Sucralfate Ciprofloxacin

Proquin XR Proquin XR and other oral formulations of ciprofloxacin are not interchangeable. Proquin XR should be administered orally once daily for 3 days with a main meal of the day, preferably the evening meal. Proquin XR should be administered at least 4 hours before or 2 hours after antacids containing magnesium or aluminum, sucralfate, Videx (didanosine) chewable/buffered tablets or pediatric powder, metal cations such as iron, and multivitamin preparations containing zinc. Pragy/n XR tablets should be taken whole and never split, crushed, or chewed. 

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,... 

Interference with T4 absorption Cholestyramine, chromium picolinate, colestipol, ciprofloxacin, proton pump inhibitors, sucralfate, sodium polystyrene sulfonate, raloxifene, sevelamer hydrochloride, aluminum hydroxide, ferrous sulfate, calcium carbonate, bran, soy, coffee. 

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 a man with prostatitis, co-administration of ciprofloxacin and sucralfate resulted in treatment failure, presumably because of impaired absorption of ciprofloxacin... 

Spivey JM, Cummings DM, Pierson NR. Failure of prostatitis treatment secondary to probable ciprofloxacin-sucralfate drug interaction. Pharmacotherapy 1996 16(2) 314-16. 

If ciprofloxacin, a member of the fluoroquinolones family, is prescribed, then it should be given two hours before the patient is given antacids, ferrous sulfate, or sucralfate because these medications lower the absorption of ciprofloxacin. 

Brouwers JRBJ, van der Kam HJ, Sijtsma J, Proost JH. Important reduction of ciprofloxacin absorption by sucralfate and magnesium citrate solution. Drug Invest (1990) 2, 197-9. 

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. 

In a study in 8 healthy subjects sucralfate 1 g four times daily reduced the AUC and maximum serum concentration of ciprofloxacin 500 mg by 88% and 90%, respectively. ... 

Garrelts JC, Godley PJ, Peterie JD, Gerlach EH, Yakshe CC. Sucralfate significantly reduces ciprofloxacin concentrations in serum. Antimicrob Agents Chemother ( 990) 34, 931-3. 

Yuk JH, Nightingale CN, Quintiliani R. Ciprofloxacin levels when receiving sucralfate. JAMA(m9) 262, 901. 

Nix DE, Watson WA, Handy L, Frost RW, Rescott DL, Goldstein HR. The effect of sucralfate pretreatment on the pharmacokinetics of ciprofloxacin. Pharmacotherapy (1989) 9,377-80. 

Krueger WA, Ruckdeschel G, Unertl K. Influence of intravenously administered ciprofloxacin on aerobic intestinal microflora and fecal drug levels when administered simultaneously with sucralfate. Antimicrob Agents Chemother (1997) 41, 1725-30. 

---