10 Ciprofloxacin Side Effects You Should Know About
Key takeaways:
Ciprofloxacin (Cipro) is a fluoroquinolone antibiotic. It treats a wide variety of infections, including urinary tract, gut, and lung infections.
The most common ciprofloxacin side effects are nausea, vomiting, and diarrhea. Skin rashes and liver changes are also possible.
Rare but serious side effects, such as tendon rupture, nerve damage, and central nervous system (brain and spinal cord) changes, can be disabling and long-lasting. As a precaution, the FDA recommends saving ciprofloxacin for when there are no other options.
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Imagine this scenario: You wake up in the morning and experience pain while urinating. You try several remedies for relief, but nothing seems to work. It’s time to give your primary care provider a call. After a quick visit, a diagnosis of an upper urinary tract infection (pyelonephritis), and a prescription for ciprofloxacin, the problem is addressed.
It’s beneficial to have antibiotics that can treat infections like this and complications from them. Ciprofloxacin (Cipro) in particular can treat urinary tract, gut, and respiratory infections — among many others. It’s part of a class of medications called fluoroquinolones.
Despite its benefits, no medication is perfect. Fluoroquinolones like ciprofloxacin have made headlines in the past for having potentially serious side effects, such as tendon ruptures. A successful experience with ciprofloxacin sometimes comes down to preventing and managing side effects.
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Ciprofloxacin side effects at a glance
It’s a good idea to talk to your healthcare professional (HCP) about what to expect while taking ciprofloxacin. Here’s an overview of side effects to get the conversation started.
Common ciprofloxacin side effects include:
Nausea
Vomiting
Diarrhea
Rash
Changes in liver enzyme (protein) levels
Taste changes
Sun sensitivity
Rare but serious ciprofloxacin side effects include:
Tendon rupture
Seizures
Nerve damage
Blood vessel damage
Infectious diarrhea
Abnormal heart rhythm
Liver damage
Kidney problems
Serious skin reactions
Here, we’ll take a closer look at 10 oral ciprofloxacin side effects and how to manage them.
1. Nausea and vomiting
Nausea and vomiting are some of the most common side effects of ciprofloxacin. Nausea is usually mild at normal doses, and vomiting happens more often in children than adults.
You can take ciprofloxacin with or without food. But if it’s upsetting your stomach, try taking it with a meal or snack. Just make sure you aren’t taking it with calcium-fortified juices, or dairy products such as milk, yogurt, or cheese. Other foods, such as leafy greens, are also common sources of calcium. The calcium in these foods can attach to ciprofloxacin and limit how much is absorbed, making it less effective.
Other strategies to manage nausea include drinking a full glass of water with each dose, staying hydrated, and avoiding lying down for 30 minutes after taking the medication.
The right amount of medication: Check out the recommended ciprofloxacin dosages for common infections in adults and kids.
Best UTI antibiotics: See how ciprofloxacin stacks up to other antibiotics that treat UTIs.
Fluoroquinolone side effects: Discover the risks of taking fluoroquinolone antibiotics — and if you should avoid them entirely.
2. Diarrhea
Ciprofloxacin is FDA approved to treat diarrhea caused by several types of bacteria. But it can also cause diarrhea. Antibiotics like ciprofloxacin can wipe out the good bacteria in your gut, creating an imbalance and allowing harmful bacteria to take over. This can lead to loose stools.
If your diarrhea is mild, try incorporating the following tips:
Staying hydrated with clear liquids throughout the day
Avoiding fatty, fried, or high-fiber foods
Taking a probiotic supplement or eating probiotic-rich foods to restore “good” gut bacteria
If you experience diarrhea with ciprofloxacin, it usually goes away after you stop taking it. But make sure you talk to your HCP first if you feel like you need to stop ciprofloxacin early due to diarrhea.
Serious cases of diarrhea
More serious spells of diarrhea have also been reported. Sometimes, a harmful bacteria called Clostridioides difficile (“C. diff”) can spread in your gut after taking antibiotics. This bacteria makes toxins that damage the lining of your gut, causing diarrhea, cramping, and fever.
C.diff-associated diarrhea can happen while you’re taking ciprofloxacin or even months after you’ve finished it.
Reach out to your healthcare team if your diarrhea hasn’t improved with treatment or if you have stomach pain or fever with your diarrhea.
3. Liver changes
Ciprofloxacin can cause changes in liver function tests. These are blood tests that measure how well your liver is working. These changes are generally mild and go away after stopping ciprofloxacin. You likely won’t even notice the changes. But if you already have liver problems, talk with your healthcare team about whether ciprofloxacin is the right antibiotic for you.
Rarely, ciprofloxacin can cause more severe liver damage. This could potentially be life-threatening. Notify your HCP right away if you have new belly pain, dark urine, or yellowing skin while taking this antibiotic.
4. Taste changes
Ciprofloxacin has occasionally been associated with loss of taste or a bad taste in the mouth. It’s not dangerous, but it can be unpleasant.
Any taste changes should go away after stopping ciprofloxacin. Still, let your HCP know if it’s bothering you. You can try chewing sugar-free gum in the meantime to mask the bad taste in your mouth. You can also work with a dietitian to make food more appealing by experimenting with spices, texture, and color.
5. Sun sensitivity
Ciprofloxacin can cause photosensitivity. This means you’re more likely to get sunburned while out in the sun.
In addition to applying sunscreen, simple protective measures for your skin can make a big difference. Try to avoid being in the sun for too long while you’re taking ciprofloxacin. The same goes for tanning beds — avoid these altogether while taking ciprofloxacin.
If you need to go outside when it’s sunny, make sure to wear sunscreen and protective clothing, such as a long-sleeved shirt and wide-brimmed hat.
