Ciperus: detailed information

Patient Information Leaflet

CIPERUS 250 mg film-coated tablets, 500 mg film-coated tablets, 750 mg film-coated tablets

Ciprofloxacin
Generic medicine
Please read this entire leaflet carefully before taking this medicine, as it contains important information for you.

Keep this leaflet. You may need to read it again.
If you have any questions, consult your doctor or pharmacist.
This medicine has been prescribed for you only. Do not give it to others, even if their symptoms are the same as yours, as it could be harmful.
If you experience any adverse reactions, including those not listed in this leaflet, contact your doctor or pharmacist. See section 4.

Contents of this leaflet:

What CIPERUS is and what it is used for
What you need to know before taking CIPERUS
How to take CIPERUS
Possible side effects
How to store CIPERUS
Contents of the pack and other information

1. What CIPERUS is and what it is used for

CIPERUS contains the active substance ciprofloxacin, an antibiotic belonging to the family of fluorochinolones. Ciprofloxacin works by killing bacteria that cause infections. It is effective only against specific strains of bacteria.
Adults
CIPERUS is used in adults to treat the following bacterial infections:

respiratory tract infections;
long-lasting or recurrent ear or sinus infections;
urinary tract infections;
infections of the testicles;
genital infections in women;
gastrointestinal and intra-abdominal infections;
treatment of skin and soft tissue infections;
treatment of bone and joint infections;
prevention of infections caused by the bacterium Neisseria meningitidis;
exposure to inhalation of anthrax spores.

Ciprofloxacin may be used to treat patients with very low white blood cell count (neutropenia) who have fever suspected to be due to bacterial infection.
If you have a severe infection, or one caused by more than one type of bacteria, your doctor may prescribe another antibiotic in addition to CIPERUS.
Children and adolescents
CIPERUS is used in children and adolescents under specialist supervision:

to treat lung and bronchial infections in children and adolescents with cystic fibrosis;
to treat complicated urinary tract infections, including infections that have reached the kidneys (pyelonephritis);
to prevent and treat infections caused by inhalation of anthrax spores.

CIPERUS may also be used to treat other specific serious infections in children and adolescents, when considered necessary by the physician.

2. What you need to know before taking CIPERUS

Do not take CIPERUS

if you are allergic to ciprofloxacin, to other quinolones, or to any of the other ingredients of this medicine (listed in section 6);
if you are being treated with tizanidine, a muscle relaxant (see section “Other medicines and CIPERUS”).

Warnings and precautions
Before taking this medicine
Do not take quinolone/fluoroquinolone antibacterial medicines, including CIPERUS, if you have previously
experienced any serious adverse reaction during treatment with a quinolone or fluoroquinolone. In such a
case, inform your doctor as soon as possible.
Talk to your doctor or pharmacist before taking CIPERUS.
Before taking CIPERUS
Inform your doctor:

If you have kidney problems, as your treatment may need to be adjusted.
If you suffer from epilepsy or other neurological disorders.
If you have had tendon problems during previous treatment with antibiotics such as CIPERUS.
If you suffer from a type of muscle weakness called myasthenia gravis (a type of muscle weakness), as symptoms may worsen.
If you have experienced heart rhythm disturbances (arrhythmias).
If you have been diagnosed with enlargement or “bulging” of a large blood vessel (aortic aneurysm or peripheral aneurysm of a large blood vessel).
If you have previously experienced episodes of aortic dissection (a tear in the wall of the aorta).
If you have been diagnosed with insufficiency of one of the heart valves (aortic or mitral regurgitation).
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, vascular Ehlers-Danlos syndrome, Turner syndrome, Sjögren’s syndrome [an autoimmune inflammatory disease], or if you have vascular diseases such as Takayasu arteritis, giant cell arteritis, Behçet’s syndrome, known high blood pressure or atherosclerosis, rheumatoid arthritis [an autoimmune inflammatory disease], or endocarditis [inflammation of the heart]).
If you have heart problems. Particular caution is required when using CIPERUS if you were born with or have a family history of prolonged QT interval (seen on ECG, an electrical recording of the heart), have an electrolyte imbalance in the blood (especially low levels of potassium or magnesium in the blood), have a very slow heart rate (called bradycardia), have a weak heart (heart failure), have a history of heart attack (myocardial infarction), if you are female or elderly, or if you are taking other medicines that may cause abnormal changes on ECG (see section 2 “Other medicines and CIPERUS”).
Inform your doctor if you or a family member are known to have glucose-6-phosphate dehydrogenase (G6PD) deficiency, as you may be at risk of developing anaemia with ciprofloxacin.

