CIPROFLOXACIN ALTER 500 mg FILM-COATED TABLETS

2. What you need to know before you take Ciprofloxacin Alter

Do not take Ciprofloxacin Alter

• If you are allergic (hypersensitive) to the active substance, other quinolones, or any of the other components of this medication (see section 6).
• If you are taking tizanidine (see section 2: Taking Ciprofloxacin Alter with other medications).

Warnings and precautions

Before you start taking this medication

You should not take antibacterial medications that contain fluoroquinolones or quinolones, including Ciprofloxacin Alter, if you have experienced any severe adverse reaction in the past when taking a quinolone or fluoroquinolone. If this is the case, you must inform your doctor as soon as possible.

Consult your doctor before starting this medication

• If you have ever had kidney problems, because your treatment needs to be adjusted.
• If you suffer from epilepsy or other neurological conditions.
• If you have a history of tendon problems during previous treatment with antibiotics like Ciprofloxacin Alter.
• If you suffer from severe myasthenia (a type of muscle weakness).
• If you have heart problems. Caution should be exercised when administering ciprofloxacin if you were born with or have a family history of prolonged QT interval (seen on the ECG, electrical recording of the heart), have an electrolyte imbalance (especially low potassium and magnesium levels in the blood), have a very slow heart rate (known as bradycardia), have a fragile heart (cardiac arrest), have a history of heart attacks (myocardial infarction), are a woman or an elderly person, or are taking other medications that result in abnormal ECG changes (see section 2: Taking Ciprofloxacin Alter with other medications).
• If you have been diagnosed with an aneurysm of a large blood vessel (aortic aneurysm or large peripheral vessel aneurysm).
• If you have suffered a previous episode of aortic dissection (tear in the aortic wall).
• If you have been diagnosed with heart valve insufficiency (regurgitation of the heart valves).
• If you have a family history of aortic aneurysm or aortic dissection, congenital heart valve disease, or other risk factors or predisposing conditions (e.g., connective tissue disorders such as Marfan syndrome or Ehlers-Danlos vascular syndrome, Turner syndrome, or Sjögren's syndrome (an autoimmune inflammatory disease), or vascular disorders such as Takayasu arteritis, giant cell arteritis, Behçet's disease, hypertension, known atherosclerosis, rheumatoid arthritis (a joint disease), or endocarditis (a heart infection)).

For the treatment of some genital tract infections, your doctor may prescribe another antibiotic in addition to ciprofloxacin. If there is no improvement in symptoms after 3 days of treatment, please consult your doctor.

During treatment with this medication

Inform your doctor immediately if any of the following situations occur. Your doctor will decide whether it is necessary to interrupt treatment.

