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Ciprofloxacin (ophthalmic): Drug information

Ciprofloxacin (ophthalmic): Drug information
(For additional information see "Ciprofloxacin (ophthalmic): Patient drug information" and see "Ciprofloxacin (ophthalmic): Pediatric drug information")

For abbreviations, symbols, and age group definitions used in Lexicomp (show table)
Brand Names: US
  • Ciloxan
Brand Names: Canada
  • Ciloxan;
  • SANDOZ Ciprofloxacin
Pharmacologic Category
  • Antibiotic, Fluoroquinolone;
  • Antibiotic, Ophthalmic
Dosing: Adult
Bacterial conjunctivitis

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

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 to 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 (Ref).

Dosing: Kidney Impairment: Adult

There are no dosage adjustments provided in the manufacturer’s labeling; however, dosage adjustment may not be necessary as systemic absorption is minimal.

Dosing: Hepatic Impairment: Adult

There are no dosage adjustments provided in the manufacturer’s labeling; however, dosage adjustment may not be necessary as systemic absorption is minimal.

Dosing: Older Adult

Refer to adult dosing.

Dosing: Pediatric

(For additional information see "Ciprofloxacin (ophthalmic): Pediatric drug information")

Bacterial conjunctivitis; treatment

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

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.

Dosing: Kidney Impairment: Pediatric

There are no dosage adjustments provided in the manufacturer's labeling; however, dosage adjustment may not be necessary as systemic absorption is minimal.

Dosing: Hepatic Impairment: Pediatric

There are no dosage adjustments provided in the manufacturer's labeling; however, dosage adjustment may not be necessary as systemic absorption is minimal.

Adverse Reactions

The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified.

1% to 10%:

Gastrointestinal: Unpleasant taste (following instillation)

Ophthalmic: Conjunctival hyperemia, corneal disease (≤2%; including crystals), crusting of eyelid, eye discomfort (≤2%; including burning sensation of eyes), eye pruritus, foreign body sensation of eye, scaling of eyelid

<1%:

Dermatologic: Dermatitis

Gastrointestinal: Nausea

Local: Local ocular hypersensitivity reaction

Ophthalmic: Blurred vision, corneal infiltrates, corneal staining, decreased visual acuity, dry eye syndrome, erythema of eyelid, eye irritation, eye pain, eyelid edema, keratitis, keratoconjunctivitis, lacrimation, lid margin hyperemia, ocular edema, ocular epitheliopathy, photophobia, vision loss

Postmarketing: Dermatologic: Acute generalized exanthematous pustulosis (Lo 2019), erythema multiforme (major) (Arnold 2017)

Contraindications

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

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.

Dosage Forms: US

Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product

Ointment, Ophthalmic, as hydrochloride:

Ciloxan: 0.3% (3.5 g)

Solution, Ophthalmic, as hydrochloride:

Ciloxan: 0.3% (5 mL [DSC]) [contains benzalkonium chloride, edetate (edta) disodium]

Generic: 0.3% (2.5 mL, 5 mL, 10 mL)

Generic Equivalent Available: US

May be product dependent

Pricing: US

Ointment (Ciloxan Ophthalmic)

0.3% (per gram): $84.81

Solution (Ciprofloxacin HCl Ophthalmic)

0.3% (per mL): $3.23 - $9.46

Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided as reference price only. A range is provided when more than one manufacturer's AWP price is available and uses the low and high price reported by the manufacturers to determine the range. The pricing data should be used for benchmarking purposes only, and as such should not be used alone to set or adjudicate any prices for reimbursement or purchasing functions or considered to be an exact price for a single product and/or manufacturer. Medi-Span expressly disclaims all warranties of any kind or nature, whether express or implied, and assumes no liability with respect to accuracy of price or price range data published in its solutions. In no event shall Medi-Span be liable for special, indirect, incidental, or consequential damages arising from use of price or price range data. Pricing data is updated monthly.

Dosage Forms: Canada

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, 10 mL) [contains benzalkonium chloride, edetate (edta) disodium]

Generic: 0.3% (5 mL)

Administration: Adult

Ophthalmic: For topical ophthalmic use only; avoid touching tip of applicator to eye or other surfaces. Contact lenses should be removed prior to administration.

Administration: Pediatric

For topical ophthalmic use only. Avoid touching the dropper tip to skin, eye, or other surfaces. Contact lenses should be removed prior to administration.

Ointment: Instill in the lower conjunctival sac.

Solution: Apply gentle pressure to lacrimal sac during and for 1 to 2 minutes after instillation or instruct patient to gently close eyelid after administration to decrease risk of absorption and systemic effects (Ref).

Use: Labeled Indications

Bacterial conjunctivitis:

Ointment: Treatment of bacterial conjunctivitis caused by susceptible strains of Staphylococcus aureus, Staphylococcus epidermidis, Streptococcus pneumoniae, Viridans group streptococci, and Haemophilus influenzae.

Solution: Treatment of bacterial conjunctivitis caused by susceptible strains of S. aureus, S. epidermidis, S. pneumoniae, and H. influenzae.

Corneal ulcers: Solution: Treatment of corneal ulcers caused by susceptible strains of Pseudomonas aeruginosa, Serratia marcescens, S. aureus, S. epidermidis, S. pneumoniae, and Viridans group streptococci.

Medication Safety Issues
Sound-alike/look-alike issues:

Ciprofloxacin may be confused with cephalexin

Ciloxan may be confused with Cytoxan

Metabolism/Transport Effects

None known.

