA Repair Assay

Micronucleus Test (Mice)

Dominant Lethal Test (Mice)

Long-term carcinogenicity studies in rats and mice resulted in no carcinogenic or tumorigenic effects due to Ciprofloxacina Azevedos at daily oral dose levels up to 250 and 750 mg/kg to rats and mice, respectively (approximately 1.7- and 2.5- times the highest recommended therapeutic dose based upon mg/m2).

Results from photo co-carcinogenicity testing indicate that Ciprofloxacina Azevedos does not reduce the time to appearance of UV-induced skin tumors as compared to vehicle control. Hairless (Skh-1) mice were exposed to UVA light for 3.5 hours five times every two weeks for up to 78 weeks while concurrently being administered Ciprofloxacina Azevedos. The time to development of the first skin tumors was 50 weeks in mice treated concomitantly with UVA and Ciprofloxacina Azevedos (mouse dose approximately equal to maximum recommended human dose based upon mg/m2), as opposed to 34 weeks when animals were treated with both UVA and vehicle. The times to development of skin tumors ranged from 16 to 32 weeks in mice treated concomitantly with UVA and other quinolones.5

In this model, mice treated with Ciprofloxacina Azevedos alone did not develop skin or systemic tumors. There are no data from similar models using pigmented mice and/or fully haired mice. The clinical significance of these findings to humans is unknown.

Fertility studies performed in rats at oral doses of Ciprofloxacina Azevedos up to 100 mg/kg (approximately 0.7-times the highest recommended therapeutic dose based upon mg/m2) revealed no evidence of impairment.

Pregnancy

Teratogenic Effects. Pregnancy Category C

There are no adequate and well-controlled studies in pregnant women. Ciprofloxacina Azevedos should not be used during pregnancy unless the potential benefit justifies the potential risk to both fetus and mother. An expert review of published data on experiences with Ciprofloxacina Azevedos use during pregnancy by TERIS – the Teratogen Information System – concluded that therapeutic doses during pregnancy are unlikely to pose a substantial teratogenic risk (quantity and quality of data=fair), but the data are insufficient to state that there is no risk.9

A controlled prospective observational study followed 200 women exposed to fluoroquinolones (52.5% exposed to Ciprofloxacina Azevedos and 68% first trimester exposures) during gestation.10 In utero exposure to fluoroquinolones during embryogenesis was not associated with increased risk of major malformations. The reported rates of major congenital malformations were 2.2% for the fluoroquinolone group and 2.6% for the control group (background incidence of major malformations is 1 to 5%). Rates of spontaneous abortions, prematurity and low birth weight did not differ between the groups and there were no clinically significant musculoskeletal dysfunctions up to one year of age in the Ciprofloxacina Azevedos exposed children.

Another prospective follow-up study reported on 549 pregnancies with fluoroquinolone exposure (93% first trimester exposures).11 There were 70 Ciprofloxacina Azevedos exposures, all within the first trimester. The malformation rates among live-born babies exposed to Ciprofloxacina Azevedos and to fluoroquinolones overall were both within background incidence ranges. No specific patterns of congenital abnormalities were found. The study did not reveal any clear adverse reactions due to in utero exposure to Ciprofloxacina Azevedos.

No differences in the rates of prematurity, spontaneous abortions, or birth weight were seen in women exposed to Ciprofloxacina Azevedos during pregnancy.9,10 However, these small postmarketing epidemiology studies, of which most experience is from short term, first trimester exposure, are insufficient to evaluate the risk for less common defects or to permit reliable and definitive conclusions regarding the safety of Ciprofloxacina Azevedos in pregnant women and their developing fetuses. Reproduction studies have been performed in rats and mice using oral doses up to 100 mg/kg (0.6 and 0.3 times the maximum daily human dose based upon body surface area, respectively) and have revealed no evidence of harm to the fetus due to Ciprofloxacina Azevedos. In rabbits, oral Ciprofloxacina Azevedos dose levels of 30 and 100 mg/kg (approximately 0.4- and 1.3-times the highest recommended therapeutic dose based upon mg/m2) produced gastrointestinal toxicity resulting in maternal weight loss and an increased incidence of abortion, but no teratogenicity was observed at either dose level. After intravenous administration of doses up to 20 mg/kg (approximately 0.3-times the highest recommended therapeutic dose based upon mg/m2) no maternal toxicity was produced and no embryotoxicity or teratogenicity was observed.

