Ciplox 500: Uses, Benefits, Dosage and Side Effects

Ciplox 500 is an antibiotic tablet that contains ciprofloxacin 500 mg. It is used in adults to treat certain bacterial infections, including infections of the urinary tract, chest, sinuses, skin, and some stomach and genital infections. Ciprofloxacin belongs to a group of antibiotics called fluoroquinolones.

Ciplox 500 is not suitable for every type of infection. Due to the risk of serious side effects, doctors usually prescribe it only when other antibiotics may not be suitable. Take Ciplox 500 only as prescribed by your doctor and complete the full course.

Ciplox 500 is an antibiotic tablet that contains ciprofloxacin 500 mg. It helps treat infections caused by bacteria.

Ciplox tablets are available in three strengths:

• Ciplox 250 - 250 mg
• Ciplox 500 - 500 mg
• Ciplox 750 - 750 mg

This article is about Ciplox 500. The tablet is usually white or light yellow and oval-shaped. Its appearance may vary depending on the manufacturer, so always check the name and strength on the pack.

Ciplox 500 is a prescription medicine in India. Take it only if it has been prescribed by your doctor.

Ciprofloxacin blocks two enzymes inside bacteria: DNA gyrase (a type II topoisomerase) and topoisomerase IV. Bacteria need these enzymes to copy, repair and recombine their DNA. With both blocked, the bacteria cannot copy their DNA or divide, and they die. As the bacteria are killed, the infection clears.

Ciprofloxacin binds these two bacterial enzymes far more strongly than the similar enzymes in human cells, so it harms the bacteria and not your own cells. Viruses do not have these enzymes and are not affected by the medicine at all.

Ciplox 500 is used to treat bacterial infections in adults, when a doctor has decided that a fluoroquinolone is the right choice. Common examples include:

• Urinary tract infections, including bladder infections (cystitis) and kidney infections (pyelonephritis)
• Chest infections, including pneumonia and flare-ups of chronic bronchitis
• Sinus and ear infections, including long-standing or recurring ones
• Skin and soft tissue infections caused by Gram-negative bacteria
• Bone and joint infections
• Gut infections, including travellers' diarrhoea and cholera, and — only when testing shows the strain is susceptible — typhoid fever
• Genital infections such as gonorrhoea, and prostate infection (prostatitis)
• Infections inside the abdomen
• Fever in people with a very low white blood cell count, usually alongside another antibiotic
• To prevent meningococcal infection in close contacts of a case, and after exposure to anthrax

In children and adolescents it is used only under specialist supervision, and only for a few specific serious infections such as lung infections in cystic fibrosis and complicated urinary tract infections.

Typhoid fever in India

Typhoid fever is no longer treated with ciprofloxacin first in India. Quinolone resistance in Salmonella Typhi is high — about 69% in national data from 2017 — so doctors usually choose ceftriaxone, azithromycin or co-trimoxazole instead. Ciprofloxacin is used only when testing shows that the strain is still susceptible.

What Ciplox 500 is not for

• Viral illnesses. Colds, flu and most sore throats are not treated with antibiotics.
• Mild infections that are likely to settle on their own.
• Non-bacterial prostatitis, or infections caused by fungi.
• Preventing travellers' diarrhoea or repeated urine infections.

In the European Union, fluoroquinolone antibiotics were restricted in 2018 after a review of disabling and potentially long-lasting side effects. The European Medicines Agency said they should not be used for infections that might get better without treatment or are not severe, for non-bacterial infections, for preventing travellers' diarrhoea or recurring urine infections, or for mild to moderate bacterial infections unless other commonly recommended antibacterials cannot be used.

Ciplox 500 does not relieve symptoms by itself. Its benefit is that it kills the bacteria causing the infection, when that infection is one ciprofloxacin can treat.

• It acts against a wide range of bacteria, including several that cause urine, gut and chest infections, so it can be used when the exact germ is not yet known.
• It reaches concentrations in the urinary tract, prostate, lung and sinuses that are higher than in the blood, which is why it is used for urinary and prostate infections.
• It can be taken by mouth, so many people who would otherwise need injections can be treated at home.
• It comes in more than one strength and several dose schedules, which lets a doctor match treatment to the infection and to how well your kidneys are working.

What it does not do is work instantly. Most people start to feel better within the first few days, but the full course still has to be completed.

The usual adult dose of Ciplox 500 is one 500 mg tablet twice a day, about 12 hours apart. But the exact dose and how long you take it depend on the infection, how severe it is and how well your kidneys are working — so follow the prescription on your pack rather than a general rule.

Typical adult doses for some common infections are shown below. Your own prescription may differ.

