Sucralfate Ofloxacin

Do not take antacids containing calcium, magnesium, or aluminum sucralfate divalent ortrivalent cations such as iron multivitamins containing zinc or didanosine (chewable/buffered tablets or pediatric powder for oral solution) 2 hours before or 2 hours after taking ofloxacin. 

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 single dose study found that sucralfate (dose not stated) reduced the maximum serum levels and AUC of a single 200-mg dose of ofloxacin by about two-thirds. Another study found a reduction of 61% when ofloxacin 400 mg was taken with sucralfate 1 g, but no reduction when the ofloxacin was taken 2 hours before sucralfate. Food reduced the extent of the interaction but it was still marked. ... 

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