For the treatment of certain genital tract infections, your doctor may prescribe another antibiotic in addition to
ciprofloxacin. If there are no symptoms of improvement after 3 days of treatment, consult your doctor.
While taking CIPERUS
Inform your doctor immediately if any of the following conditions occur during treatment with CIPERUS.
Your doctor will decide whether to discontinue treatment with CIPERUS.

A severe and sudden allergic reaction (an anaphylactic reaction/anaphylactic shock, angioedema). There is a remote possibility that a severe and sudden allergic reaction may occur even after the first dose, with the following symptoms: chest tightness, dizziness, nausea or fainting, dizziness upon standing. In such a case, stop treatment with CIPERUS and contact your doctor immediately.
Rarely, joint pain and swelling, and inflammation or rupture of tendons may occur. The risk is higher if you are elderly (over 60 years of age), have received an organ transplant, have kidney problems, or are being treated with corticosteroids. Tendon inflammation and rupture may occur within the first 48 hours of treatment and up to several months after stopping treatment with CIPERUS. At the first signs of tendon pain or inflammation (e.g. in the ankle, wrist, elbow, shoulder or knee), stop treatment with CIPERUS, consult your doctor, and rest the affected area. Avoid any unnecessary movement, as the risk of tendon rupture may increase.
If you suffer from epilepsy or other neurological disorders, such as cerebral ischemia or stroke, you may experience adverse effects on the central nervous system. In such a case, stop treatment with CIPERUS and contact your doctor immediately.
Psychiatric reactions may occur the first time you take CIPERUS. If you suffer from depression or psychosis, your symptoms may worsen during treatment with CIPERUS. In rare cases, depression and psychosis may progress to suicidal thoughts or self-harming behaviours such as suicide attempts or suicide (see section 4: Possible side effects). If you experience depression, psychosis, suicidal thoughts or behaviours, contact your doctor immediately.
Quinolone antibiotics may cause elevated blood sugar levels (hyperglycaemia) or lowered blood sugar levels below normal, which in severe cases may potentially lead to loss of consciousness (hypoglycaemic coma) (see section 4). This is particularly important for people with diabetes. If you have diabetes, your blood sugar levels must be closely monitored.
Rarely, symptoms of nerve damage (neuropathy) such as pain, burning, tingling, numbness and/or weakness, particularly in the feet and legs or hands and arms, may occur. In such a case, stop treatment with CIPERUS and contact your doctor immediately to prevent permanent nerve damage.
During treatment with antibiotics, including CIPERUS, or even several weeks after stopping treatment, you may develop diarrhoea. If it worsens or persists, or if you notice blood or mucus in your stools, stop taking CIPERUS immediately, as this may be a life-threatening condition. Do not take medicines that block or reduce intestinal movements and contact your doctor.
Inform your doctor or laboratory staff that you are taking CIPERUS if you need to undergo blood or urine tests.
CIPERUS may cause liver damage. If you notice symptoms such as loss of appetite, jaundice (yellowing of the skin), dark urine, itching, or abdominal pain, contact your doctor immediately.
CIPERUS may cause a reduction in the number of white blood cells, which may lead to decreased resistance to infections. If you develop an infection with symptoms such as fever and marked deterioration in your general condition, or fever with signs of localized infection such as sore throat or throat or mouth pain, or urinary problems, you must consult your doctor immediately. A blood test will be performed to check for a possible reduction in white blood cells (agranulocytosis). It is important that you inform your doctor about this medicine.
Inform your doctor if you or a family member have glucose-6-phosphate dehydrogenase (G6PD) deficiency, as you may be at risk of developing anaemia with ciprofloxacin (the active substance in CIPERUS).
If your vision decreases or if your eyes are otherwise affected, consult an ophthalmologist immediately.
While taking CIPERUS, your skin becomes more sensitive to sunlight or ultraviolet (UV) light. Avoid exposure to intense sunlight and artificial UV light, such as tanning beds.
During treatment with ciprofloxacin, crystals may appear in the urine. In such cases, your doctor will monitor you and advise you to drink plenty of fluids to ensure adequate hydration.
If you have kidney problems, inform your doctor, as you may need a dosage adjustment.
If you experience sudden, severe abdominal, chest, or back pain, which may be a sign of aneurysm or aortic dissection, go to the emergency room immediately. The risk may be higher if you are taking systemic corticosteroid medicines.
Inform your doctor immediately if you notice a sudden onset of shortness of breath, especially when lying down, or swelling of the ankles, feet, or abdomen, or new episodes of palpitations (sensation of rapid or irregular heartbeat).

