1. What Quinox is and what it is used for 
Quinox contains the active substance ciprofloxacin. Ciprofloxacin is an antibiotic belonging to the fluoroquinolone family. Ciprofloxacin works by killing bacteria that cause infections. It only works with specific strains of bacteria.
Adults: Quinox is used to treat the following bacterial infections: 
-   Respiratory tract infections.
-   Long lasting or recurring ear or sinus infections.
-   Urinary tract infections.
-   Genital tract infections in men and women.
-   Gastro-intestinal tract infections and intra-abdominal infections.
-   Skin and soft tissue infections.
-   Bone and joint infections.
-   To prevent infections due to the bacterium Neisseria meningitidis.
-   Anthrax inhalation exposure.
Ciprofloxacin may be used in the management of patients with low white blood cell counts (neutropenia) who have a fever that is suspected to be due to a bacterial infection.
If you have a severe infection or one that is caused by more than one type of bacterium, you may be given additional antibiotic treatment in addition to ciprofloxacin.
Children and adolescents
Quinox is used in children and adolescents, under specialist medical supervision, to treat the following bacterial infections: 
-    Lung and bronchial infections in children and adolescents suffering from cystic fibrosis. 
-    Complicated urinary tract infections, including infections that have reached the kidneys (pyelonephritis).
-    Anthrax inhalation exposure.
Quinox may also be used to treat other specific severe infections in children and adolescents when your doctor considers this as necessary.

2. Before you take Quinox
Do not take Quinox 
-    If you are allergic (hypersensitive) to the ciprofloxacin, to any other quinolone drugs or to any of the other ingredients of Quinox tablets. 
-    If you are taking tizanidine.
Warnings and precautions
Take special care with Quinox tablets: 
Before taking Quinox tablets, tell your doctor: 
-    If you have ever had kidney problems because your treatment may need to be adjusted. 
-    If you suffer from ‘fits’ or epilepsy or any other neurological conditions. 
-    If you have a history of tendon problems during previous treatment with antibiotics such as ciprofloxacin.
-    If you are diabetic because you may experience a risk of hypoglycaemia with ciprofloxacin. 
-    If you have myasthenia gravis (a type of muscle weakness) because symptoms can be exacerbated.
-    If you have heart problems. Caution should be taken when using Quinox, if you were born with or have family history of prolonged QT interval (seen on ECG, electrical recording of the heart), have salt imbalance in the blood (especially low level of potassium or magnesium in the blood), have a very slow heart rhythm (called ‘bradycardia’), have a weak heart (heart failure), have a history of heart attack (myocardial infarction), you are female or elderly or you are taking other medicines that result in abnormal ECG changes.  
-    If you or a member of your family is known to have a deficiency in glucose-6-phosphate dehydrogenase (G6PD), since you may experience a risk of anaemia with ciprofloxacin.
-    If you have been diagnosed with an enlargement or “Bulge” of a large blood vessel (aortic aneurysm or large vessel peripheral aneurysm).
-    If you have experienced a previous episode of aortic dissection (a tear in the aorta wall).
-    If you have a family history of aortic aneurysm or aortic dissection or other risk factors or predisposing conditions (e.g. connective tissue disorders such as marfan syndrome, or vascular Ehlers-Danlos syndrome, or vascular disorders such as takayasu arteries, giant cell arteries, Behcet’s disease, high blood pressure, or known atherosclerosis).
If you feel sudden, severe pain in your abdomen, chest or back, go immediately to an emergency room.
Fluoroquinolone antibiotics may cause significant decreases in blood sugar and certain mental health side effects. Blood sugar disturbances, including high blood sugar and low blood sugar, and that hypoglycemia can lead to coma.
The mental health side effects are disturbances in attention, disorientation, agitation, nervousness, memory impairment, and serious disturbances in mental abilities  called delirium. 
Tell your health care professionals if you are taking a diabetes medicine when he is considering prescribing an antibiotic, and also if you have low blood sugar or symptoms of it while taking a fluoroquinolone.
Early signs and symptoms of low blood sugar include: confusion, pounding heart or very fast pulse, dizziness, pale skin, feeling shaky, sweating, unusual hunger, trembling, headaches, weakness, irritability, unusual anxiety.
For the treatment of some genital tract infections, your doctor can prescribe another antibiotic in addition to ciprofloxacin. If there is no improvement in symptoms after 3 days of treatment, please consult your doctor.
While taking Quinox
Tell your doctor immediately, if any of the following occurs while taking Quinox. Your doctor will decide whether treatment with Quinox needs to be stopped.
-    Severe, sudden allergic reaction (an anaphylactic reaction/shock, angio-edema). Even with the first dose, there is a small chance that you may experience a severe allergic reaction with the following symptoms: tightness in the chest, feeling dizzy, sick or faint, or experiencing dizziness when standing up. If this happens, stop taking Ciprofloxacin and contact your doctor immediately.
