Gastrointestinal disturbances include nausea, vomiting, diarrhoea, abdominal pain, and dyspepsia are the most frequent adverse effects. Pseudomembranous colitis, pancreatitis, and dysphagia have been reported rarely.
Headache, dizziness, and restlessness are among the commonest effects on the CNS. Others include tremor, drowsiness, nightmares, visual and other sensory disturbances, hallucinations, psychotic reactions, depression, convulsions, and intracranial hypertension. Paresthesia and peripheral neuropathy have been reported.
In addition to rash and pruritus, hypersensitivity type reactions affecting the skin have included, rarely, vasculitis, erythema multiforme, Stevens Johnson syndrome, and toxic epidermal necrolysis. Photosensitivity has occurred, and may be more frequent with some newer fluoroquinolones such as lomefloxacin and sparfloxacin. Anaphylaxis has been reported. As with other quinolone antibacterials reversible arthralgia has sometimes occurred and joint erosions have been documented in immature animals. Tendon damage has been reported.
Other adverse effects reported with ciprofloxacin include crystalluria, transient increases in serum creatinine or blood urea nitrogen and, rarely, acute renal failure secondary to interstitial nephritis. Elevated liver enzyme values, jaundice, and hepatitis; haematological disturbances including eosinophilia, leucopenia, thrombocytopenia and very rarely, haemolytic anemia or agranulocytosis. Cardiovascular adverse effects include tachycardia, hypotension, oedema, syncope, hot flushes, and sweating. Some fluoroquinolones may rarely cause prolongation of the QT interval and ventricular arrhythmias, including torsade de pointes. As with other antibacterials, superinfection with organisms not very susceptible to ciprofloxacin is possible. Such organisms include Candida
, Clostridium difficile
, and Streptococcus pneumoniae
. There is some evidence that fluoroquinolones use may be associated with an increased risk of colonisation by MRSA.
Pain and irritation also occur at the site of infusion accompanied rarely by phlebitis or thrombophlebitis. Adverse effects reported after ocular use of ciprofloxacin include local burning or discomfort, keratopathy, corneal staining, corneal precipitates or infiltrates and photophobia.