Enoxacin Caffeine

Caffeine [P] Ciprofloxacin, enoxacin, pipedemic acid, and to a lesser extent, norfloxacin, inhibit caffeine metabolism. 

The interaction between the quinolone antibacterials and CYP1A2 has been studied in some depth for enoxacin and pefloxacin. Both compounds have been shown to inhibit CYPlA2-mediated metabolism of caffeine in vitro (49). This in vitro inhibition translated into a twofold decrease in caffeine clearance by pefloxacin and a sixfold decrease in clearance by enoxacin (50). Because pefloxacin undergoes N-demethylation to norfloxacin (51) and norfloxacin is much more potent as an inhibitor than pefloxacin (50), the observed in vivo interaction seen for pefloxacin may, in part, be due to norfloxacin. Many other quinolone antibacterial agents have been investigated for their interaction with theophylline, and ciprofloxacin has also been shown to have notable inhibitory effects (52). 

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... 

CYP1A2 participates in the metabohsm of both enoxacin and caffeine, and inhibition of caffeine metabolism by enoxacin can cause adverse effects (131). 

Noninterfering adenosine, albuterol, alphenal, aspirin, caffeine, carbamazepine, cefazo-lin, cephalexin, cephalothin, cimetidine, ciprofloxacin, claforan, desipramine, enoxacin, fleroxacin, furosemide, hydralazine, hydrochlorothiazide, minoxidil, norfloxacin, pheny-toin, propafenone, sulindac, teicoplanin, theophylline, vancomycin Interfering some indocyanine green impurities... 

CYP1A2 caffeine, imipramine, paracetamol, theophylline cigarette smoke, omeprazole cimetidine, ciprofloxacin, enoxacin, fluvoxamine... 

Enoxacin markedly increases caffeine levels. The effects of caffeine derived from drinks such as tea, coffee or cola, would be expected to be increased. Pipemidic acid interacts to a lesser extent, and ciprofloxacin, norfloxacin and pefloxacin interact less still Fleroxacin, lomefloxacin, ofloxacin, rufloxacin, and trovafloxacin appear not to interact. 

It would seem that the metabolism (7V-demethylation) of caffeine is markedly reduced by some quinolones (notably pipemidic acid and enoxacin) resulting in greater levels and possibly greater effects. Other quinolones... 

Established interactions. Based on the results of two studies, on a scale of 100 to 0, the relative potencies of these quinolones as inhibitors of caffeine elimination have been determined as follows enoxacin 100, pipemidic acid 29, ciprofloxacin 11, norfloxacin 9 and ofloxacin 0. From further studies, clinafloxacin appears to be similar to enoxacin (profound effect), pefloxacin to norfloxacin (to which it is metabolised modest effect), and fleroxacin, lomefloxacin, rufloxacin, and trovafloxacin appear to behave like ofloxacin (no effect). Patients taking enoxacin might be expected to experience an increase in the effects of caffeine (such as headache, jitteriness, restlessness, insomnia) if, for example, they continue to drink their usual amounts of caffeine-containing drinks (tea, coffee, cola drinks, etc.). They should be warned to cut out or reduce their intake of caffeine if this occurs. The authors of one report suggest that patients with hepatic disorders, cardiac arrhythmias or latent epilepsy should avoid caffeine if they take enoxacin for one week or more. The effects of pipemidic acid arc less, and those of ciprofloxacin, norfloxacin and pefloxacin arc probably of little or no clinical importance. Fleroxacin, lomefloxacin, ofloxacin, rufloxacin, and trovafloxacin do not interact. 

Peloquin CA, Nix DE, Sedman AJ, Wilton JH, Toothaker RD, Harrisim NJ, Schentag JJ Fliarmacokinetics and clinical effects of caffeine alone and in combination with oral enoxacin Rev Infect Dis (1989) II (SuppI 5), S1095. 

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