-    Pain and swelling in the joints and tendinitis may occur occasionally, particularly if you are elderly and are also being treated with corticosteroids. Inflammation and ruptures of tendons may occur even with the first 48 hours of treatment or up to several months after discontinuation of Ciprofloxacin therapy. At the first sign of any pain or inflammation stop taking Ciprofloxacin, contact your doctor and rest the painful area. Avoid any unnecessary exercise, as this might increase the risk of a tendon rupture.
-    If you suffer from epilepsy or other neurological conditions such as cerebral ischemia or stroke, you may experience side effects associated with the central nervous system. If this happens, stop taking Ciprofloxacin and contact your doctor immediately.
-    You may experience psychiatric reactions the first time you take Ciprofloxacin. If you suffer from depression or psychosis, your symptoms may become worse under treatment with Ciprofloxacin. You may have distressing thoughts of harming yourself. In rare cases, depression or psychosis can progress to thoughts of suicide, suicide attempts, or completed suicide. If this happens, stop taking Ciprofloxacin and contact your doctor immediately.
-    You may rarely 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 and contact your doctor immediately.
-    Hypoglycemia has been reported most often in diabetic patients, predominantly in elderly population. If this happens, contact your doctor immediately.
-    Diarrhoea may develop while you are taking antibiotics, including Ciprofloxacin, or even several weeks after you have stopped taking them. If it becomes severe or persistent or you notice that your stool contains blood or mucus, stop taking Ciprofloxacin and contact your doctor immediately, as this can be life− threatening. Do not take medicines that stop or slow down bowel movements.
-    If your eyesight becomes impaired or if your eyes seem to be otherwise affected, consult an eye specialist immediately.
-    Your skin becomes more sensitive to sunlight or ultraviolet (UV) light when taking ciprofloxacin. Avoid exposure to strong sunlight, or artificial UV light such as sunbeds.
-    Tell the doctor or laboratory staff that you are taking Ciprofloxacin if you have to provide a blood or urine sample.
-    If you suffer from kidney problems, tell the doctor because your dose may need to be adjusted.
-    Ciprofloxacin may cause liver damage. If you notice any symptoms such as loss of appetite, jaundice (yellowing of the skin), dark urine, itching, or tenderness of the stomach, stop taking Ciprofloxacin and contact your doctor immediately.
-    Ciprofloxacin may cause a reduction in the number of white blood cells and your resistance to infection may be decreased. If you experience an infection with symptoms such as fever and serious deterioration of your general condition, or fever with local infection symptoms such as sore throat/ pharynx/ mouth or urinary problems you should see your doctor immediately. A blood test will be taken to check possible reduction of white blood cells (agranulocytosis). It is important to inform your doctor about your medicine.
Taking other medicines: 
Please tell your doctor or pharmacist if you are taking or have recently taken any other medicines, including those medicines obtained without a prescription. 
Do not take Quinox together with tizanidine, because this may cause side effects such as low blood pressure and sleepiness.
The following medicines are known to interact with Quinox in your body. Taking Quinox together with these medicines can influence the therapeutic effect of those medicines. It can also increase the probability of experiencing side effects.
Tell your doctor if you are taking: 
-    Vitamin K antagonists (e.g. warfarin, acenocoumarol, phenprocoumon or fluindione) or other oral anti-coagulants (to thin the blood).
-    Probenecid (for gout).
-    Methotrexate (for certain types of cancer, psoriasis, rheumatoid arthritis).
-    Theophylline (for breathing problems).
-    Tizanidine (for muscle spasticity in multiple sclerosis).
-    Clozapine (an antipsychotic).
-    Olanzapine (an antipsychotic).
-    Ropinirole (for Parkinson’s disease).
-    Phenytoin (for epilepsy).
-    Metoclopramide (used to treat nausea and vomiting). 
-    Cyclosporin (used to treat skin conditions: psoriasis, dermatitis, rheumatoid arthritis and in organ transplantation).
-    Other medicines that can alter your heart rhythm: Medicines that belong to the group of anti-arrhythmics (e.g. quinidine, hydroquinidine, disopyramide, amiodarone, sotalol, dofetilide, ibutilide), tricyclic antidepressants, some antimicrobials (that belong to the group of macrolides), some antipsychotics.
-    Zolpidem (for sleep disorders)
Quinox may increase the levels of the following medicines in your blood:
-    Pentoxifylline (for circulatory disorders).
-    Caffeine.
-    Duloxetine (for depression, diabetic nerve damage or incontinence).
-    Lidocaine (for heart conditions or anesthetic use).
