Clozapine ciprofloxacin

Clozapine 1A2 3A3/4, 2D6, 2C19 Fluvoxamine, ciprofloxacin, paroxetine Cigarette smoking... 

A possible pharmacokinetic interaction between ciprofloxacin, which inhibits CYP1A2, and clozapine, with moderately increased serum concentrations of clozapine, has been reported (249). 

Ciprofloxacin can alter plasma clozapine concentrations, perhaps by inhibition of cytochrome P450 enzymes... 

Raaska K, Neuvonen PJ. Ciprofloxacin increases serum clozapine and N-desmethylclozapine a study in patients with schizophrenia. Eur J Clin Pharmacol 2000 56(8) 585-9. 

CLOZAPINE, OLANZAPINE CIPROFLOXACIN t clozapine levels and possibly t olanzapine levels Ciprofloxacin inhibits CYP1A2 clozapine is primarily metabolized by CYP1A2, while olanzapine is partly metabolized by it Watch for the early features of toxicity to these antipsychotics. A1 in dose of clozapine and olanzapine may be required... 

Anecdotal data suggest that low doses (250 mg twice daily) of ciprofloxacin, a potent inhibitor of CYP1A2, result in a moderate elevation (about 30%) of clozapine plasma levels. There are anecdotal data suggesting that the addition of ciprofloxacin 250 mg twice daily almost doubles the plasma concentration of olanzapine. 

Ampicillin, cefotaxime, ceftazidine, ciprofloxacin, methicillin, sulfathiazole, sulfamethoxazole Carbamazepine, felbamate, mesantoin, phenytoin, valproic acid Cimetidine, ranitidine Amodiaquin, chloroquine, quinine Chlorpromazine, clozapine, mianserin... 

An isolated report describes the development of agitation in an elderly man taking clozapine, which was tentatively attributed to an interaction with ciprofloxacin. A study supports this observation. 

An elderly man with multi-infarct dementia and behavioural disturbances, taking clozapine, glibenclamide (glyburide), trazodone and melatonin, was hospitalised for agitation on the last day of a 10-day course of ciprofloxacin 500 mg twice daily. When the ciprofloxacin course was completed, his plasma clozapine serum levels fell from 90 nanograms/mL to undetectable levels (lower limit of detection being 50 nanograms/mL). ... 

This appears to be an isolated case but it is consistent with the way rifampicin interacts with other drugs. Clozapine serum levels should be well monitored if rifampicin is added, being alert for the need to increase its dosage. An alternative (as in this case) is to use another antibacterial. However, note that there are reports of an interaction between clozapine and ciprofloxacin , (p.749). 

Brouwers EE, Sohne M, Kuipers S, van Gorp EC, Schellens JH, Koks CH, Beijnen JH, Huitema AD. Ciprofloxacin strongly inhibits clozapine metabolism two case reports. Clin Drug Investig 2009 29(1) 59-63. 

Drug-drug interactions A case series of four patients reported elevation in clozapine serum levels with the coadministration of perazine, possibly through the inhibition of CYP1A2 [137 ]. Self-medication with St John s wort Hypericum perforatum), an inducer of CYP1A2, led to a reduction in clozapine levels and decompensation in a stable patient [138 ]. An increase in clozapine concentration is reported in a patient being treated for an infection with ciprofloxacin [139 ]. Pregabalin-associated increase of clozapine levels has been described [140 ]. 

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