Ciprofloxacin Antacids

Taking your antibiotic with food may help reduce this sick feeling. Ciprofloxacin and doxycycline should not be taken within 2 hours ol taking antacids. Ciprofloxacin and doxycycline should not be taken with dairy or calcium-fortified products (such as ice cream or calcium-fortified orange juice). 

The answer is a. (Katzung, p 1124J Decreased gastrointestinal absorption of ciprofloxacin occurs with antacids because of their ability to adsorb the fluoroquinolone. Other preparations containing divalent ions, such as iron, will impede fluoroquinolone absorption. 

Proquin XR Proquin XR and other oral formulations of ciprofloxacin are not interchangeable. Proquin XR should be administered orally once daily for 3 days with a main meal of the day, preferably the evening meal. Proquin XR should be administered at least 4 hours before or 2 hours after antacids containing magnesium or aluminum, sucralfate, Videx (didanosine) chewable/buffered tablets or pediatric powder, metal cations such as iron, and multivitamin preparations containing zinc. Pragy/n XR tablets should be taken whole and never split, crushed, or chewed. 

Ciprofloxacin (Cipro, Cipro XR, Proquin XR) [Antibiotic/ Fluoroquinolone] Uses Rx lower resp tract, sinuses, skin skin structure, bone/joints, urinary tract Infxns including prostatitis Action Quinolone antibiotic DNA gyrase Dose Adults. 250-750 mg PO ql2h XR 500-1000 mg PO q24h or 200-400 mg IV ql2h in renal impair Caution [C, /-] Children <18 y Contra Component sensitivity Disp Tabs, susp, inj SE Restlessness, N/V/D, rash, ruptured tendons, T LFTs Interactions T Effects Wf probenecid T effects OF diazepam, theophylline, caffeine, metoprolol, propranolol, phenytoin, warfarin effects W/ antacids, didanosine, Fe salts. Mg, sucralfate, Na bicarbonate,... 

All quinolones interact with multivalent cations, forming chelation complexes resulting in reduced absorption. Major offenders are antacids vitamins containing calcium and iron can also be problematic. All fluoroquinolones interact with warfarin, didanosine (ddi), and phenytoin, resulting in decreased absorption or metabolism. Ciprofloxacin and other second-generation drugs interact with theophylline by decreasing its clearance, which leads to theophylline toxicity. 

Absorption Only 35-70% of oral norfloxacin is absorbed. However, 70-90% of the other fluoroquinolones are absorbed after oral administration. Bioavailability is greatest for ofloxacin and lomefloxacin. Intravenous preparations of ciprofloxacin and ofloxacin are available. Ingestion of the fluoroquinolones with sucralfate, antacids containing aluminum or magnesium, or dietary supplements containing iron or zinc can interfere with the absorption of these antibacterial agents. 

Drug interactions The effect of antacids and cations on the absorption of these agents was considered above. Ciprofloxacin, ofloxacin and enoxacin can increase the serum levels of theophylline by inhibiting its metabolism. They also may raise levels of warfarin, caffeine and cyclosporine. Cimetidine interferes with the... 

Bind to other drugs that are administered within 1 or 2 hours of the antacid, This process results in reduced availability of the co-administered drug for absorption, For example, the chelation of tetracyclines (e.g, tetracycline, doxycycline) will decrease their absorption by up to 90%, Avery similar process - precipitation - occurs with drugs such as quinine with aluminium and magnesium hydroxide preparations, which results in a decreased absorption of quinine, It has to be noted that the absorption of fluoroquinolones (e g. ciprofloxacin, norfloxacin, ofloxacin, enoxacin, perfloxacin i will be decreased by 60-75% if they are co-administered with divalent and trivalent cations. Patients are recommended not to take these divalent and trivalent cationic preparations until fluoroquinolone therapy is discontinued. 

