Methotrexate Ciprofloxacin

Dalle JH, Auvrignon A, Vassal G, Leverger G, Possible ciprofloxacin-methotrexate interaction a report of 2 cases, Intersci Conf Antimicrob Agents Cnemother (2000) 40,477. 

The major types of drug therapy used in IBD include aminosalicylates, glucocorticoids, immunosuppressive agents (azathioprine, mercaptopu-rine, cyclosporine, and methotrexate), antimicrobials (metronidazole and ciprofloxacin), and agents to inhibit tumor necrosis factor-a (TNF-a) (anti-TNF-a antibodies). 

Drugs that may affect cyclosporine include allopurinol, amiodarone, androgens (eg, danazol, methyltestosterone), anticonvulsants (eg, carbamazepine, phenobarbital, phenytoin), azole antifungals (eg, fluconazole, ketoconazole), beta-blockers, bosentan, bromocriptine, calcium channel blockers, colchicine, oral contraceptives, corticosteroids, fluoroquinolones (eg, ciprofloxacin), foscarnet, HMG-CoA reductase inhibitors, imipenem-cilastatin, macrolide antibiotics, methotrexate, metoclopramide, nafcillin, nefazodone, orlistat, potassium-sparing diuretics, probucol, rifamycins (rifampin, rifabutin), serotonin reuptake inhibitors (SSRIs eg, fluoxetine, sertraline),... 

The present primary mode of therapy for these diseases involves the use 5-amino-salicylate (5-ASA) products. Often patients require additional medications, including corticosteroids, to help induce remission and various immune modulators, such as azathioprine, 6-mercaptopurine or methotrexate, to maintain remission. In Crohn s disease certain antibiotics, such as metronidazole and ciprofloxacin, and infliximab Remi-cade), an anti-tumor necrosis factor-a(TNFa) antibody, also have been used. The pharmacology of antibiotics, immunosuppressive drugs, and corticosteroids is discussed in Chapters 43,57, and 60, respectively. 

Methotrexate elimination can be delayed by ciprofloxacin. Two adolescents with malignant diseases had reduced elimination of methotrexate (12 g/m 4-hourly) when they took ciprofloxacin 500 mg bd (74). 

Clinically important, potentially hazardous interactions with abarelix, acenocoumarol, amisulpride, amprenavir, anisindione, anticoagulants, arsenic, astemizole, carbimazole, celiprolol, ciprofloxacin, dabigatran, degarelix, dicumarol, digoxin, diltiazem, enoxacin, fentanyl, fosamprenavir, gatifloxacin, grapefruit juice, lomefloxacin, methotrexate, moxifloxacin, nilotinib, norfloxacin, ofloxacin, oxprenolol, quinidine, quinolones, rifabutin, rifampin, rifapentine, ritonavir, simvastatin, sparfloxacin, sulpiride, tacrolimus, tipranavir, verapamil, warfarin, zuclopenthixol... 

Clinically important, potentially hazardous interactions with aspirin, ciprofloxacin, doxycycline, hypoglycemics, lomefloxacin, lymecycline, methotrexate, minocycline, tetracycline, warfarin... 

Transporter absorptive effects predominant Examples. Acyclovir, Amiloride -, Amoxicillin Atenolol Atropine, Bidisomide Bisphosphonates Captoprit, Cefazolin Cetirizine Cimetidine Ciprofloxacin, Cloxacillin Dicloxacillin Erythromycin - -, Famotidine Fexofenadine Folinic acid Furosemide, Ganciclovir Hydrochlorothiazide, Lisinopril Metformin Methotrexate, Nadolol Penicillins Pravastatin Ranitidine Tetracycline Trimethoprim Valsartan Zalcitabine... 

Chlorthalidone Ciprofloxacin Colistin Furosemide, Hydrochlorothiazide Mebendazole Methotrexate Neomycin... 

Noninterfering acetaminophen, N-acetylprocainamide, amikacin, amitriptyline, amlodi-pine, carbamazepine, cefotaxime, ceftazidime, chloramphenicol, ciprofloxacin, cisapride, clindamycin, clonidine, codeine, cyclosporine, digoxin, diphenhydramine, disopyramide, ethosuximide, fluconazole, gentamicin, gentamicin, heparin, labetalol, levothyroxine, li-docaine, lithium, methotrexate, metronidazole, minoxidil, nafcillin, nifedipine, phenobar-bital, phenobarbital, phenytoin, phenytoin, primidone, procainamide, propranolol, quini-dine, ranitidine, salicylic acid, theophylline, tobramycin, tobramycin, valproic acid, warfarin... 

A report describes two patients who developed methotrexate toxicity when they were given ciprofloxacin. 

When 2 patients with osteosarcoma, treated with high-dose methotrexate 12 give per course, were given ciprofloxacin 500 mg twice daily, either during or 2 days before the start of the methotrexate course, methotrexate elimination was delayed, resulting in raised serum levels, severe cutaneous toxicity and renal impairment. The first patient also had hepatic injury and haematological toxicity. Following increased folinic acid rescue, methotrexate levels normalised after several days. In earlier courses without ciprofloxacin in the first patient and subsequent courses without ciprofloxacin in the second patient, methotrexate elimination was normal. This preliminary report has subsequently been published in full. ... 

Not fully understood. Ciprofloxacin may displace methotrexate from its plasma-protein binding sites resulting in a rise in levels of unbound methotrexate. Ciprofloxacin may also cause a decrease in renal clearance of methotrexate. 

Jarfaut A, Santucci R, Leveque D, Herbrecht R. Severe methotrexate toxicity due to a concomitant administration of ciprofloxacin. Med Mai Infect 2013 43(1) 39 1. 

Nephrolithiasis, urinary crystals or debris Aciclovir, amoxicillin, atazanavir [17],ciprofloxacin, ephedrine/guaifenesin, floctafenine [18], indinavir [19], magnesium trisilicate, methotrexate, primidone, sulfasalazine [20], sulfonamides, triamterene [21,22] ceftriaxone [23,24] felbamate [25] ketamine [26] Djenkol beans [27] Microscopy, infrared spectroscopy. X-ray diffraction, mass spectroscopy... 

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