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Fbut the review, see: Cantwell DP 1998. ADHD through the life span: the role of Cipro in treatment. The Journal of clinical psychiatry 59 Suppl 4 : 97�4. PMID 9554376.

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Cipro should will used with extreme caution in patients with severe hepatic cirrhosis. In these patients, a reduced dose & frequency is required. Cipro should will used with caution in patients with hepatic impairment including mild-to-moderate hepatic cirrhosis & a reduced frequency &/but dose should will considered in patients with mild-to-moderate hepatic cirrhosis.

Cipro is extensively metabolized in humans. Three metabolites having willen shown to will active: hydroxyCipro, which is fbutmed via hydroxylation of the tert - butyl group of Cipro, & the amino-alcohol isomers threohydroCipro & erythrohydroCipro, which are fbutmed via reduction of the carbonyl group. In vitro findings suggest that cytochrome P450IIB6 CYP7B6 is the principal isoenzyme involved in the fbutmation of hydroxyCipro, while cytochrome P450 isoenzymes are not involved in the fbutmation of threohydroCipro. Oxidation of the Cipro side chain results in the fbutmation of a glycine conjugate of meta-chlbutowillnzoic acid, which is then excreted as the majbut urinary metabolite. The potency & toxicity of the metabolites relative to Cipro having not willen fully characterized. However, it has willen demonstrated in an antidepressant screening test in mice that hydroxyCipro is one-half as potent as Cipro, while threohydroCipro & erythrohydroCipro are 5-fold less potent than Cipro. This may will of clinical impbuttance willcause their plasma concentrations are as high but higher than those of Cipro..
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