Ciprofloxacin drug interactions

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

List of drug interactions


Food

Multivalent cation-containing products, highly buffered drugs, calcium-, iron-, or zinc-containing products

Metronidazole

Histamine H2-receptor antagonists

Sulfonylurea glyburide

Cyclosporine

Warfarin

Probenecid

Phenytoin

Methotrexate

Metoclopramide

Non-steroidal anti-inflammatory drugs

Tizanidine

Theophylline

Caffeine


Food

When Ciprofloxacin Tablets USP is given concomitantly with food, there is a delay in the absorption of the drug, resulting in peak concentrations that occur closer to 2 hours after dosing rather than 1 hour. The overall absorption of Ciprofloxacin Tablets USP, however, is not substantially affected. The pharmacokinetics of Ciprofloxacin given as the suspension are also not affected by food.

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Multivalent cation-containing products, highly buffered drugs, calcium-, iron-, or zinc-containing products

Concurrent administration of a quinolone, including Ciprofloxacin, with multivalent cation-containing products such as magnesium/aluminum antacids, sucralfate, Videx® (didanosine) chewable/buffered tablets or pediatric powder, other highly buffered drugs, or products containing calcium, iron, or zinc may substantially decrease its absorption, resulting in serum and urine levels considerably lower than desired.

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Metronidazole

The serum concentrations of Ciprofloxacin and metronidazole were not altered when these two drugs were given concomitantly.

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Histamine H2-receptor antagonists

Histamine H2-receptor antagonists appear to have no significant effect on the bioavailability of Ciprofloxacin.

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Sulfonylurea glyburide

The concomitant administration of Ciprofloxacin with the sulfonylurea glyburide has, on rare occasions, resulted in severe hypoglycemia.

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Cyclosporine

Some quinolones, including Ciprofloxacin, have been associated with transient elevations in serum creatinine in patients receiving cyclosporine concomitantly.

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Warfarin

Quinolones, including Ciprofloxacin, have been reported to enhance the effects of the oral anticoagulant warfarin or its derivatives. When these products are administered concomitantly, prothrombin time or other suitable coagulation tests should be closely monitored.

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Probenecid

Probenecid interferes with renal tubular secretion of Ciprofloxacin and produces an increase in the level of Ciprofloxacin in the serum. This should be considered if patients are receiving both drugs concomitantly. Return to top

Phenytoin

Altered serum levels of phenytoin (increased and decreased) have been reported in patients receiving concomitant Ciprofloxacin.

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Methotrexate

Renal tubular transport of methotrexate may be inhibited by concomitant administration of Ciprofloxacin potentially leading to increased plasma levels of methotrexate. This might increase the risk of methotrexate associated toxic reactions. Therefore, patients under methotrexate therapy should be carefully monitored when concomitant Ciprofloxacin therapy is indicated.

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Metoclopramide

Metoclopramide significantly accelerates the absorption of oral Ciprofloxacin resulting in shorter time to reach maximum plasma concentrations. No significant effect was observed on the bioavailability of Ciprofloxacin.

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Non-steroidal anti-inflammatory drugs

Non-steroidal anti-inflammatory drugs (but not acetyl salicylic acid) in combination of very high doses of quinolones have been shown to provoke convulsions in pre-clinical studies.

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Tizanidine

In a pharmacokinetic study, systemic exposure of tizanidine (4 mg single dose) was significantly increased (Cmax 7-fold, AUC 10-fold) when the drug was given concomitantly with Ciprofloxacin (500 mg bid for 3 days). The hypotensive and sedative effects of tizanidine were also potentiated. Concomitant administration of tizanidine and Ciprofloxacin is contraindicated.

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Theophylline

As with some other quinolones, concurrent administration of Ciprofloxacin with theophylline may lead to elevated serum concentrations of theophylline and prolongation of its elimination half-life. This may result in increased risk of a patient developing CNS or other adverse reactions. If concomitant use cannot be avoided, serum levels of theophylline should be monitored and dosage adjustments made as appropriate.

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Caffeine

Some quinolones, including Ciprofloxacin, have also been shown to interfere with the metabolism of caffeine. This may lead to reduced clearance of caffeine and a prolongation of its serum half-life. Ciprofloxacin also inhibits the formation of paraxanthine after caffeine administration.

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Complete List of Drug Interactions

Major Interactions

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Moderate Interactions

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Minor Interactions

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The content of this page is taken from the FDA package insert for this drug and should not be edited.

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