Sucralfate Quinolones

Multivalent cations (antacids, iron, sucralfate, zinc, vitamins, dairy, citric acid) didanosine Decreased absorption of quinolone Separate by 2 hours... 

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,... 

Like other aluminium salts, pulmonary aspiration of sucralfate can lead to acute lung injury. There is some systemic absorption of aluminium, which is probably significant only in patients with renal impairment. Administration can be associated with a degree of hypophosphataemia, and there is also interference with absorption of some other drugs, e.g. quinolone antibacterials, digoxin, quinidine, and warfarin. 

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

QUINOLONES SUCRALFATE i levels of these antibiotics L absorption of these antibiotics Give the antibiotics at least 2 hours before sucralfate... 

The pharmacokinetics of levofloxacin are unaffected by sucralfate taken 2 hours after the quinolone. 

In a study in 15 healthy subjects sucralfate 1 g four times daily reduced the maximum serum levels, the AUC and the relative bioavailability of sparfloxacin 400 mg daily by 39%, 47%, and 44%, respectively. In a study assessing staggered dosing of sucralfate 1.5 g on the pharmacokinetics of sparfloxacin 300 mg, the AUC was unaffected when sucralfate was given 4 hours after the quinolone, but was decreased by 34% when given 2 hours before, and 51% when given at the same time as sucralfate. ... 

The aluminium hydroxide component of sucralfate (about 200 mg in each gram) forms an insoluble chelate between the cation and the 4-keto and 3-carboxyl groups of the quinolone, which reduces its absorption. See Quinolones + Antacids or Calcium compounds , p.328 for more on this mechanism. 

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