Sucralfate Norfloxacin

Magnesium trisilicate, when taken with drugs such as mebeverine hydrochloride, proguanil, norfloxacin, sucralfate, and tetracycline, may cause a reduction in bioavailability via binding or chelation. The dissolution rate of folic acid, erythromycin stearate, paracetamol, and chloroquine phosphate may be retarded by adsorption onto magnesium trisilicate. Antimicrobial preservatives, such as the parabens, may be inactivated by the addition of magnesium trisilicate. Magnesium trisilicate is also readily decomposed by mineral acids. 

Sucralfate [HP] Reduced gastrointestinal absorption of ciprofloxacin, norfloxacin, and probably other quinolones. 

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. 

In two separate crossover studies in eight healthy volunteers sucralfate 1 g reduced the systemic availability of both norfloxacin 400 mg and ofloxacin 400 mg (9). However, sucralfate had no effect when it was given 2 hours after the antibiotics. 

Lehto P, Kivisto KT. Effect of sucralfate on absorption of norfloxacin and ofloxacin. Antimicrob Agents Chemother 1994 38(2) 248-51. 

Sucralfate causes a marked reduction in the absorption of ciprofloxacin, enoxacin, gemifloxacin, lomefloxacin, moxifloxacin, ofloxacin, norfloxacin and sparfloxacin, but only a modest reduction in fleroxacin levels. 

A study in 8 healthy subjects found that sucralfate 1 g four times daily reduced the AUC of a single 400-mg dose of norfloxacin by 98%, when fak-en with the sucralfate, and by 42% when taken 2 hours after the sucralfate. Another study found a reduction of 91% in the AUC of norfloxacin 400 mg when it was taken with sucralfate 1 g, but no reduction when it was taken 2 hours before sucralfate. ... 

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