Embedded Files
Pharmacologic Category
Antibiotic, Fluoroquinolone; Antibiotic, Ophthalmic
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).
* See Dosage and Administration in AHFS Essentials for additional information.
Dosing: Geriatric
Refer to adult dosing.
Dosing: Renal 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: 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.
Dosing: Renal 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.
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
* See Uses in AHFS Essentials for additional information.
Class and Related Monographs
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.
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 (Urtti 1993; Zimmerman 1984).
Storage/Stability
Store at 2°C to 25°C (36°F to 77°F). Protect solution from light.
Medication Patient Education with HCAHPS Considerations
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.
Medication Safety Issues
Sound-alike/look-alike issues:
Contraindications
Hypersensitivity to ciprofloxacin, any component of the formulation, or other quinolones
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.
* See Cautions in AHFS Essentials for additional information.
Geriatric Considerations
Evaluate the patient’s or caregiver’s ability to safely administer the correct dose of ophthalmic medication.
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).
Breast-Feeding 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.
Lexicomp Pregnancy & Lactation, In-Depth
Briggs' Drugs in Pregnancy & Lactation
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
* See Cautions in AHFS Essentials for additional information.
Allergy and Idiosyncratic Reactions
Metabolism/Transport Effects
None known.
Drug Interactions Open Interactions
There are no known significant interactions.
Dosage Forms: US
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)
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 disodium]
Generic: 0.3% (5 mL)
Anatomic Therapeutic Chemical (ATC) Classification
- S01AE03
Generic Available (US)
May be product dependent
Pricing: US
Ointment (Ciloxan Ophthalmic)
0.3% (per gram): $73.49
Solution (Ciloxan Ophthalmic)
0.3% (per mL): $29.02
Solution (Ciprofloxacin HCl Ophthalmic)
0.3% (per mL): $3.44 - $10.36
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.
Mechanism of Action
Inhibits DNA-gyrase in susceptible organisms; inhibits relaxation of supercoiled DNA and promotes breakage of double-stranded DNA
Pharmacodynamics/Kinetics
Absorption: Only small amounts are absorbed systemically after ophthalmic instillation
Local Anesthetic/Vasoconstrictor Precautions
No information available to require special precautions
Effects on Dental Treatment
No significant effects or complications reported
Effects on Bleeding
No information available to require special precautions
Index Terms
Ciprofloxacin HCl; Ciprofloxacin Hydrochloride
References
Ciloxan ointment (ciprofloxacin) [prescribing information]. Fort Worth, TX: Alcon Laboratories, Inc; April 2018.
Ciloxan solution (ciprofloxacin) [prescribing information]. Fort Worth, TX: Alcon Laboratories, Inc; April 2018.
Ciloxan (ciprofloxacin) [product monograph]. Dorval, Quebec, Canada: Norvartis Pharmaceuticals Canada Inc; May 2018.
Ciprofloxacin hydrochloride ophthalmic solution. Fort Worth, TX: Alcon Laboratories, Inc; July 2007.
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]
Ludlam H, Wreghitt TG, Thornton S. Q fever in pregnancy. J Infect. 1997;34(1):75-78.[PubMed 9120330 ]
Samples JR, Meyer SM. Use of ophthalmic medications in pregnant and nursing women. Am J Ophthalmol. 1988;106(5):616-623.[PubMed 2903673 ]
Urtti A, Salminen L. Minimizing systemic absorption of topically administered ophthalmic drugs. Surv Ophthalmol. 1993;37(6):435-456.[PubMed 8100087]
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]
Brand Names: International
Alcon Cilox (CO, ID); Aprocin (HK); Baquinor (ID); Beuflox (LK); Ceflox (IN); Cetraflux (ES); Cifloptic (PE); Cifran DPS (IN); Cilobact (CO); CiloQuin (AU); Cilox (NO); Ciloxan (AE, AR, AT, AU, BB, BE, BG, BH, BR, CH, CL, CR, CY, CZ, DE, DK, DO, EE, EG, FR, GB, GR, GT, HN, HR, HU, IE, IL, JO, KW, LB, LK, LT, LU, LV, MT, MY, NI, NL, NZ, PA, PH, PK, PL, PY, QA, SA, SE, SK, SV, TH, TR, TW, UY, VE, VN, ZA); Cipcin (BD, TW); Ciplox (ET, LK); Ciplus (KR); Cipro (LK); Ciprocin (EG); Ciprodar (HK, JO, SA); Ciprolak (PE); Ciprotal (PH); Ciroxin (TW); Ifloxin (PH); Interflox (ID); Nafloxin (IL); Neofloxin (BD); Novaflox (SG); Oftacilox (PT); Optal-Pro (TH); Opticin (AE, BH, JO, KW, QA); Polyvision (EG); Qiu Lu (CN); Quinoryl (PH); Sophixin Ofteno (VE); Vistaflox (PH); Xcipro (MY); Ximex Cyclowam (ID); Zoxan (ET, MY)
Last Updated 1/25/20
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