• Severe and sudden allergic reaction(anaphylactic reaction or shock, angioedema). There is a reduced possibility that, even with the first dose, you may experience a severe allergic reaction, with the following symptoms: chest tightness, dizziness, nausea, or fainting, or experience dizziness when standing up. If this happens, do not take any more Ciprofloxacin Alter and contact your doctor immediately.
• Severe, disabling, and potentially irreversible adverse effects.Antibacterial medications that contain fluoroquinolones or quinolones, including Ciprofloxacin Alter, have been associated with very rare but severe adverse effects, some of which were long-lasting (persistent for months or years), disabling, or potentially irreversible. This includes pain in the tendons, muscles, and joints of the upper and lower limbs, difficulty walking, abnormal sensations such as pinching, burning, tingling, numbness, or burning, sensory disorders such as decreased vision, taste, smell, and hearing, depression, decreased memory, intense fatigue, and severe sleep disorders.
• If you experience any of these adverse effects after taking Ciprofloxacin Alter, contact your doctor immediately before continuing treatment. You and your doctor will decide whether to continue or not, also considering the use of an antibiotic from another class.
• In rare cases, joint pain and swelling and tendon inflammation or rupturemay occur. The risk is higher if you are an elderly person (over 60 years old), have received an organ transplant, have kidney problems, or are being treated with corticosteroids. Tendon inflammation and rupture can occur within the first 48 hours of treatment and even several months after stopping treatment with Ciprofloxacin Alter. At the first sign of pain or inflammation of a tendon (e.g., in the ankle, wrist, elbow, shoulder, or knee), stop taking Ciprofloxacin Alter, contact your doctor, and rest the affected area. Avoid any unnecessary exercise, as it may increase the risk of tendon rupture.
• If you feel severe and sudden abdominal, chest, or back pain, which can be symptoms of aortic dissection or aneurysm, go to the emergency room immediately. The risk may increase if you are receiving systemic corticosteroid treatment.
• If you start experiencing sudden shortness of breath, especially when lying down, or if you notice swelling in your ankles, feet, or abdomen, or the appearance of heart palpitations (feeling of rapid and irregular heartbeat), inform your doctor immediately.
• If you suffer from epilepsyor other neurological conditions, such as cerebral ischemia or infarction, you may experience adverse effects associated with the central nervous system. If this occurs, stop taking this medication and contact your doctor immediately.
• In rare cases, you may experience symptoms of nerve damage (neuropathy)such as pain, burning, tingling, numbness, and/or weakness, especially in the feet and legs or hands and arms. If this happens, stop taking Ciprofloxacin Alter and inform your doctor immediately to prevent the development of a potentially irreversible disorder.
• You may experience psychiatric reactions the first time you take this medication. If you suffer from depressionor psychosis, your symptoms may worsen with treatment with this medication. In rare cases, depression or psychosis may progress to suicidal thoughts, attempted suicide, or completed suicide. If this occurs, stop taking this medication and contact your doctor immediately.
• Quinolone antibiotics may cause an increase in your blood sugar levelsabove normal levels (hyperglycemia) or a decrease in your blood sugar levelsbelow normal levels, which in severe cases can lead to loss of consciousness (hypoglycemic coma) (see section 4). This is important for people with diabetes. If you have diabetes, your blood sugar levels should be carefully monitored.
• Diarrheamay develop while you are taking antibiotics, including this medication, or even several weeks after you have stopped taking them. If the diarrhea becomes intense or persistent, or if you notice that the stools contain blood or mucus, stop taking this medication immediately, as it can be life-threatening. Do not take medications that stop or slow down bowel movements, and consult your doctor.
• While taking this medication, inform your doctor or laboratory personnel if you need to undergo a blood or urine test.
• This medication can cause liver damage. If you notice symptoms such as loss of appetite, jaundice (yellowing of the skin), dark urine, itching, or stomach pain, stop taking Ciprofloxacin Alter immediately and consult your doctor immediately.
• If you have kidney problems, inform your doctor, as your dose may need to be adjusted.
• This medication can cause a decrease in the white blood cell countand may decrease your resistance to infections. If you experience an infection with symptoms such as fever and severe deterioration of your general condition, or fever with symptoms of local infection such as sore throat/pharynx/mouth, or urinary problems, consult your doctor immediately. They will perform a blood test to examine the possible decrease in white blood cells (agranulocytosis). It is essential that you inform your doctor about your medication.
• Inform your doctor if you or a family member has a confirmed deficiency of glucose-6-phosphate dehydrogenase (G6PD), as you may be at risk of anemia with ciprofloxacin.
• Your skin becomes more sensitive to sunlight or ultraviolet (UV) lightwhen taking this medication. Avoid exposure to intense sunlight or artificial UV light, such as tanning booths.
• Consult an ophthalmologist immediately if you experience any changes in your vision or have any eye problems.

Taking Ciprofloxacin Alter with other medications

Inform your doctor or pharmacist if you are using, have recently used, or might use any other medications.

Do not take Ciprofloxacin Alter at the same time as tizanidine, as this may cause adverse effects such as low blood pressure and drowsiness (see section 2: Do not take Ciprofloxacin Alter).

It is known that the following medications interact with this medication in your body. If you take this medication at the same time as these medications, it may affect the therapeutic effect of these medications. It may also increase the likelihood of experiencing adverse effects.