Drug Interactions

There are no known significant interactions.

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).

Breastfeeding Considerations

It is not known if ciprofloxacin can be detected in breast milk following ophthalmic administration. When administered orally, ciprofloxacin enters breast milk. The manufacturer's labeling recommends that caution be exercised when administering ciprofloxacin ophthalmic to nursing women.

Mechanism of Action

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

Pharmacokinetics (Adult Data Unless Noted)

Absorption: Only small amounts are absorbed systemically after ophthalmic instillation

Brand Names: International
International Brand Names by Country
For country code abbreviations (show table)

  • (AE) United Arab Emirates: Ciloxan;
  • (AR) Argentina: Ciloxan;
  • (AT) Austria: Ciloxan;
  • (BD) Bangladesh: Aprocin | Bactin | Cero | Ciflox | Ciprin | Ciprox;
  • (BR) Brazil: Biamotil | Ciloxan | Cloridrato de ciprofloxacino | Maxiflox;
  • (CI) Côte d'Ivoire: Ciloxan;
  • (CL) Chile: Ciloxacin | Ciproval;
  • (CN) China: Ciprofloxacin;
  • (CO) Colombia: Alcon cilox | Ciprodan oftalmico;
  • (DO) Dominican Republic: Opthaflox;
  • (EC) Ecuador: Ciloxan | Ciproval | Sophixin ofteno | Sophixin ungena;
  • (EG) Egypt: Ciprocin;
  • (ES) Spain: Oftacilox;
  • (FR) France: Ciloxan;
  • (GB) United Kingdom: Ciloxan;
  • (HK) Hong Kong: Ciloxan | Ciprocin;
  • (IE) Ireland: Ciloxan;
  • (IN) India: Adiflox | Cinfax | Ciplox | Ciplox-i | Ciprocent e/e | Ciprocin | Ciprol | Ciprolar | Ciprozen | Joxin | Ultiflox | Zoxan;
  • (IT) Italy: Oftacilox;
  • (KE) Kenya: Ciprocent;
  • (KR) Korea, Republic of: Ciloxan;
  • (MA) Morocco: Ciloxan;
  • (MX) Mexico: Ciloxan | Ciprofloxacin | Opthaflox | Sophixin;
  • (MY) Malaysia: Ciloxan;
  • (NO) Norway: Cilox | Ciloxan;
  • (PE) Peru: Ciloxan | Ciprolin | Ciproval;
  • (PK) Pakistan: Invoflox | Rocip;
  • (PL) Poland: Ciloxan;
  • (PR) Puerto Rico: Ciloxan;
  • (PT) Portugal: Oftacilox;
  • (PY) Paraguay: Ciloxan;
  • (QA) Qatar: Ceprolen | Ciloxan | Ciprocin | Opticin;
  • (RO) Romania: Ciloxan | Ciplox;
  • (RU) Russian Federation: Ciprofloxacin | Oftocipro;
  • (SA) Saudi Arabia: Ciprocin | Cipromax;
  • (SE) Sweden: Ciloxan;
  • (SG) Singapore: Ciloxan;
  • (TR) Turkey: Ciloxan;
  • (UG) Uganda: Ciprocin;
  • (UY) Uruguay: Ciloxan | Ciproval;
  • (VE) Venezuela, Bolivarian Republic of: Quinoftal;
  • (ZA) South Africa: Ciloxan;
  • (ZM) Zambia: Ciplox
  1. Arnold M, Wilkerson M. A case of erythema multiforme major following administration of ciprofloxacin ophthalmic drops. Dermatol Online J. 2017;23(10):13030/qt49k2k7xt. [PubMed 29469784]
  2. Ciloxan ointment (ciprofloxacin) [prescribing information]. East Hanover, NJ: Novartis Pharmaceuticals Corp; November 2019.
  3. Ciloxan solution (ciprofloxacin) [prescribing information]. Fort Worth, TX: Alcon Laboratories Inc; April 2018.
  4. Ciloxan (ciprofloxacin) [product monograph]. Dorval, Quebec, Canada: Norvartis Pharmaceuticals Canada Inc; May 2018.
  5. Giamarellou H, Kolokythas E, Petrikkos G, et al. "Pharmacokinetics of Three Newer Quinolones in Pregnant and Lactating Women," Ciprofloxacin: major advances in intravenous and oral quinolone therapy. Proceedings of a symposium. April 28 to 29, 1989, Naples, Florida. Am J Med. 1989; 87(5A):49S-51S. [PubMed 2589353]
  6. Lo KBU, Azmaiparashvili Z. Desquamating pustular rash. Cleve Clin J Med. 2019;86(12):780-781. doi:10.3949/ccjm.86a.19061 [PubMed 31821140]
  7. Ludlam H, Wreghitt TG, Thornton S. Q fever in pregnancy. J Infect. 1997;34(1):75-78. [PubMed 9120330]
  8. Samples JR, Meyer SM. Use of ophthalmic medications in pregnant and nursing women. Am J Ophthalmol. 1988;106(5):616-623. [PubMed 2903673]
  9. Urtti A, Salminen L. Minimizing systemic absorption of topically administered ophthalmic drugs. Surv Ophthalmol. 1993;37(6):435-456. [PubMed 8100087]
  10. Zimmerman TJ, Kooner KS, Kandarakis AS, Ziegler LP. Improving the therapeutic index of topically applied ocular drugs. Arch Ophthalmol. 1984 102(4):551-553. [PubMed 6704011]
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