Ciprofloxacin interactions

Hoey LL, Lake KD. Does ciprofloxacin interact with cyclosporine Ann Pharmacother 1994 28(l) 93-6. 

Dalle JH, Auvrignon A, Vassal G, Leverger G, Kalifa C. Interaction methotrexate-ciprofloxacine a propos de deux cas d intoxication severe. [Methotrexate-ciprofloxacin interaction report of two cases of severe intoxication..] Arch Pediatr 2001 8(10) 1078-81. 

Bianco TM, Bussey HI, Farnett LE, Linn WD, Roush MK, Wong YW. Potential warfarin-ciprofloxacin interaction in patients receiving long-term anticoagulation. Pharmacotherapy 1992 12(6) 435-9. 

Dibasic sodium phosphate is incompatible with alkaloids, antipyrine, chloral hydrate, lead acetate, pyrogallol, resorcinol and calcium gluconate, and ciprofloxacin. Interaction between calcium and phosphate, leading to the formation of insoluble calcium-phosphate precipitates, is possible in parenteral admixtures. 

Roberge RJ, Kaplan R, Frank R, Fore C. Glyburide-ciprofloxacin interaction widi resistant h f co v(. AnnEmergMed(200(i) 36,160-3. 

HuURL. Possible phen3doin-ciprofloxacin interaction. ylnnP/wnwacoi/ier (1993) 27,1283. 

Cooper JG, Harboe K, Frost SK, Skadberg 0. Ciprofloxacin interacts with lh3n oid replacement... 

Absorption of antimicrobial agents such as fluoroquinolones and tetracyclines that can be bound by divalent and trivalent cations potentially could be compromised by administration with EN formulas containing these cations. The fluoroquinolones (e.g., levofloxacin and ciprofloxacin) have been best studied in this regard, and results of studies are not consistent. Mechanisms for an interaction between fluoroquinolones and EN formulas other than chelation by cations have been postulated.40 Some institutions hold tube feedings for 30 to 60 minutes or more before and after enteral dosages of fluoroquinolones. Because ciprofloxacin absorption has been shown to be decreased with jejunal administration, this drug probably should not be given by jejunal tube.41... 

There is an increased risk of hyperkalaemia when ciclosporin is given with Coversyl, which contains perindopril, an angiotensin-converting enzyme inhibitor. Risk of nephrotoxicity associated with ciclosporin is increased with concomitant use with quinolones. Ciproxin contains ciprofloxacin, which is a quinolone. Tenormin contains atenolol, which is a beta-adrenoceptor blocker and there are no interactions between these agents and ciclosporin. 

In patients allergic to penicillin, macrolides are usually indicated in mild respiratory tract infections. Zithromax contains azithromycin, which is a macrolide that may be indicated for respiratory tract infections. As opposed to clarithromycin (another macrolide), azithromycin does not present any significant clinical interaction with phenytoin. Ciproxin contains ciprofloxacin. 

The fluorinated 4-quinoline antibiotic ciprofloxacin (295) is known to interact with iron-containing drugs and mineral supplements. Stability constants have been determined for complex formation of iron(III) with ciprofloxacin, presumably acting as a bidentate 0,(9-donor, in aque-ous " and in micellar media. 

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,... 

T Pancreatic insulin release Metformin Peripheral insulin sensitivity hepatic glucose output/production i intestinal glucose absorption Dose Ist-line (naive pts), 1.25/250 mg PO daily-bid 2nd-line, 2.5/500 mg or 5/500 mg bid (max 20/2000 mg) take w/ meals, slowly T dose hold before 48 h after ionic contrast media Caution [C, -] Contra SCr >1.4 mg/dL in females or >1.5 mg/dL in males hypoxemic conditions (sepsis, recent MI) alcoholism metabolic acidosis liver Dz Disp Tabs SE HA, hypoglycemia, lactic acidosis, anorexia, N/V, rash Additional Interactions T Effects W/ amiloride, ciprofloxacin cimetidine, digoxin, miconazole, morphine, nifedipine, procainamide, quinidine, quinine, ranitidine, triamterene,... 

WARNING Exacerbation of ischemic heart Dz w/ abrupt D/C Uses HTN MI Action p-Adrenergic receptor blocker, pj, P2 Dose HTN 10-20 mg bid, up to 60 mg/d MI 10 mg bid Caution [C (1st tri D if 2nd or 3rd tri), +] Contra CHF, cardiogenic shock, bradycardia, heart block, COPD, asthma Disp Tabs SE Sexual dysfxn, arrhythmia, dizziness, fatigue, CHF Interactions t Effects W/ antihyper-tensives, ciprofloxacin, fentanyl, nitrates, quinidine, res pine t bradycardia and... 

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. 

About a week later, the patient was admitted to the hospital with acute onset of confusion and possible seizurelike activity. His wife states that he is compliant with medications and even felt well after initiation of antibiotics. Possible ciprofloxacin-induced acute CNS toxicity or drug interaction was suspected, and all his medications were discontinued. Which of the following is the possible explanation for the patient s acute onset of CNS toxicity ... 

B) Acute alcohol withdrawal was precipitated by ciprofloxacin due to an alcohol-drug interaction. 

Displacement of GABA from its receptors by ciprofloxacin results in increased levels of the neu-roexcitatory transmitter and acute CNS toxicity. The neuroexcitation can range from irritability, confusion, and agitation to seizures and toxic psychosis. Ciprofloxacin has no interaction with alcohol. A disulfiramlike reaction (flushing, nausea, vomiting, and profuse sweating) is associated with alcohol and metronidazole. Avoid alcohol and metronidazole coadministration. 

There are drug products whose interaction with PVC bags and infusion sets are so high that they must include labehng precautions for use with PVC containers. These drugs include antineoplastics such as pachtaxel, docetaxel, tacrolimus, and teniposide, and others such as ciprofloxacin, cefoperazone sodium, fluconazole, metronidazole HC1, cimetidine, and propofol [64,65]. 

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