Serious, prolonged, disabling, and potentially irreversible side effects
Fluoroquinolone/quinolone antibacterial medicines, including CIPERUS, have been associated with very rare but
serious side effects, some of which may be prolonged (lasting months or years), disabling, or may not improve.
These include tendon, muscle, and joint pain in the arms and legs, difficulty walking, abnormal sensations such as
pricking, tingling, itching, numbness, or burning (paraesthesia), sensory organ disturbances such as changes in
vision, taste, smell, or hearing, depression, memory impairment, severe fatigue, and severe sleep disturbances.
If you experience any of these side effects after taking CIPERUS, contact your doctor immediately before
continuing treatment. Your doctor will decide together with you whether to continue treatment and will
consider using an antibiotic from another class.
Other medicines and CIPERUS
Inform your doctor or pharmacist if you are taking, have recently taken, or might take any other medicines.
Do not take CIPERUS with tizanidine, a muscle relaxant, as it may cause side effects such as low blood pressure
and drowsiness (see section 2 “What you need to know before taking CIPERUS”).
Some medicines may interact with CIPERUS. If you take CIPERUS together with the medicines listed below,
the therapeutic effect of CIPERUS may be affected and the likelihood of side effects may increase.
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, or rheumatoid arthritis);
theophylline (for respiratory problems);
tizanidine (for muscle spasticity in multiple sclerosis);
metoclopramide, a medicine used to prevent nausea and vomiting;
clozapine (an antipsychotic);
olanzapine (an antipsychotic);
ropinirole (for Parkinson’s disease);
phenytoin (for epilepsy);
ciclosporin (to modulate the body’s immune response or to prevent organ transplant rejection);
glibenclamide (for diabetes);
other medicines that may alter heart rhythm: medicines belonging to the antiarrhythmic group (e.g. quinidine, hydroquinidine, disopyramide, amiodarone, sotalol, dofetilide, ibutilide), tricyclic antidepressants, some antimicrobials (belonging to the macrolide group), some antipsychotics;
zolpidem (for sleep disorders);

CIPERUS may increase blood levels of the following medicines:

pentoxifylline (for circulatory disorders);
caffeine;
duloxetine (for depression, diabetic neuropathy, or incontinence);
lidocaine (for heart problems or as an anaesthetic);
sildenafil (e.g. for erectile dysfunction);
agomelatine (for depression);

Certain medicines reduce the effect of CIPERUS. Inform your doctor if you are taking or plan to take:

antacids;
omeprazole;
mineral supplements;
sucralfate, used to control stomach acidity;
a polymeric phosphate binder (e.g. sevelamer or lanthanum carbonate), used to reduce elevated phosphate levels in the blood;
medicines or supplements containing calcium, magnesium, aluminium, or iron;
highly buffered drugs such as didanosine.

If these preparations are essential, take CIPERUS approximately two hours before or no sooner than four hours
after taking them.
CIPERUS with food and drink
Calcium consumed in food during meals does not significantly affect absorption. However, do not take dairy
products and derivatives (such as milk or yoghurt) or calcium-fortified drinks when taking the tablets, as they may
interfere with the absorption of the active substance.
You may take the tablets regardless of meals.
Taking the tablets on an empty stomach will result in faster absorption of the active substance.
Pregnancy and breastfeeding
If you are pregnant, suspect you may be pregnant, are planning a pregnancy, or are breastfeeding, consult your
doctor or pharmacist before taking this medicine.
Pregnancy
It is preferable to avoid using CIPERUS during pregnancy. Inform your doctor if you are planning a pregnancy.
Breastfeeding
Do not take CIPERUS while breastfeeding, as ciprofloxacin is excreted in breast milk and may be harmful to your
baby.
Driving and using machines
CIPERUS may affect your level of alertness. Since neurological side effects may occur, check your response to
CIPERUS before driving or operating machinery. If you have any doubts, discuss them with your doctor.
This medicine contains less than 1 mmol (23 mg) of sodium per tablet, i.e. essentially ‘sodium-free’.

