May 23 2022




Active ingredient: ciprofloxacin

Ciprofloxacin hydrochloride can be taken before or after meals, although absorption may be faster on an empty stomach. Patients should be advised to drink fluids liberally and avoid taking dairy products or antacids containing magnesium or aluminum. The drug should be administered at least 2 hours before or 6 hours after antacids or mineral supplements that contain magnesium or aluminum [1] [2] [3].

The administration of oral ciprofloxacin with dairy products or calcium-fortified juices alone (ie without food) or a significant intake of calcium (over 800 mg) can reduce the absorption gastrointestinal of ciprofloxacin [4] [5].

In one study, a dose of 500 mg of ciprofloxacin with 300 ml of whole milk (360 mg of calcium, 33 mg magnesium) or plain yogurt (450 mg of calcium, 40 mg magnesium) decreased AUC by 33 and 36%, respectively, and lower peak plasma concentrations at 36 and 47%, respectively, compared with the administration of water.

The manufacturer claims that the absorption is not affected by an essential dietary calcium, ie forming part of the meals.

Caffeine has been shown to interfere with the metabolism and pharmacokinetics of ciprofloxacin. Avoid excessive consumption of this substance [6] [7 [8] [9] [10].

Ferrous sulfate and multivitamins with zinc significantly impair the absorption of ciprofloxacin and is likely to be clinically significant [11].

References:

1: Miyata K, Ohtani H, Tsujimoto M, Sawada Y. Antacid interaction with new quinolones: dose regimen recommendations based on pharmacokinetic modeling of clinical data for ciprofloxacin, gatifloxacin and norfloxacin and metal cations. Int J Clin Pharmacol Ther. 2007 Jan;45(1):63-70.
2: Arayne MS, Sultana N, Hussain F. Interactions between ciprofloxacin and antacids--dissolution and adsorption studies. Drug Metabol Drug Interact. 2005;21(2):117-29.
3: Gugler R, Allgayer H. Effects of antacids on the clinical pharmacokinetics of drugs. An update. Clin Pharmacokinet. 1990 Mar;18(3):210-9.
4: Akinleye MO, Coker HA, Chukwuani CM, Adeoye AW. Effect of Five Alive fruit juice on the dissolution and absorption profiles of ciprofloxacin. Nig Q J Hosp Med. 2007 Jan-Mar;17(1):53-7.
5: Neuhofel AL, Wilton JH, Victory JM, Hejmanowsk LG, Amsden GW. Lack of bioequivalence of ciprofloxacin when administered with calcium-fortified orange juice: a new twist on an old interaction. J Clin Pharmacol. 2002 Apr;42(4):461-6.
6: Parker AC, Preston T, Heaf D, Kitteringham NR, Choonara I. Inhibition of caffeine metabolism by ciprofloxacin in children with cystic fibrosis as measured by the caffeine breath test. Br J Clin Pharmacol. 1994 Dec;38(6):573-6.
7: Harder S, Fuhr U, Staib AH, Wolff T. Ciprofloxacin-caffeine: a drug interaction established using in vivo and in vitro investigations. Am J Med. 1989 Nov 30;87(5A):89S-91S.
8: Healy DP, Polk RE, Kanawati L, Rock DT, Mooney ML. Interaction between oral ciprofloxacin and caffeine in normal volunteers. Antimicrob Agents Chemother. 1989 Apr;33(4):474-8.
9: Harder S, Staib AH, Beer C, Papenburg A, Stille W, Shah PM. 4-quinolones inhibit biotransformation of caffeine. Eur J Clin Pharmacol. 1988;35(6):651-6. Erratum in: Eur J Clin Pharmacol 1989;36(1):100.
10: Staib AH, Stille W, Dietlein G, Shah PM, Harder S, Mieke S, Beer C. Interaction between quinolones and caffeine. Drugs. 1987;34 Suppl 1:170-4.
11: Polk RE, Healy DP, Sahai J, Drwal L, Racht E. Effect of ferrous sulfate and multivitamins with zinc on absorption of ciprofloxacin in normal volunteers. Antimicrob Agents Chemother. 1989 Nov;33(11):1841-4.