"The U.S. Food and Drug Administration today announced its intention to take enforcement action against companies that manufacture and/or distribute certain unapproved prescription ear drop products (known as otic products) labeled to relieve ear "...
Otic Use Only
CETRAXAL (ciprofloxacin otic solution) is for otic use only. It should not be used for injection, for inhalation or for opical ophthalmic use.
CETRAXAL (ciprofloxacin otic solution) should be discontinued at the first appearance of a skin rash or any other ign of hypersensitivity.
Growth of Resistant Organisms with Prolonged Use
As with other anti-infectives, use of CETRAXAL (ciprofloxacin otic solution) may result in overgrowth of onsusceptible organisms, including yeast and fungi. If super-infection occurs, discontinue use and institute alternative therapy.
Lack of Clinical Response
If the infection is not improved after one week of therapy, cultures may help guide further treatment.
Carcinogenesis, Mutagenesis, and Impairment of Fertility
Long-term carcinogenicity studies in mice and rats have been completed for ciprofloxacin. After daily oral doses of 750 mg/kg (mice) and 250 mg/kg (rats) were administered for up to 2 years, there was no evidence that ciprofloxacin had any carcinogenic or tumorigenic effects in these species. No long-term studies of CETRAXAL (ciprofloxacin otic solution) have been performed to evaluate carcinogenic potential.
Eight in vitro mutagenicity tests have been conducted with ciprofloxacin, and the test results are listed below:
- Salmonella/Microsome Test (Negative)
- Escherichia coli DNA Repair Assay (Negative)
- Mouse Lymphoma Cell Forward Mutation Assay (Positive)
- Chinese Hamster V79 Cell HGPRT Test (Negative)
- Syrian Hamster Embryo Cell Transformation Assay (Negative)
- Saccharomyces cerevisiae Point Mutation Assay (Negative)
- Saccharomyces cerevisiae Mitotic Crossover and Gene Conversion Assay (Negative)
- Rat Hepatocyte DNA Repair Assay (Positive).
Two of the 8 in vitro tests were positive, but results of the following 3 in vivo test systems gave negative results:
- Rat Hepatocyte DNA Repair Assay
- Micronucleus Test (Mice)
- Dominant Lethal Test (Mice).
Fertility studies performed in rats at oral doses of ciprofloxacin up to 100 mg/kg/day revealed no evidence of impairment. This would be over 100 times the maximum recommended clinical dose of ototopical ciprofloxacin based upon body surface area, assuming total absorption of ciprofloxacin from the ear of a patient treated with CETRAXAL (ciprofloxacin otic solution) twice per day.
Use In Specific Populations
Pregnancy Category C.
Reproduction studies have been performed in rats and mice using oral doses of up to 100 mg/kg and intravenous (IV) doses up to 30 mg/kg and have revealed no evidence of harm to the fetus as a result of ciprofloxacin. In rabbits, ciprofloxacin (30 and 100 mg/kg orally) produced gastrointestinal disturbances resulting in maternal weight loss and an increased incidence of abortion, but no teratogenicity was observed at either dose. After intravenous administration of doses up to 20 mg/kg, no maternal toxicity was produced in the rabbit, and no embryotoxicity or teratogenicity was observed.
Animal reproduction studies have not been conducted with CETRAXAL (ciprofloxacin otic solution) . No adequate and well-controlled studies have been performed in pregnant women. Caution should be exercised when CETRAXAL (ciprofloxacin otic solution) is used by a pregnant woman.
Ciprofloxacin is excreted in human milk with systemic use. It is not known whether ciprofloxacin is excreted in human milk following otic use. Because of the potential for serious adverse reactions in nursing infants, a decision should be made whether to discontinue nursing or to discontinue the drug, taking into account the importance of the drug to the mother.
The safety and effectiveness of CETRAXAL (ciprofloxacin otic solution) in infants below one year of age have not been established. The efficacy of CETRAXAL (ciprofloxacin otic solution) in treating otitis externa in pediatric patients one year or older has been demonstrated in controlled clinical trials (seeClinical Studies).
There is no evidence that the otic administration of quinolones has any effect on weight bearing joints, even though systemic administration of some quinolones has been shown to cause arthropathy in immature animals.
No overall differences in safety and effectiveness have been observed between elderly and younger patients.This monograph has been modified to include the generic and brand name in many instances.
Last reviewed on RxList: 5/26/2009
Additional Cetraxal Information
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