Inform your doctor if you are taking:

• vitamin K antagonists (e.g., warfarin, acenocoumarol, phenprocoumon, or fluindione) or other oral anticoagulants (to thin the blood)
• probenecid (for gout)
• methotrexate (for certain types of cancer, psoriasis, rheumatoid arthritis)
• theophylline (for respiratory problems)
• tizanidine (for muscle spasticity in multiple sclerosis)
• olanzapine (an antipsychotic)
• clozapine (an antipsychotic)
• ropinirole (for Parkinson's disease)
• phenytoin (for epilepsy)
• metoclopramide (for nausea and vomiting)
• cyclosporine (for skin diseases, rheumatoid arthritis, and organ transplants)
• other medications that may alter your heart rhythm: antiarrhythmic medications (e.g., quinidine, hydroquinidine, disopyramide, amiodarone, sotalol, dofetilide, ibutilide), tricyclic antidepressants, some antimicrobials (that belong to the macrolide group), some antipsychotics.

This medication may increaseblood levels of the following medications:

• pentoxifylline (for circulatory disorders)
• caffeine
• duloxetine (for depression, diabetic neuropathic pain, or incontinence)
• lidocaine (for heart conditions or anesthetic use)
• sildenafil (e.g., for erectile dysfunction)

Some medications decreasethe effect of this medication. Inform your doctor if you are taking or plan to take:

• antacids
• omeprazole
• mineral supplements
• sucralfate
• a polymeric phosphate binder (e.g., sevelamer or lanthanum carbonate)
• medications or supplements that contain calcium, magnesium, aluminum, or iron

If these preparations are essential, take this medication approximately twohours before or fourhours after you have taken these preparations.

Taking Ciprofloxacin Alter with food and drinks

Although you can take this medication with meals, you should not eat or drink any dairy products (such as milk or yogurt) or beverages with added calcium when taking the tablets, as they may affect the absorption of the active substance.

Pregnancy and breastfeeding

If you are pregnant or breastfeeding, think you may be pregnant, or plan to become pregnant, consult your doctor or pharmacist before using this medication.

It is preferable to avoid using this medication during pregnancy.

Do not take this medication during breastfeeding, as ciprofloxacin is excreted in breast milk and may harm your baby.

Driving and using machines

This medication may decrease your alertness. Some neurological effects may occur. Therefore, make sure you know how you react to this medication before driving a vehicle or using a machine. In case of doubt, consult your doctor.

3. How to take Ciprofloxacino Alter

Follow exactly the administration instructions of this medication indicated by your doctor. In case of doubt, consult your doctor or pharmacist again.

Your doctor will explain exactly what amount of this medication you should take, how often, and for how long. This will depend on the type of infection you have and its severity.

Inform your doctor if you have kidney problems because it may be necessary to adjust your dose.

Treatment usually lasts from 5 to 21 days, but it can last longer for severe infections. Take the tablets exactly as your doctor has indicated. If you have doubts about how many Ciprofloxacino Alter tablets you should take and how you should take them, ask your doctor or pharmacist how many tablets you should take and how you should take them.

1. Swallow the tablets with a large amount of liquid. Do not chew the tablets because their taste is not pleasant.
2. Try to take the tablets at the same time every day.
3. You can take the tablets with or between meals. The calcium you take as part of a meal will not seriously affect the absorption of the medication. However, do not take Ciprofloxacino Alter tablets with dairy products such as milk or yogurt, or with fruit juices enriched with minerals (e.g., calcium-enriched orange juice).

Remember to drink a large amount of liquids while taking this medication.

If you take more Ciprofloxacino Alter than you should

In case of overdose or accidental ingestion, consult your doctor or pharmacist immediately or call the Toxicology Information Service, phone: 91 562 04 20, indicating the medication and the amount ingested.

If you forget to take Ciprofloxacino Alter

Take the normal dose as soon as possible and then continue the treatment as prescribed. However, if it is almost time for your next dose, do not take the missed dose and continue as usual. Do not take a double dose to make up for missed doses. Make sure to complete the treatment cycle.