3. How to take CIPERUS

Take this medicine exactly as instructed by your doctor or pharmacist. If you have any doubts, consult your doctor or pharmacist.
Your doctor will explain exactly how much CIPERUS you should take, how often, and for how long. This will depend on the type and severity of your infection.
Inform your doctor if you have kidney problems, as your dosage may need to be adjusted.
Treatment usually lasts from 5 to 21 days, but may be longer for severe infections. Always take the tablets exactly as directed by your doctor. Consult your doctor or pharmacist if you are unsure about how many tablets to take or how to take CIPERUS.

Instructions for administration
a. Swallow the tablets with plenty of liquid.
b. If you are unable to swallow the tablets, inform your doctor.
c. Do not chew the tablets, as they have an unpleasant taste.
d. Try to take the tablets at approximately the same time each day.
e. You may take the tablets with or without food. Calcium taken during meals does not significantly affect absorption. However, do not take CIPERUS tablets with dairy products such as milk or yogurt, or with mineral-fortified fruit juices (e.g. calcium-fortified orange juice).

Remember to drink plenty of fluids during treatment with CIPERUS.

If you take more CIPERUS than you should
If you take more than the prescribed dose, consult your doctor immediately. If possible, bring the tablets or the pack to show your doctor. If you have taken an excessive dose of CIPERUS, you may experience the following symptoms: dizziness, tremor, headache, fatigue, seizures, hallucinations, confusion, abdominal discomfort, impaired kidney and liver function, or presence of deposits or blood in the urine.

If you forget to take CIPERUS
If you forget to take CIPERUS and:

There are 6 hours or more before your next scheduled dose, take the missed dose immediately. Then take the next dose as scheduled.
There are less than 6 hours before your next scheduled dose, do not take the missed dose. Take the next dose as scheduled.

Do not take a double dose to make up for a forgotten dose. Make sure you complete the full course of treatment.

If you stop taking CIPERUS
It is important that you complete the full course of treatment, even if you start to feel better after a few days. If you stop taking this medicine too early, the infection may not be completely cured, and symptoms may return or worsen. You may also develop antibiotic resistance.

If you have any questions about the use of this medicine, consult your doctor or pharmacist.

4. Possible side effects

Like all medicines, this medicine can cause side effects, although not everyone will experience them.
If any of the side effects worsen, or if you notice any side effect not listed in this leaflet, please inform your doctor or pharmacist.
Stop taking Ciperus and contact your doctor immediately if you experience any of the following serious side effects, so that an alternative antibiotic treatment can be considered:

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

seizures (see section 2: Warnings and precautions)

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

severe and sudden allergic reaction with symptoms such as chest tightness, dizziness, feeling unwell or fainting, or dizziness upon standing (anaphylactic reaction/anaphylactic shock) (see section 2: Warnings and precautions)
muscle weakness, tendon inflammation which may lead to tendon rupture – especially of the large tendon at the back of the ankle (Achilles tendon) (see section 2: Warnings and precautions)
A life-threatening skin rash, usually presenting as blisters or ulcers in the mouth, throat, nose, eyes, and other mucous membranes such as the genital area, which may progress to widespread blistering or skin peeling (Stevens-Johnson Syndrome, Toxic Epidermal Necrolysis)

Not known (frequency cannot be estimated from available data):

unusual sensation of pain, burning, tingling, numbness, or muscle weakness in the extremities (neuropathy) (see section 2: Warnings and precautions)
A reaction causing skin rash, fever, internal organ inflammation, blood abnormalities, and systemic symptoms (DRESS: Drug Reaction with Eosinophilia and Systemic Symptoms, AGEP: Acute Generalized Exanthematous Pustulosis)

Other side effects observed during treatment with Ciperus are listed below, classified by frequency:

