Ciprofloxacin Pharmacology Podcast

On this podcast, I cover ciprofloxacin pharmacology. Ciprofloxacin is one of the most widely recognized fluoroquinolone antibiotics and has been on the market for decades. Because of its broad utility, it often comes up in practice, but it also carries significant adverse effect concerns and boxed warnings that pharmacists and prescribers need to keep in mind.

From a pharmacology standpoint, ciprofloxacin works by inhibiting bacterial DNA gyrase and topoisomerase IV, enzymes that are essential for bacterial DNA replication, transcription, and repair. This action gives ciprofloxacin bactericidal activity against a variety of gram-negative organisms, including E. coli, Klebsiella, Enterobacter, and Pseudomonas aeruginosa. It also has some gram-positive activity, though it is generally not the best choice for strep infections.

Ciprofloxacin comes in multiple dosage forms, including oral tablets, oral suspension, and intravenous formulations, which makes it flexible across care settings. I discuss the conversion of IV and PO formulations.

Pharmacokinetics are important to consider. Ciprofloxacin is primarily renally eliminated, so dose adjustments are necessary in patients with impaired kidney function. Distribution into tissues is generally good, but it has limited activity in the lungs against Streptococcus pneumoniae, which is why it is not a first-line option for community-acquired pneumonia.

Adverse effects are a major concern. The fluoroquinolone class carries multiple boxed warnings. Ciprofloxacin has been associated with tendon rupture, peripheral neuropathy, CNS effects such as agitation or seizures, and exacerbation of myasthenia gravis. More recent warnings include the risk for aortic aneurysm and hypoglycemia or hyperglycemia, particularly in older adults or those with comorbidities. On top of these boxed warnings, ciprofloxacin can also prolong the QT interval and cause GI upset.

Drug interactions are another big factor in practice. Ciprofloxacin is a CYP1A2 inhibitor, which can raise levels of drugs like theophylline, tizanidine, and clozapine. It also interacts with polyvalent cations such as calcium, magnesium, iron, and aluminum, which can dramatically reduce its absorption—sometimes by more than 50%. This is a common reason for treatment failure if counseling isn’t provided.

From a dosing perspective, ciprofloxacin is usually given 250–750 mg orally twice daily or 400 mg IV every 8–12 hours depending on the indication and severity of infection. Renal dosing adjustments are needed as kidney function declines.

In summary, ciprofloxacin is a powerful antibiotic when used appropriately. It remains an option for urinary tract infections, complicated intra-abdominal infections, and some cases of hospital-acquired pneumonia, but its use must be balanced with the potential for significant adverse effects and interactions. For pharmacists, educating patients on drug interactions, counseling about boxed warnings, and ensuring correct dosing in renal impairment are some of the most valuable interventions when ciprofloxacin shows up on a medication list.

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Top 200 Drugs – Medications 156-160

Welcome back to the Real Life Pharmacology podcast! We are on the home stretch of the top 200 medications. This is meant to be a quicker refresher of some of the most important drugs you’ll come across in practice. Please be sure to go search the archives at RealLifePharmacology.com if you are looking for more information on one specific medication. We have over 300 individual episodes on specific drugs!

On this episode of the Top 200 medications, we’ve covered the medications below.

Niaspan (niacin) is vitamin B3 and may be used in patients who fail other therapies for triglyceride management.

Uroxatral (alfuzosin) is a selective alpha-blocker that can be helpful in relieving urinary retention symptoms in BPH.

Biaxin (clarithromycin) is a macrolide antibiotic that is notorious for many drug interactions because it inhibits CYP3A4.

Zomig (zolmitriptan) is a “triptan” medication that can be used for the acute relief of migraine headaches.

Invokana (canagliflozin) was one of the first SGLT2 inhibitors invented that can be used to lower blood sugar in type 2 diabetes.

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Clindamycin Pharmacology Podcast

On this podcast episode, I discuss clindamycin pharmacology, adverse effects, drug interactions, and much more!

Clindamycin (oral administration) can cause esophageal irritation and it is recommended to take this medication with a full glass of water.

C. Diff risk and frequent dosing are two of the biggest downsides to using clindamycin to manage infections.

Clindamycin has good activity against many gram-positive organisms like Staph and Strep as well as anaerobic activity.

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Terbinafine Pharmacology

Terbinafine can inhibit CYP2D6 which plays an important role in the metabolism of many drugs such as metoprolol, fluoxetine, and clozapine.

With terbinafine’s ability to inhibit CYP2D6, it can also increase the risk of treatment failure with drugs like tamoxifen.

When using anti-fungal drugs like terbinafine, remember that fungal infections can often require more time to treat.

Terbinafine has the potential to cause liver impairment. I discuss this further on the podcast.

I discuss important drug interactions on the podcast, be sure to check out my latest project which is a 200+ page book on managing drug interactions in primary care.