Nursing Mothers

Ciprofloxacina Azevedos is excreted in human milk. The amount of Ciprofloxacina Azevedos absorbed by the nursing infant is unknown. Because of the potential risk of serious adverse reactions (including articular damage) in infants nursing from mothers taking Ciprofloxacina Azevedos, a decision should be made whether to discontinue nursing or to discontinue the drug, taking into account the importance of the drug to the mother.

Pediatric Use

Ciprofloxacina Azevedos, like other quinolones, causes arthropathy and histological changes in weight-bearing joints of juvenile animals resulting in lameness.

Inhalational Anthrax (Post-Exposure)

Ciprofloxacina Azevedos is indicated in pediatric patients for inhalational anthrax (post-exposure). The risk-benefit assessment indicates that administration of Ciprofloxacina Azevedos to pediatric patients is appropriate. For information regarding pediatric dosing in inhalational anthrax (post-exposure), see and.

Complicated Urinary Tract Infection and Pyelonephritis

Ciprofloxacina Azevedos is indicated for the treatment of complicated urinary tract infections and pyelonephritis due to Escherichia coli. Although effective in clinical trials, Ciprofloxacina Azevedos is not a drug of first choice in the pediatric population due to an increased incidence of adverse events compared to the controls, including events related to joints and/or surrounding tissues. The rates of these events in pediatric patients with complicated urinary tract infection and pyelonephritis within six weeks of follow-up were 9.3% (31/335) versus 6% (21/349) for control agents. The rates of these events occurring at any time up to the one year follow-up were 13.7% (46/335) and 9.5% (33/349), respectively. The rate of all adverse events regardless of drug relationship at six weeks was 41% (138/335) in the Ciprofloxacina Azevedos arm compared to 31% (109/349) in the control arm.

Cystic Fibrosis

Short-term safety data from a single trial in pediatric cystic fibrosis patients are available. In a randomized, double-blind clinical trial for the treatment of acute pulmonary exacerbations in cystic fibrosis patients (ages 5-17 years), 67 patients received Ciprofloxacina Azevedos IV 10 mg/kg/dose q8h for one week followed by Ciprofloxacina Azevedos tablets 20 mg/kg/dose q12h to complete 10-21 days treatment and 62 patients received the combination of ceftazidime IV 50 mg/kg/dose q8h and tobramycin IV 3 mg/kg/dose q8h for a total of 10-21 days. Patients less than 5 years of age were not studied. Safety monitoring in the study included periodic range of motion examinations and gait assessments by treatment-blinded examiners. Patients were followed for an average of 23 days after completing treatment (range 0-93 days). This study was not designed to determine long term effects and the safety of repeated exposure to Ciprofloxacina Azevedos.

Musculoskeletal adverse events in patients with cystic fibrosis were reported in 22% of the patients in the Ciprofloxacina Azevedos group and 21% in the comparison group. Decreased range of motion was reported in 12% of the subjects in the Ciprofloxacina Azevedos group and 16% in the comparison group. Arthralgia was reported in 10% of the patients in the Ciprofloxacina Azevedos group and 11% in the comparison group. Other adverse events were similar in nature and frequency between treatment arms. One of sixty-seven patients developed arthritis of the knee nine days after a ten day course of treatment with Ciprofloxacina Azevedos. Clinical symptoms resolved, but an MRI showed knee effusion without other abnormalities eight months after treatment. However, the relationship of this event to the patient's course of Ciprofloxacina Azevedos can not be definitively determined, particularly since patients with cystic fibrosis may develop arthralgias/arthritis as part of their underlying disease process.