Common (may affect up to 1 in 10 people)

nausea, diarrhoea
joint pain and joint inflammation in children

Uncommon (may affect up to 1 in 100 people)

fungal superinfections
elevated levels of eosinophils, a type of white blood cell
loss of appetite (anorexia)
hyperactivity, restlessness
headache, dizziness, sleep disturbances, taste disturbances
vomiting, abdominal pain, digestive problems (stomach discomfort, indigestion/heartburn), flatulence
increased levels of certain substances in the blood (transaminases and/or bilirubin)
skin rash, itching, urticaria
joint pain in adults
reduced kidney function
muscle and bone pain, malaise (asthenia), fever
increased alkaline phosphatase in the blood (an enzyme produced by the liver)

Rare (may affect up to 1 in 1,000 people)

inflammation of the intestine (colitis) associated with antibiotic use (in very rare cases may be fatal) (see section 2 “Warnings and precautions”)
changes in blood cell counts (leucopenia, leukocytosis, neutropenia, anaemia), increase or decrease in a blood clotting factor (platelets)
allergic reaction, swelling (oedema), sudden swelling of the skin and mucous membranes (angioedema) (see section 2: Warnings and precautions)
increased blood sugar (hyperglycaemia)
decreased blood sugar (hypoglycaemia) (see section 2: Warnings and precautions)
confusion, disorientation, anxiety reaction, unusual dreams, depression (which in rare cases may progress to suicidal thoughts, suicide attempts or suicide), hallucinations (seeing or hearing things that are not real)
tingling, unusual sensitivity to sensory stimuli, reduced skin sensitivity, tremor, seizures (see section “Warnings and precautions”), dizziness
visual disturbances (diplopia)
tinnitus (ringing or noise in the ear), hearing loss, decreased hearing
rapid heartbeat (tachycardia)
dilation of blood vessels (vasodilation), low blood pressure, fainting
shortness of breath, including asthma-like symptoms (dyspnoea)
liver disorders, jaundice (cholestatic jaundice, yellowing of the skin), hepatitis
sensitivity to light (see section “Warnings and precautions”)
muscle pain, joint inflammation, increased muscle tone, cramps
kidney failure, blood or crystals in the urine (see section “Warnings and precautions”), inflammation of the urinary tract
fluid retention, excessive sweating
increased levels of the enzyme amylase

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

a specific type of reduction in red blood cells (haemolytic anaemia); a dangerous reduction in a type of white blood cells (agranulocytosis); reduction in red blood cells, white blood cells and platelets (pancytopenia), which may be fatal; bone marrow suppression, which may also be fatal (see section “Warnings and precautions”)
severe allergic reaction (anaphylactic reaction or anaphylactic shock, which may be fatal – serum sickness) (see section “Warnings and precautions”)
psychiatric disorders (psychotic reactions, which in rare cases may progress to suicidal thoughts, suicide attempts or suicide) (see section “Warnings and precautions”)
migraine, coordination disorders, unsteady gait (gait disturbances), disturbances in smell (olfactory disturbances), pressure in the brain (increased intracranial pressure including pseudotumor cerebri)
colour vision disturbances
inflammation of blood vessel walls (vasculitis)
pancreatitis (inflammation of the pancreas)
liver cell death (hepatic necrosis), which very rarely may lead to life-threatening liver failure
pinpoint bleeding under the skin (petechiae); various types of skin rashes (e.g., erythema multiforme, erythema nodosum, Stevens-Johnson Syndrome or Toxic Epidermal Necrolysis, potentially fatal)
muscle weakness, tendon inflammation, tendon rupture – especially of the large tendon at the back of the ankle (Achilles tendon) (see section “Warnings and precautions”); worsening of symptoms of myasthenia gravis (see section “Warnings and precautions”)

Frequency not known (cannot be estimated from available data)

nervous system disorders such as pain, burning, tingling, numbness and/or weakness in the extremities
severe heart rhythm abnormalities, irregular heartbeat (torsades de pointes)
changes in heart rhythm (known as “prolongation of the QT interval”, visible on ECG, a recording of the heart’s electrical activity)
acute generalized pustulosis
effects on blood clotting (in patients treated with vitamin K antagonists)
excessive excitement (mania) or feelings of extreme optimism and hyperactivity (hypomania)
hypersensitivity reaction called DRESS (Drug Reaction with Eosinophilia and Systemic Symptoms)
syndrome associated with impaired water excretion and low sodium levels (SIADH)
loss of consciousness due to severe drop in blood sugar levels (hypoglycaemic coma). See section 2