6. Skin rashes
Rash is another possible side effect of ciprofloxacin. However, a rash could also be a sign of a serious reaction.
To play it safe, if you develop a rash of any type while taking ciprofloxacin, stop taking it and call your HCP immediately. They can determine whether your rash can be managed at home or if you should be seen urgently at a clinic.
7. Abnormal heart rhythm
Ciprofloxacin can rarely cause QT prolongation — an abnormal heartbeat that can put you at risk for long QT syndrome. The risk is higher if you take ciprofloxacin along with other medications that cause QT prolongation. The risk is also higher if your potassium and magnesium levels are too low.
If you have a history of abnormal heartbeats, your HCP may recommend a different antibiotic. In addition, it’s a good idea to make sure your HCP or pharmacist checks for any interactions with your current medications before you start taking ciprofloxacin.
8. Tendon rupture
Clinical trials are a helpful way to determine a medication’s most likely side effects. But, some side effects aren’t noticed until a medication is used regularly in the real world.
In 2008, the FDA warned the public that ciprofloxacin and other fluoroquinolone antibiotics can cause tendon inflammation and rupture. They issued a boxed warning (the FDA’s strongest medication warning) for this risk.
The risk of tendon inflammation is highest the first month after taking ciprofloxacin. Other risk factors include being of older age, taking corticosteroids with ciprofloxacin, and having a history of certain organ transplants. The tendon most likely to be affected is your Achilles tendon, which is attached to the back of your heel. But other tendons can be affected, too.
Stop taking ciprofloxacin and immediately notify your healthcare team if you experience pain or swelling in your tendons or joints.
9. Nerve pain
In 2013, the FDA updated ciprofloxacin’s boxed warnings to include new information about possible nerve damage. Called peripheral neuropathy, this rare side effect can cause burning, tingling, or numbness in your arms or legs. It’s usually temporary, but it can be permanent.
The risk of neuropathy seems to increase the longer you take ciprofloxacin. The risk is also higher among older adults.
You should stop taking ciprofloxacin and notify your healthcare team if you develop any nerve-related side effects. If you already have nerve damage, ask your HCP if an alternative antibiotic might be better for you.
10. Central nervous system changes
In 2016, the FDA updated ciprofloxacin’s boxed warnings again. They added that central nervous system (which refers to the brain and spinal cord) changes are possible while taking ciprofloxacin. Reported side effects may include:
Agitation
Anxiety
Confusion
Depression
Dizziness
Memory loss
Seizures
Shakiness
Suicidal thoughts
Trouble concentrating or sleeping
Central nervous system changes, nerve pain, and tendon rupture can be disabling and potentially permanent. The FDA recommends that fluoroquinolones should only be used when there are no other effective options.
Frequently asked questions
Ciprofloxacin itself doesn’t typically make you feel tired. But ciprofloxacin can cause confusion and dizziness, which may make you feel out of sorts. You might also attribute fatigue to your body working hard to fight off an infection.
Mild ciprofloxacin side effects, such as taste changes, liver test changes, and nausea, are usually temporary. They should resolve once you stop taking the medication. However, disabling side effects can be irreversible — especially if they become severe. This includes tendon rupture, peripheral neuropathy, and central nervous system changes.
Older adults, or people ages 60 and older, should use caution while taking ciprofloxacin. It can raise the risk of tendon rupture, especially if you’re also taking corticosteroids. Older adults may also be at a higher risk of developing aortic aneurysm and dissection — a bulge or tear of a major blood vessel in the chest — within 2 months of taking ciprofloxacin.
What’s more, older adults with a history of kidney problems or QT prolongation should use caution with ciprofloxacin. These side effects may get worse while taking this antibiotic.
The bottom line
The most common ciprofloxacin (Cipro) side effects are nausea, vomiting, and diarrhea. Serious side effects, such as tendon rupture, nerve damage, and central nervous system changes, have also been reported. The FDA recommends reserving ciprofloxacin for specific infections, only when no other options are available.
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References
Aurobindo Pharma Limited. (2024). CIPROFLOXACIN- ciprofloxacin hydrochloride tablet, film coated. DailyMed.
Bromley, S. M. (2000). Smell and taste disorders: A primary care approach. American Family Physician.
Morales, D., et al. (2019). Association between peripheral neuropathy and exposure to oral fluoroquinolone or amoxicillin-clavulanate therapy. JAMA Neurology.
National Institute of Diabetes and Digestive and Kidney Diseases. (2024). Ciprofloxacin. LiverTox: Clinical and Research Information on Drug-Induced Liver Injury.
Patangia, D. V., et al. (2022). Impact of antibiotics on the human microbiome and consequences for host health. Microbiology Open.
Shu, Y., et al. (2022). Fluoroquinolone-associated suspected tendonitis and tendon rupture: A pharmacovigilance analysis from 2016 to 2021 based on FAERS database. Frontiers in Pharmacology.
Thai T., et al. (2022). Ciprofloxacin. StatPearls.
U.S. Food and Drug Administration. (2008). Information for healthcare professionals: Fluoroquinolone antimicrobial drugs [ciprofloxacin (marketed as Cipro and generic ciprofloxacin), ciprofloxacin extended-release (marketed as Cipro XR and Proquin XR), gemifloxacin (marked as Factive), levofloxacin (marketed as Levaquin), moxifloxacin (marketed as Avelox), norfloxacin (marketed as Noroxin), and ofloxacin (marketed as Floxin)].
U.S. Food and Drug Administration. (2013). FDA drug safety communication: FDA requires label changes to warn of risk for possibly permanent nerve damage from antibacterial fluoroquinolone drugs taken by mouth or by injection.
U.S. Food and Drug Administration. (2018). FDA drug safety communication: FDA updates warnings for oral and injectable fluoroquinolone antibiotics due to disabling side effects.
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