• Simple bladder infection (cystitis); Usual adult dose: 250 mg twice a day; Typical duration: 3 days

• Kidney infection and other urinary tract infections; Usual adult dose: 250–500 mg twice a day; Typical duration: 7 to 14 days

• Chest infection (lower respiratory tract); Usual adult dose: 500–750 mg twice a day; Typical duration: 7 to 14 days

• Acute sinus infection; Usual adult dose: 500 mg twice a day; Typical duration: 10 days
• Skin and soft tissue infection; Usual adult dose: 500–750 mg twice a day; Typical duration: 7 to 14 days
• Bone and joint infection; Usual adult dose: 500–750 mg twice a day; Typical duration: 4 to 8 weeks
• Gut infection (infectious diarrhoea); Usual adult dose: 500 mg twice a day; Typical duration: 5 to 7 days
• Typhoid fever; Usual adult dose: 750 mg twice a day, and only if the strain is susceptible (see the note above); Typical duration: 10 to 14 days
• Gonorrhoea; Usual adult dose: 500 mg as a single dose, only for a strain known to be susceptible; Typical duration: one day
• Prostate infection (prostatitis); Usual adult dose: 500 mg twice a day; Typical duration: 28 days
• Infection inside the abdomen; Usual adult dose: 500 mg twice a day, together with another antibiotic; Typical duration: 7 to 14 days

Two things to keep in mind about this table.

• Doses can differ between countries and between hospitals. What is written on your own prescription is what applies to you.
• For gonorrhoea, ciprofloxacin is used only when the infection is known to be caused by a strain that is still susceptible. Resistance is now common, so your doctor may choose a different antibiotic.

Timing and food

• Take the tablets at about the same times each day, roughly 12 hours apart.
• You can take them with or without food. If they upset your stomach, taking a dose after a meal often helps.
• Swallow the tablet whole with plenty of water. Do not chew or crush it. The tablet is scored, so it can be broken in half along the line if your doctor asks you to. If you cannot swallow tablets, tell your doctor — another form may suit you better.
• You can take Ciplox 500 with a meal that contains milk, yoghurt or calcium-fortified drinks. Do not take the tablet with those on their own, without food.
• Keep antacids, and calcium, iron, zinc, magnesium or aluminium supplements, at least 2 hours before, and 4 to 6 hours after, your dose (different labels give 4 hours and 6 hours). Taken together, they stop the antibiotic being absorbed properly.
• Drink plenty of water while you are taking it.
• Limit coffee, strong tea, cola, energy drinks and chocolate. Ciprofloxacin makes caffeine stay in the body longer and can cause jitteriness, a racing heartbeat and trouble sleeping.

If your kidneys are not working well

The dose or the gap between doses is reduced when kidney function is impaired. It is often reduced to 250-500 mg every 12 hours, every 18 hours, or once a day, depending on how much kidney function is left (once a day if you are on dialysis). This is worked out from your kidney function tests. Never adjust it yourself.

Do not stop the course early

Finish the whole course even if you feel better after two or three days. Stopping early can leave the infection partly treated and bring the symptoms back.

If you miss a dose

If your next dose is 6 hours away or more, take the missed dose as soon as you remember and then carry on as usual. If your next dose is less than 6 hours away, skip the missed dose and take only the next one at its normal time. Never take two doses together to catch up.

Do not take Ciplox 500 if either of these applies to you.

• You are allergic to ciprofloxacin, to any other quinolone antibiotic, or to any ingredient in the tablet.
• You are taking tizanidine, a muscle relaxant. These two medicines must not be taken together.

Tell your doctor before you start if any of the following apply to you.

• You have ever had a serious reaction to a quinolone or fluoroquinolone antibiotic.
• You have had tendon problems, or a tendon injury during an earlier course of these antibiotics.
• You are over 60, which on its own raises the risk of tendon injury.
• You have had a kidney, heart or lung transplant.
• You have kidney disease — your dose may need adjusting.
• You have liver disease. No change in dose is usually needed, but tell your doctor, and report jaundice, dark urine, itching or abdominal tenderness during treatment.
• You have myasthenia gravis. Ciprofloxacin can make muscle weakness worse and, rarely, cause serious breathing difficulty.
• You have epilepsy or another neurological condition.
• You have glucose-6-phosphate dehydrogenase (G6PD) deficiency — a blood disorder some Indian families carry. Ciprofloxacin can occasionally cause red blood cells to break down in people with this condition.
• You have diabetes. Ciprofloxacin can make blood sugar fall or rise, especially if you take insulin or a sulfonylurea such as glibenclamide. Check your sugars more often.
• You have a heart rhythm problem, a long QT interval, low potassium or magnesium, or you take other medicines that affect heart rhythm.
• You have an aortic aneurysm or a previous aortic dissection, a heart valve problem, or a family history of these, or you have Marfan syndrome or Ehlers-Danlos syndrome.
• You are pregnant, planning a pregnancy, or breastfeeding.
• You are under 18. It is not normally given to children, except for a few serious infections under specialist care.

Pregnancy and breastfeeding. Ciprofloxacin is best avoided in pregnancy as a precaution. It should not be used while you are breastfeeding. If you are breastfeeding and need ciprofloxacin, you can express and throw away your milk during treatment and for 2 days after the last dose. Ask your doctor for advice.

Driving and machinery. Ciplox 500 can make you dizzy or drowsy and slow your reactions. Do not drive or use machinery until you know how it affects you.

Sunlight. Your skin can become much more sensitive to sunlight and UV light. Avoid strong sun and sunbeds, and use sunscreen and protective clothing while you are taking it.