Very rare cases of prolonged (lasting months or years) or permanent adverse drug reactions, such as tendon inflammation, tendon rupture, joint pain, pain in arms or legs, difficulty walking, abnormal sensations such as pricking, tingling, itching, burning, numbness or pain (neuropathy), fatigue, impaired memory and concentration, effects on mental health (which may include sleep disturbances, anxiety, panic attacks, depression and suicidal ideation), changes in hearing, vision, taste and smell, have been associated with the use of quinolone and fluoroquinolone antibiotics, in some cases regardless of pre-existing risk factors.

Cases of aortic wall dilation and weakening or aortic wall tear (aneurysms and dissections), with possible rupture that may be fatal, as well as cases of regurgitation of blood from heart valves, have been reported in patients treated with fluoroquinolones. See also section 2.

Reporting of side effects

If you experience any side effect, including those not listed in this leaflet, please consult your doctor or pharmacist. You may also report side effects directly via the Italian Medicines Agency (Agenzia Italiana del Farmaco) at http://www.aifa.gov.it/content/segnalazioni-reazioni-avverse.

By reporting side effects, you can help provide more information on the safety of this medicine.

5. How to store CIPERUS

Keep this medicine out of the sight and reach of children.
This medicine requires no special storage conditions.
Do not use this medicine after the expiry date stated on the carton after "Exp.". The expiry date refers to the last day of that month.
Do not dispose of medicines via wastewater or household waste. Ask your pharmacist how to dispose of medicines you no longer use. This will help protect the environment.

6. Package contents and other information

What CIPERUS contains

The active substance is ciprofloxacin hydrochloride monohydrate.

CIPERUS 250 mg film-coated tablets
One film-coated tablet contains 291 mg of ciprofloxacin hydrochloride monohydrate, equivalent to 250 mg of
ciprofloxacin.
CIPERUS 500 mg film-coated tablets
One film-coated tablet contains 582 mg of ciprofloxacin hydrochloride monohydrate, equivalent to 500 mg of
ciprofloxacin.
CIPERUS 750 mg film-coated tablets
One film-coated tablet contains 873 mg of ciprofloxacin hydrochloride monohydrate, equivalent to 750 mg of
ciprofloxacin.

The other components are: microcrystalline cellulose (E460), sodium starch glycolate (type A), crospovidone (E1202), maize starch, anhydrous colloidal silica, magnesium stearate (E572), titanium dioxide (E171), hypromellose (E464), macrogol 4000.

Description of the appearance of CIPERUS and contents of the pack
Film-coated tablets
250 mg film-coated tablets: 10 tablets
500 mg film-coated tablets: 6 tablets
750 mg film-coated tablets: 12 tablets

Marketing Authorization Holder and Manufacturer
Marketing Authorization Holder
S.F. Group S.r.l. – Via Tiburtina, 1143 – 00156 Rome – Italy
Manufacturer
Laboratorio Farmacologico Milanese S.r.l. – Via Monterosso, 273 – 21042 Caronno Pertusella (VA)

Health advice/education
Antibiotics are used to treat bacterial infections. They are not effective against viral infections.
If your doctor has prescribed antibiotics, you need them specifically for your current illness.
Despite antibiotic treatment, certain bacteria may survive or grow. This phenomenon is known as
resistance: some antibiotic treatments become ineffective.
Improper use of antibiotics increases resistance. You may even promote the development of bacterial
resistance and delay recovery or reduce the effectiveness of antibiotics if you do not adhere to:

dosage
frequency of administration
duration of treatment

Therefore, to preserve the effectiveness of this medicine:
1 – Use antibiotics only when prescribed.
2 – Follow your doctor's instructions exactly.
3 – Do not reuse an antibiotic without a medical prescription, even if you are trying to treat a similar illness.
4 – Never give your antibiotics to another person; it may not be suitable for their illness.
5 – At the end of treatment, return all unused medicines to a pharmacy so they can be properly disposed of.