If you interrupt treatment with Ciprofloxacino Alter

It is important that you complete the full treatment, even if you start to feel better after a few days. If you stop taking this medication too soon, your infection may not be completely cured and the symptoms may worsen. You may develop resistance to the antibiotic.

If you have any other doubts about the use of this medication, ask your doctor or pharmacist.

4. Possible side effects

Like all medications, this medication can cause side effects, although not all people experience them.

Frequent:may affect up to 1 in 10 people

• nausea, diarrhea
• joint pain in children

Uncommon:may affect up to 1 in 100 people

• fungal superinfections
• a high concentration of eosinophils, a type of white blood cell
• decreased appetite
• hyperactivity or agitation
• headache, dizziness, sleep problems or taste disorders
• vomiting, abdominal pain, digestive problems such as slow digestion (indigestion/heartburn) or flatulence
• increased levels of certain substances in the blood (transaminases and/or bilirubin)
• skin rash, itching or hives
• joint pain in adults
• renal impairment
• muscle and bone pain, feeling of discomfort (asthenia) or fever
• increased alkaline phosphatase in blood

Rare:may affect up to 1 in 1,000 people

• inflammation of the intestine (colitis) associated with antibiotic use (can be fatal in very rare cases) (see section 2: Warnings and precautions)
• changes in blood cell count (leukopenia, leukocytosis, neutropenia, anemia), increase or decrease in blood clotting factor levels (thrombocytes)
• allergic reaction, swelling (edema) or rapid swelling of the skin and mucous membranes (angioedema)
• increased blood sugar (hyperglycemia)
• decreased blood sugar (hypoglycemia) (see section 2: Warnings and precautions)
• confusion, disorientation, anxiety reactions, strange dreams, depression (potentially leading to suicidal thoughts, suicide attempts, or completed suicides) or hallucinations
• tingling and numbness, unusual sensitivity to sensory stimuli, decreased skin sensitivity, tremors, convulsions (see section 2: Warnings and precautions) or dizziness
• vision problems (including double vision)
• tinnitus (ringing in the ears), hearing loss, hearing impairment
• increased heart rate (tachycardia)
• expansion of blood vessels (vasodilation), decreased blood pressure or fainting
• breathing difficulties, including asthma-like symptoms
• liver disorders, jaundice (cholestatic jaundice), hepatitis
• photosensitivity (see section 2: Warnings and precautions)
• muscle weakness, tendon inflammation, tendon rupture - especially the long tendon in the back of the ankle (Achilles tendon) (see section 2: Warnings and precautions), worsening of myasthenia gravis symptoms (see section 2: Warnings and precautions)

Very rare:may affect up to 1 in 10,000 people

• a special type of decrease in blood cell count (hemolytic anemia), a dangerous decrease in a type of white blood cell (agranulocytosis), a decrease in the number of white and red blood cells and platelets (pancytopenia), with a risk of death, and bone marrow depression, also with a risk of death (see section 2: Warnings and precautions)
• severe allergic reactions (anaphylactic reaction or anaphylactic shock, with a risk of death, serum sickness) (see section 2: Warnings and precautions)
• mental disorders (psychotic reactions potentially leading to suicidal thoughts, suicide attempts, or completed suicides) (see section 2: Warnings and precautions)
• migraine, coordination disorder, walking instability (gait disorders), disorders of the sense of smell (olfactory disorders); brain pressure (intracranial pressure and pseudotumor cerebri)
• visual color distortions
• inflammation of the blood vessel wall (vasculitis)
• pancreatitis
• death of liver cells (liver necrosis), which can very rarely lead to liver failure with a risk of death
• small pinpoint bleeding under the skin (petechiae), various skin rashes or exanthems (e.g., Stevens-Johnson syndrome with a risk of death or toxic epidermal necrolysis)
• muscle weakness, tendon inflammation, tendon rupture - especially the long tendon in the back of the ankle (Achilles tendon) (see section 2: Warnings and precautions), worsening of myasthenia gravis symptoms (see section 2: Warnings and precautions)

Frequency not known(cannot be estimated from available data):