Alcohol. Ciplox 500 can make you dizzy or drowsy, and it can rarely affect the liver. Alcohol can add to the dizziness, so it is best avoided while you are taking it and until you know how the medicine affects you. Ask your doctor whether any alcohol is safe for you.

Most side effects are mild and settle, but some are serious and need urgent medical care. Nausea and diarrhoea are the ones reported most often.

Side effects that are common (up to about 1 in 10 people):

• Nausea
• Diarrhoea

Side effects that are uncommon (up to about 1 in 100 people):

• Vomiting
• Stomach pain, indigestion or heartburn, and wind
• Headache, dizziness
• Sleeping problems, or changes in taste
• Rash, itching or hives
• Raised liver enzymes or bilirubin, seen on a blood test
• Poor kidney function
• Pain in the muscles and bones, and joint pain in adults
• Fever and feeling unwell, or loss of appetite
• Fungal infections such as oral or vaginal thrush
• Feeling agitated or overactive

Side effects that are rare (up to about 1 in 1,000 people):

• Feeling confused, disoriented or anxious, or having strange dreams
• Tremor, pins and needles or giddiness
• Ringing in the ears, or some hearing loss
• Changes in the blood count, seen on a blood test

Serious side effects — stop the medicine and get medical help

• Tendon pain or swelling, or a tendon tear. This most often affects the Achilles tendon behind the ankle and can happen within 48 hours of starting, or even months after stopping. It has also been reported in the shoulder, hand, biceps and thumb.
• Numbness, tingling, burning, pain or weakness in the hands and feet. This nerve damage can last a long time.
• A seizure, a severe headache that will not go away, confusion, hallucinations, or a sudden change in mood.
• Thoughts of harming yourself. Get help immediately. Tele-MANAS, Government of India, 24x7: 14416 or 1800-891-4416. Emergency: 112. Ambulance: 108.
• Severe or bloody diarrhoea, with or without fever or stomach cramps. It can start up to two months after treatment ends.
• A rash with swelling of the face, lips, tongue or throat, difficulty breathing or swallowing, or peeling or blistering skin.
• Yellowing of the eyes or skin, dark urine, pale stools or severe stomach pain, which can point to liver injury.
• Sudden severe pain in the chest, stomach or back, which can point to a problem with the aorta.
• An irregular or very fast heartbeat, or fainting.
• Any sudden change in your eyesight — blurred, double or altered colour vision — needs to be checked straight away.

Some people have side effects affecting muscles, tendons, joints, nerves and mood that continue for months after the medicine is stopped. Report anything that does not settle.

Ciprofloxacin interacts with a number of medicines and supplements. Some combinations are not allowed, and others simply need to be spaced apart or monitored.

• Tizanidine (muscle relaxant) — Not allowed — see above.
• Antacids, and calcium, magnesium, aluminium, iron or zinc supplements, sucralfate, phosphate binders — Take Ciplox 500 at least 2 hours before or 6 hours after these. Otherwise the antibiotic is not absorbed properly.
• Steroid medicines such as prednisolone — Tell your doctor. Combined use raises the risk of tendon injury and is best avoided.
• Methotrexate — Not recommended with ciprofloxacin.
• Theophylline — Levels in the blood can rise and cause serious effects. Your doctor may check levels and adjust the dose.
• Warfarin and similar blood thinners — Bleeding risk can rise. Your INR needs checking more often.
• Insulin and sulfonylureas such as glibenclamide — Blood sugar can fall or rise. Check your sugars more often.
• NSAID painkillers such as ibuprofen and naproxen — Tell your doctor or pharmacist if you use these regularly. Taken with ciprofloxacin they can raise the risk of nervous-system effects and seizures.
• Probenecid — Raises the level of ciprofloxacin in the body.
• Clozapine, and medicines that affect heart rhythm (some antidepressants, antipsychotics and antibiotics) — Tell your doctor, as the combination may need monitoring.
• Sleeping tablets such as zolpidem — Not recommended together. Tell your doctor if you use them.
• Caffeine, from coffee, strong tea, cola, energy drinks and chocolate — Limit these. Ciprofloxacin makes caffeine stay in the body longer.

If someone takes more Ciplox 500 than prescribed, get medical help immediately. Go to the nearest hospital emergency department even if there are no symptoms yet, and carry the strip or box with you so the staff know exactly what was taken. Do not try to make yourself vomit.

There is no specific antidote. Treatment is supportive, with fluids and monitoring of kidney function, because ciprofloxacin is removed from the body mainly by the kidneys. Only a small amount (less than 10%) is removed by dialysis.

In an emergency in India, call 112. For an ambulance, call 108.

• Keep the tablets in their original blister pack and carton, out of the reach and sight of children.
• Store the tablets in their original container at room temperature, away from excess heat and moisture — not in the bathroom. This medicine does not need to be kept in the refrigerator.
• Do not use the tablets after the expiry date printed on the pack. That date is the last day of the month shown.
• Do not flush unused tablets or throw them in household waste. Ask your pharmacist how to dispose of medicines you no longer need.

Ciplox 500 is a prescription-only medicine. Buy it only against a valid prescription, and check the name and strength on the pack before you take it.