-    Sildenafil (e.g. for erectile dysfunction).
-    Agomelatine (for depression).
Some medicines reduce the effect of Quinox. Tell your doctor if you take or wish to take:
-    Antacids, omeprazole, mineral supplements, sucralfate, a polymeric phosphate binder (e.g. sevelamer or lanthanum carbonate), medicines or supplements containing calcium, magnesium, aluminium or iron (e.g. didanosine tablets (an antiviral drug used to treat HIV)).
If these preparations are essential, take Quinox about two hours before or no sooner than four hours after them.
Taking Quinox with food and drink 
Unless you take Quinox during meals, do not eat or drink any dairy products (e.g. milk or yogurt) or drinks with added calcium when you take tablets, as they may affect the absorption of the ciprofloxacin.
Pregnancy and breast-feeding 
If you are pregnant or breast-feeding, think you may be pregnant or are planning to have a baby, ask your doctor or pharmacist for advice before taking this medicine.
It is preferable to avoid the use of Quinox during pregnancy.
Do not take Quinox during breast-feeding because ciprofloxacin is excreted in breast milk and can be harmful for your child.
Driving and using machines
Quinox may make you feel less alert. Some neurological adverse events can occur. Therefore, make sure you know how you react to Quinox before driving a vehicle or operating machinery. If in doubt, talk to your doctor.

3. How to take Quinox 
Your doctor will explain to you exactly how much Quinox you will have to take as well as how often and for how long. This will depend on the type of infection you have and how bad it is.
Tell your doctor if you suffer from kidney problems because your dose may need to be adjusted.
The treatment usually lasts from 5 to 21 days, but may take longer for severe infections. Always take this medicine exactly as your doctor has told you. Check with your doctor or pharmacist if you are not sure how many tablets to take and how to take Quinox.
-    Swallow the tablets with plenty of fluid. Do not chew the tablets because they do not taste nice.
-    Do try to take the tablets at around the same time every day.
-    You can take the tablets at mealtimes or between meals. Any calcium you take as part of a meal will not seriously affect uptake. However, do not take Quinox tablets with dairy products such as milk or yoghurt or with fortified fruit juices (e.g. calcium-fortified orange juice).
Remember to drink plenty of fluids while you are taking this medicine.
If you take more Quinox tablets than you should 
If you take more than the prescribed dose, get medical help immediately. If possible, take your tablets or the box with you to show the doctor.
If you forget to take Quinox tablets 
Take the normal dose as soon as possible and then continue 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 a forgotten dose. Be sure to complete your course of treatment.
If you stop taking Quinox tablets 
It is important that you finish the course of treatment even if you begin to feel better after a few days. If you stop taking this medicine too soon, your infection may not be completely cured and the symptoms of the infection may return or get worse. You might also develop resistance to the antibiotic. 
If you have any further questions on the use of this product, ask your doctor or pharmacist.

4. Possible side effects
Like all medicines, ciprofloxacin can cause side effects, although not everybody gets them.
Severe allergic reactions can occur very rarely. These can happen after the first dose or even after the treatment has stopped.
The following section contains the most serious side effects that you can recognize yourself:
Stop taking Quinox and contact your doctor immediately in order to consider another antibiotic treatment if you notice any of the following serious side effects:
Rare (may affect up to 1 in 1,000 people)
-    Cases of long lasting (up to months or years) or permanent adverse drug reactions, have been associated with quinolone and fluoroquinolone antibiotics.These may include tendon inflammations, tendon rupture, joint pain, pain in the limbs, difficulty in walking, abnormal sensations such as pins and needles, tingling, pricking, burning, numbness or pain (neuropathy), fatigue, sleep disorders, memory impairment, mental health effects which may include, but are not necessarily limited to, anxiety, panic attacks, confusion, or depression, as well as impairment of hearing, vision, and taste and smell. There are no medicines that have been established as being effective treatments for the symptoms of long lasting or disabling side effects associated with fluoroquinolones.
-    Seizure.
Very rare (may affect up to 1 in 10,000 people)
-    Severe, sudden allergic reaction with symptoms such as tightness in the chest, feeling dizzy, sick or faint, or experience dizziness when standing up (anaphylactic reaction/shock).
-    Muscle weakness, inflammation of the tendons which could lead to rupture of the tendon, particularly affecting the large tendon at the back of the ankle (Achilles tendon).
-    A serious life-threatening skin rash, usually in the form of blisters or ulcers in the mouth, throat, nose, eyes and other mucous membranes such as genitals which may progress to widespread blistering or peeling of the skin (Stevens-Johnson syndrome, toxic epidermal necrolysis).
Not known (frequency cannot be estimated from the available data)
-    Unusual feelings of pain, burning, tingling, numbness or muscle weakness in the extremities (neuropathy).