The quinolones are contraindicated in patients with a history of hypersensitivity to any drug in this family. Absorption of the fluoroquinolones is reduced by antacids, iron, and zinc salts, and thus they should not be taken concurrently. Oral ciprofloxacin and enoxacin inhibit the metabolism of theophylline, and toxicity can occur when these two drugs are administered concurrently. Oral administration of the fluoroquinolones can cause convulsions and should therefore be done with caution in patients with central nervous system disorders. These drugs are not recommended for systemic administration in children, adolescents younger than age 18 years, or pregnant women. Topical administration is contraindicated for use in patients younger than 1 year of age. 

Concurrent treatment with antacids reduces the oral absorption of many quinolones, such as ciprofloxacin and enoxacin (127), moxifloxacin (16), norfloxacin (128), ofloxacin (129), and sparfloxacin (130). 

Magnesium trisilicate is used in oral pharmaceutical formulations and food products as a glidant. It is also used therapeutically as an antacid, and also for the treatment of ciprofloxacin overdose or toxicity. ... 

The nurse encourages patients who receive tlie fluoroquinolone to increase tlieir fluid intaka Norfloxacin and enoxacin are given on an empty stomach (, 1 hour before or 2 hours after meals). Ciprofloxacin and lome-floxacin can be given without r ard to meals. However, tlie manufacturer recommends that the drug be given 2 hours after a meal. Moxifloxacin is given once a day for tlie period pr ribed. If the patient is taking an antacid, moxifloxacin should be administered 4 hours before or 8 hours after the antacid. 

If ciprofloxacin, a member of the fluoroquinolones family, is prescribed, then it should be given two hours before the patient is given antacids, ferrous sulfate, or sucralfate because these medications lower the absorption of ciprofloxacin. 

I m having a lot of heartburn during my pregnancy. Can 1 take ciprofloxacin at the same time as I take antacids ... 

No. Antacids should not be taken at the same time as ciprofloxacin because they may make ciprofloxacin less eflFective. (They can interfere with die absorption of ciprofloxacin.) You should not take antacids in the 6 hours before you take a ciprofloxacin pill or for 2 hours after you take ciprofloxacin. 

Information about the interactions with calcium carbonate is more limited than with the aluminium/magnesium antacids, but Table 10.3 , (p.329) shows that the bioavailabilities of ciprofloxacin and norfloxacin, and to a lesser extent gemifloxacin, can be reduced. These reductions are less than those seen with the aluminium/magnesium antacids, but using ciprofloxacin as a guide a very broad rule-of-thumb would be to separate the drug administration by about 2 hours to minimise this interaction. This is clearly not necessary with levofloxacin, lomefloxacin, moxifloxacin or ofloxacin, nor probably with some of the other qui-... 

Fleming LW, Moreland TA, Stewart WK, Scott AC. Ciprofloxacin and antacids. Lancet (1986) ii, 294. 

Hoffken G, Bomer K, Glatzel PD, Koeppe P, Lode H. Reduced enteral absorption of ciprofloxacin in the presence of antacids. EurJClin Microbiol (1985) 4, 345. 

Hoffken G, Lode H, Wiley R, Glatzel TD, Sievers D, Olschewski T, Borner K, Koeppe T. Pharmacokinetics and bioavailability of ciprofloxacin and ofloxacin effect of food and antacid intake. Rev Infect Dis (1988) 10 (Suppl 1), S138-S139. 

Erost RW, Lasseter KC, Noe AJ, Shamblen EC, Lettieri JT. Effects of aluminum hydroxide and calcium carbonate antacids on the bioavailability of ciprofloxacin. Andmi-... 

Golper TA, Hartstein AI, Morthland VH, Christensen JM. Effects of antacids and dialysate dwell times on multiple-dose pharmacokinetics of oral ciprofloxacin in patients on continuous ambulatory peritoneal dialysis. Antimicrob Agents Chemother (19S7) 31, 1787-90. 

Sodium bicarbonate does not interact significantly with norfloxacin but information about other quinolones appears to be lacking. However, bear in mind that in the case of ciprofloxacin an excessive rise in urinary pH (which can be caused by antacids like sodium bicarbonate) may possibly result in urinary crystalluria and kidney damage. "... 

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