• nervous system problems such as pain, burning, tingling, numbness, and/or weakness in the limbs (peripheral neuropathy and polyneuropathy)
• abnormal and potentially life-threatening heart rhythm, irregular heart rhythm with a risk to life, alteration of heart rhythm (called "prolongation of the QT interval", observed in the ECG, heart electrical activity)
• pustular rash
• influence on blood coagulation (in patients treated with vitamin K antagonists)
• syndrome associated with inadequate water secretion and low sodium concentrations (SIADH, by its English acronym)
• loss of consciousness due to a severe decrease in blood sugar levels (hypoglycemic coma). See section 2.

The administration of antibiotics containing quinolones and fluoroquinolones has been associated with very rare cases of long-lasting (even months or years) or permanent adverse reactions, such as tendon inflammation, tendon rupture, joint pain, limb pain, walking difficulties, abnormal sensations such as pinching, tingling, prickling, burning, numbness, or pain (neuropathy), fatigue, decreased memory and concentration, effects on mental health (which can include sleep disorders, anxiety, panic attacks, depression, and suicidal thoughts), also decreased hearing, vision, taste, and smell, in some cases regardless of the presence of pre-existing risk factors.

There have been reports of increased size and weakening or tearing of the aortic wall (aneurysms and dissections), which could lead to rupture and be fatal, and heart valve failure in patients who have received fluoroquinolones. See also section 2.

Reporting of side effects

If you experience any type of side effect, consult your doctor or pharmacist, even if it is a possible side effect that does not appear in this prospectus. You can also report them directly through the Spanish Pharmacovigilance System for Human Use Medicines: https://www.notificaram.es. By reporting side effects, you can contribute to providing more information on the safety of this medication.

5. Conservation of Ciprofloxacino Alter

Keep this medication out of sight and reach of children.

Do not use this medication after the expiration date that appears on the packaging or blister, after "CAD". The expiration date is the last day of the month indicated.

Medications should not be thrown down the drain or into the trash. Deposit the packaging and unused medications at the SIGRE Point in the pharmacy. In case of doubt, ask your pharmacist how to dispose of the packaging and unused medications. This way, you will help protect the environment.

6. Package contents and additional information

Composition of Ciprofloxacino Alter

• The active ingredient is Ciprofloxacin. Each tablet contains 250 mg of ciprofloxacin (as hydrochloride).
• The other components are: Core:microcrystalline cellulose, sodium carboxymethyl starch (type A) (from potato), crospovidone, anhydrous colloidal silica, and magnesium stearate. Coating:hypromellose, titanium dioxide (E-171), and glycerol triacetate.

Appearance of the product and package contents

Ciprofloxacino Alter 250 mg film-coated tablets are presented in the form of film-coated, lenticular-shaped tablets, white in color, scored on one side.

Each package contains 14 tablets.

Marketing authorization holder and manufacturer

Laboratorios ALTER, S.A.

Mateo Inurria, 30

28036 Madrid

Date of the last revision of this prospectus: March 2025

Detailed and updated information on this medication is available on the website of the Spanish Agency for Medicines and Health Products (AEMPS) http://www.aemps.gob.es/

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Medical advice/education

Antibiotics are used to cure bacterial infections. They are not effective against viral infections.

If your doctor has prescribed antibiotics, you need them precisely for your current illness. Despite antibiotics, some bacteria may survive or grow. This phenomenon is known as resistance: some antibiotic treatments become ineffective.

Misuse of antibiotics increases resistance. You can even help bacteria become more resistant and, therefore, delay your recovery or decrease the effectiveness of antibiotics if you do not respect:

• the dose
• the program
• the duration of treatment

Consequently, to maintain the effectiveness of this medication:

1. Use antibiotics only when they are prescribed.
2. Follow the prescription strictly.
3. Never reuse an antibiotic without a medical prescription, even if you want to treat a similar illness.
4. Never give your antibiotic to another person; it may not be suitable for their illness.
5. After finishing a treatment, return all unused medications to the pharmacy, to ensure they are disposed of correctly.