Geriatric Use

Geriatric patients are at increased risk for developing severe tendon disorders including tendon rupture when being treated with a fluoroquinolone such as Ciprofloxacina Azevedos. This risk is further increased in patients receiving concomitant corticosteroid therapy. Tendinitis or tendon rupture can involve the Achilles, hand, shoulder, or other tendon sites and can occur during or after completion of therapy; cases occurring up to several months after fluoroquinolone treatment have been reported. Caution should be used when prescribing Ciprofloxacina Azevedos to elderly patients especially those on corticosteroids. Patients should be informed of this potential side effect and advised to discontinue Ciprofloxacina Azevedos and contact their healthcare provider if any symptoms of tendinitis or tendon rupture occur.

In a retrospective analysis of 23 multiple-dose controlled clinical trials of Ciprofloxacina Azevedos encompassing over 3500 Ciprofloxacina Azevedos treated patients, 25% of patients were greater than or equal to 65 years of age and 10% were greater than or equal to 75 years of age. No overall differences in safety or effectiveness were observed between these subjects and younger subjects, and other reported clinical experience has not identified differences in responses between the elderly and younger patients, but greater sensitivity of some older individuals on any drug therapy cannot be ruled out. Ciprofloxacina Azevedos is known to be substantially excreted by the kidney, and the risk of adverse reactions may be greater in patients with impaired renal function. No alteration of dosage is necessary for patients greater than 65 years of age with normal renal function. However, since some older individuals experience reduced renal function by virtue of their advanced age, care should be taken in dose selection for elderly patients, and renal function monitoring may be useful in these patients.

In general, elderly patients may be more susceptible to drug-associated effects on the QT interval. Therefore, precaution should be taken when using Ciprofloxacina Azevedos with concomitant drugs that can result in prolongation of the QT interval (for example, class IA or class III antiarrhythmics) or in patients with risk factors for torsade de pointes (for example, known QT prolongation, uncorrected hypokalemia)..



Active ingredient matches for Ciprofloxacina Azevedos:

Ciprofloxacin in Portugal.


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References

  1. DailyMed. "CIPROFLOXACIN; DEXAMETHASONE: DailyMed provides trustworthy information about marketed drugs in the United States. DailyMed is the official provider of FDA label information (package inserts).". https://dailymed.nlm.nih.gov/dailyme... (accessed September 17, 2018).
  2. PubChem. "ciprofloxacin". https://pubchem.ncbi.nlm.nih.gov/com... (accessed September 17, 2018).
  3. DrugBank. "ciprofloxacin". http://www.drugbank.ca/drugs/DB00537 (accessed September 17, 2018).
  4. DTP/NCI. "ciprofloxacin: The NCI Development Therapeutics Program (DTP) provides services and resources to the academic and private-sector research communities worldwide to facilitate the discovery and development of new cancer therapeutic agents.". https://dtp.cancer.gov/dtpstandard/s... (accessed September 17, 2018).
  5. Wikipedia. "ciprofloxacin: Link to the compound information in Wikipedia.". https://en.wikipedia.org/wiki/Ciprof... (accessed September 17, 2018).

Reviews

The results of a survey conducted on ndrugs.com for Ciprofloxacina Azevedos are given in detail below. The results of the survey conducted are based on the impressions and views of the website users and consumers taking Ciprofloxacina Azevedos. We implore you to kindly base your medical condition or therapeutic choices on the result or test conducted by a physician or licensed medical practitioners.

User reports

3 consumers reported time for results

To what extent do I have to use Ciprofloxacina Azevedos before I begin to see changes in my health conditions?
As part of the reports released by ndrugs.com website users, it takes 1 day and a few days before you notice an improvement in your health conditions.
Please note, it doesn't mean you will start to notice such health improvement in the same time frame as other users. There are many factors to consider, and we implore you to visit your doctor to know how long before you can see improvements in your health while taking Ciprofloxacina Azevedos. To get the time effectiveness of using Ciprofloxacina Azevedos drug by other patients, please click here.
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66.7%
2 weeks1
33.3%

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