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Ciprofloxacin (Ophthalmic)

Generic name: ciprofloxacin ophthalmic

Brand names: Ciloxan

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)

Pharmacology

Mechanism of Action

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

Pharmacokinetics/Pharmacodynamics

Absorption

Only small amounts are absorbed systemically after ophthalmic instillation

Use: Labeled Indications

Ocular infections:

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

Contraindications

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

Dosage and Administration

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 (off-label): 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 (Ciloxan Canadian product labeling).

Dosing: Geriatric

Refer to adult dosing.

Dosing: Pediatric

Bacterial conjunctivitis; treatment: Ophthalmic:

Solution: Infants, Children, and Adolescents: Instill 1 to 2 drops into the conjunctival sac of the affected eye(s) every 2 hours while awake for 2 days, then 1 to 2 drops every 4 hours while awake for the next 5 days.

Ointment: Children ≥2 years and Adolescents: Apply 1/2-inch ribbon into the conjunctival sac 3 times daily for 2 days, then twice daily for the next 5 days.

Canadian labeling: Children ≥1 year and Adolescents: Apply 1/2-inch ribbon into the conjunctival sac 3 times daily for 2 days, then twice daily for the next 5 days.

Corneal ulcers; treatment: Ophthalmic:

Solution: Infants, Children, and Adolescents: Instill 2 drops into the conjunctival sac every 15 minutes for the first 6 hours, then 2 drops every 30 minutes for the remainder of the first day; on the second day, instill 2 drops every hour; on the third day and for the duration of therapy, instill 2 drops every 4 hours thereafter for a total of 14 days; treatment may be extended if re-epithelialization has not occurred.

Ointment [Canadian Product]: Children ≥12 years and Adolescents: Apply 1/2-inch ribbon into the conjunctival sac every 1 to 2 hours around the clock for 2 days, then every 4 hours for up to 12 days; treatment may be extended if re-epithelialization has not occurred.

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%, postmarketing, and/or case reports: 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

Pregnancy Considerations

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 punctal occlusion for 3 to 5 minutes after application to decrease potential exposure to the fetus (Samples 1988).

Patient Education

What is this drug used for?

  • It is used to treat eye infections.

Frequently reported side effects of this drug

  • Blurred vision
  • Eye redness
  • Crusting of eyelid
  • Foreign body sensation in eye
  • Bad taste

Other side effects of this drug: Talk with your doctor right away if you have any of these signs of:

  • Vision changes
  • Eye pain
  • Severe eye irritation
  • Eye or eyelid swelling
  • Joint pain
  • Joint swelling
  • Crystalline eye deposits
  • Signs of a significant reaction like 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. Talk to your doctor if you have questions.

Consumer Information Use and Disclaimer: This information should not be used to decide whether or not to take this medicine or any other medicine. Only the healthcare provider has the knowledge and training to decide which medicines are right for a specific patient. This information does not endorse any medicine as safe, effective, or approved for treating any patient or health condition. This is only a brief summary of general information about this medicine. It does NOT include all information about the possible uses, directions, warnings, precautions, interactions, adverse effects, or risks that may apply to this medicine. This information is not specific medical advice and does not replace information you receive from the healthcare provider. You must talk with the healthcare provider for complete information about the risks and benefits of using this medicine.

Source: Wolters Kluwer Health. Last updated January 25, 2020.