-    A drug reaction that causes rash, fever, inflammation of internal organs, hematologic abnormalities and systemic illness (DRESS Drug Reaction with Eosinophilia and Systemic Symptoms, AGEP Acute Generalised Exanthematous Pustulosis).
Other side effects which have been observed during treatment with Ciprofloxacin are listed below by how likely they are:
Common (may affect up to 1 in 10 people): 
-    Nausea, diarrhea. 
-    Joint pain and joint inflammation 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 (anorexia).
-    Hyperactivity or agitation. 
-    Headache, dizziness, sleeping problems, or taste disorders.
-    Vomiting, abdominal pain, digestive problems such as stomach upset (indigestion/ heartburn), or wind. 
-    Increased amounts of certain substances in the blood (transaminases and/or bilirubin).
-    Rash, itching, or hives.
-     joint pain in adults. 
-    Poor kidney function. 
-    Pain in your muscles and bones, feeling unwell (asthenia), or fever. 
-    Increase in blood alkaline phosphatase (a certain substance in the blood).
Rare (may affect up to 1 in 1000 people):
-    Inflammation of the bowel (colitis) linked to antibiotic use (can be fatal in very rare cases).
-    Changes to the blood count (leukopenia, leukocytosis, neutropenia, anaemia), increased or decreased amounts of a blood clotting factor (thrombocytes).
-    Allergic reaction, swelling (oedema), or rapid swelling of the skin and mucous membranes (angioedema). 
-    Increased blood sugar (hyperglycaemia). 
-    Decreased blood sugar (hypoglycaemia).
-    Confusion, disorientation, anxiety reactions, strange dreams, depression (potentially leading to thoughts of suicide, suicide attempts, or completed suicide), or hallucinations.
-    Pins and needles, unusual sensitivity to stimuli of the senses, decreased skin sensitivity, tremors, or giddiness.
-    Eyesight problems including double vision.
-    Tinnitus, loss of hearing, impaired hearing. 
-    Rapid heartbeat (tachycardia).
-    Expansion of blood vessels (vasodilation), low blood pressure, or fainting.
-    Shortness of breath, including asthmatic symptoms.
-    Liver disorders, jaundice (cholestatic icterus), or hepatitis.
-    Sensitivity to light.
-    Muscle pain, inflammation of the joints, increased muscle tone and cramping.
-    Kidney failure, blood or crystals in the urine, urinary tract inflammation.
-    Fluid retention or excessive sweating.
-    Increased levels of the enzyme amylase.
Very rare (may affect up to 1 in 10,000 people):
-    A special type of reduced red blood cell count (haemolytic anaemia); a dangerous drop in a type of white blood cells (agranulocytosis); a drop in the number of red and white blood cells and platelets (pancytopenia), which may be fatal; and bone marrow depression, which may also be fatal.
-    Allergic reaction called serum sickness-like reaction.
-    Mental disturbances (psychotic reactions potentially leading to thoughts of suicide, suicide attempts, or completed suicide).
-    Migraine, disturbed coordination, unsteady walk (gait disturbance), disorder of sense of smell (olfactory disorders), pressure on the brain (intracranial pressure and pseudotumor cerebri).
-    Visual colour distortions.
-    Inflammation of the wall of the blood vessels (vasculitis).
-    Pancreatitis.
-    Death of liver cells (liver necrosis) very rarely leading to life-threatening liver failure.
-    Small, pin-point bleeding under the skin (petechiae); various skin eruptions or rashes.
-    Worsening of the symptoms of myasthenia gravis. 
Not known (frequency cannot be estimated from the available data)
-    Syndrome associated with impaired water excretion and low levels of sodium (SIADH).
-    Feeling highly excited (mania) or feeling great optimism and overactivity (hypomania).
-    Abnormal fast heart rhythm, life-threatening irregular heart rhythm, alteration of the heart rhythm (called ‘prolongation of QT interval’, seen on ECG, electrical activity of the heart).
-    Influence on blood clotting (in patients treated with Vitamin K antagonists).
-     loss of consciousness due to severe decrease in blood sugar levels (hypoglycaemic coma).
Cases of an enlargement and weakening of the aortic wall or a tear in the aortic wall (aneurysms and dissections), which may rupture and may be fatal, and of leaking heart valves have been reported in patients receiving fluoroquinolones. 
If any of the side effects gets serious, or if you notice any side effects not listed in this leaflet, please tell your doctor or pharmacist.

5. How to store Quinox
Keep out of reach of children.
Store below 30°C.
Do not use beyond the expiry date or if the product shows any sign of deterioration.
Do not throw away any medicines via wastewater or household waste. Ask your pharmacist how to throw away the medicines you no longer use. These measures will help to protect the environment.