Nivoflox (Ciprofloxacin Hydrochloride Monohydrate)

• Ciprofloxacin is a fluoroquinolone antibiotic used to treat infections caused by susceptible bacteria in several organ systems.
• Urinary tract infections: effective in eradicating common uropathogens and relieving symptoms.
• Respiratory tract infections: treats community‑acquired pneumonia and acute exacerbations of chronic bronchitis caused by susceptible strains.
• Skin and soft tissue infections: resolves cellulitis, wound infections and abscesses due to susceptible organisms.
• Gastrointestinal infections: used for travel‑related diarrhoea and other bacterial GI infections.

• Ciprofloxacin inhibits bacterial DNA gyrase (topoisomerase II) and topoisomerase IV, enzymes essential for DNA replication, transcription and repair. By stabilising the DNA‑enzyme complex, it prevents the resealing of DNA strands, leading to bacterial cell death and a bactericidal effect against a broad spectrum of Gram‑negative and some Gram‑positive organisms.

Ciprofloxacin may cause a range of adverse reactions, from mild to severe.

Common Side Effects

• Nausea
• Diarrhoea
• Abdominal pain
• Headache
• Dizziness
• Rash

Serious or Rare Side Effects

• Tendon rupture or tendinitis
• Peripheral neuropathy
• Clostridioides difficile‑associated diarrhoea
• Severe allergic reactions (anaphylaxis)
• QT interval prolongation
• Hepatic dysfunction

• Ciprofloxacin requires careful use in specific patient groups and conditions.
• Assess renal function: adjust dose in impaired clearance.
• Monitor for tendon pain: discontinue if signs of tendonitis or rupture appear.
• Evaluate for QT prolongation: avoid in patients with known cardiac arrhythmias.
• Avoid use in children and pregnant women unless benefits outweigh risks.
• Review concomitant medications: consider interactions with antacids, warfarin, corticosteroids, and others.
• Store at room temperature: keep in the original container, protect from moisture and light.

Ciprofloxacin interacts with several medicines; some combinations should be avoided while others need close monitoring.

Major Interactions (Avoid)

• Antacids containing aluminum or magnesium: reduce ciprofloxacin absorption.
• Warfarin: increase anticoagulant effect, monitor INR closely.
• Theophylline: raise serum levels, risk toxicity.
• Cyclosporine: increase levels, monitor renal function.
• Non‑steroidal anti‑inflammatory drugs (NSAIDs): heightened risk of central nervous system stimulation.

Moderate Interactions (Monitor Closely)

• Diuretics (e.g., furosemide): may increase risk of hypoglycaemia.
• Oral contraceptives: reduced efficacy, advise backup contraception.
• Corticosteroids: increased risk of tendon rupture.
• Antidiabetic agents: enhanced hypoglycaemic effect.
• HIV protease inhibitors: may alter ciprofloxacin plasma concentrations.