This information is generalized and not intended as specific medical advice. Consult your healthcare professional before taking or discontinuing any drug or commencing any course of treatment.
Moderate. These medicines may cause some risk when taken together. Contact your healthcare professional (e.g. doctor or pharmacist) for more information.
How the interaction occurs:
Your medicine contains aluminum, calcium, iron, lanthanum, magnesium, and/or zinc, which are cations that may bind to your antibiotic in your digestive tract. This prevents your body from absorbing the antibiotic.
What might happen:
The blood levels of your antibiotic may be decreased, which will decrease the effectiveness in treating your infection.
What you should do about this interaction:
You should time when you take your antibiotic and your other medicine so that you do not take: ---ciprofloxacin for at least 2 hours before or 6 hours after oral cations. ---enoxacin for at least 2 hours before or 8 hours after oral cations. ---levofloxacin for at least 2 hours before or 2 hours after oral cations. ---nalidixic acid for at least 2 hours before or 2 hours after oral cations. ---norfloxacin for at least 2 hours before or 2 hours after oral cations. ---ofloxacin for at least 2 hours before or 2 hours after oral cations. ---sparfloxacin for at least 4 hours before oral cations.If you are taking lanthanum, your doctor may tell you to follow the above timing instructions or different ones, or your doctor may tell you to skip doses that you would normally take at the same time as your antibiotic.If you are not sure which antibiotic you are on, if you do not see your antibiotic listed, or if you have questions about the timing of doses of your medicine, contact your healthcare professionals (e.g. doctor or pharmacist). They may already be aware of this interaction and may be monitoring you for it. Do not start, stop, or change the dosage of any medicine before checking with them first.
1.Cipro (ciprofloxacin hydrochloride) US prescribing information. Bayer Corporation July, 2016.
2.Penetrex (enoxacin) US prescribing information. Aventis Pharmaceuticals, Inc. July, 1998.
3.Levaquin (levofloxacin) US prescribing information. Janssen Pharmaceuticals, Inc. July, 2016.
4.NegGram (nalidixic acid) US prescribing information. Sanofi-Synthelabo, Inc. November, 2012.
5.Noroxin (norfloxacin) US prescribing information. Merck & Co., Inc. July, 2016.
6.Floxin (ofloxacin) US prescribing information. Ortho-McNeil Pharmaceutical, Inc. February, 2011.
7.Zagam (sparfloxacin) US prescribing information. Bertek Pharmaceuticals, Inc. February, 2003.
8.Fosrenol (lanthanum carbonate) US prescribing information. Shire US Inc. February, 2016.
9.LePennec MP, Kitzis MD, Terdjman M, Foubard S, Garbarz E, Hanania G. Possible interaction of ciprofloxacin with ferrous sulphate. J Antimicrob Chemother 1990 Jan;25(1):184-5.
10.Spivey JM, Cummings DM, Pierson NR. Failure of prostatitis treatment secondary to probable ciprofloxacin-sucralfate drug interaction. Pharmacotherapy 1996 Mar-Apr;16(2):314-6.
11.Noyes M, Polk RE. Norfloxacin and absorption of magnesium-aluminum. Ann Intern Med 1988 Jul 15;109(2):168-9.
12.Sahai J, Gallicano K, Oliveras L, Khaliq S, Hawley-Foss N, Garber G. Cations in the didanosine tablet reduce ciprofloxacin bioavailability. Clin Pharmacol Ther 1993 Mar;53(3):292-7.
13.Videx (didanosine) US prescribing information. Bristol-Myers Squibb Company November, 2011.
14.Knupp CA, Barbhaiya RH. A multiple-dose pharmacokinetic interaction study between didanosine (Videx) and ciprofloxacin (Cipro) in male subjects seropositive for HIV but asymptomatic. Biopharm Drug Dispos 1997 Jan; 18(1):65-77.
15.Nix DE, Watson WA, Lener ME, Frost RW, Krol G, Goldstein H, Lettieri J, Schentag JJ. Effects of aluminum and magnesium antacids and ranitidine on the absorption of ciprofloxacin. Clin Pharmacol Ther 1989 Dec; 46(6):700-5.
16.Frost RW, Lasseter KC, Noe AJ, Shamblen EC, Lettieri JT. Effects of aluminum hydroxide and calcium carbonate antacids on the bioavailability of ciprofloxacin. Antimicrob Agents Chemother 1992 Apr;36(4):830-2.
17.Golper TA, Hartstein AI, Morthland VH, Christensen JM. Effects of antacids and dialysate dwell times on multiple-dose pharmacokinetics of oral ciprofloxacin in patients on continuous ambulatory peritoneal dialysis. Antimicrob Agents Chemother 1987 Nov;31(11):1787-90.
18.Kays MB, Overholser BR, Mueller BA, Moe SM, Sowinski KM. Effects of sevelamer hydrochloride and calcium acetate on the oral bioavailability of ciprofloxacin. Am J Kidney Dis 2003 Dec;42(6):1253-9.
19.Sahai J, Healy DP, Stotka J, Polk RE. The influence of chronic administration of calcium carbonate on the bioavailability of oral ciprofloxacin. Br J Clin Pharmacol 1993 Mar;35(3):302-4.
20.Lomaestro BM, Bailie GR. Effect of multiple staggered doses of calcium on the bioavailability of ciprofloxacin. Ann Pharmacother 1993 Nov; 27(11):1325-8.
21.Lomaestro BM, Bailie GR. Effect of staggered dose of calcium on the bioavailability of ciprofloxacin. Antimicrob Agents Chemother 1991 May; 35(5):1004-7.
22.Kato R, Ueno K, Imano H, Kawai M, Kuwahara S, Tsuchishita Y, Yonezawa E, Tanaka K. Impairment of ciprofloxacin absorption by calcium polycarbophil. J Clin Pharmacol 2002 Jul;42(7):806-11.
23.Brouwers JR, Van der Kam HJ, Sijtsma J, Proost JH. Decreased ciprofloxacin absorption with concomitant administration of ferrous fumarate. Pharm Weekbl Sci 1990 Oct 19;12(5):182-3.
24.Pazzucconi F, Barbi S, Baldassarre D, Colombo N, Dorigotti F, Sirtori CR. Iron-ovotransferrin preparation does not interfere with ciprofloxacin absorption. Clin Pharmacol Ther 1996 Apr;59(4):418-22.
25.Lehto P, Kivisto KT, Neuvonen PJ. The effect of ferrous sulphate on the absorption of norfloxacin, ciprofloxacin and ofloxacin. Br J Clin Pharmacol 1994 Jan;37(1):82-5.
26.Kara M, Hasinoff BB, McKay DW, Campbell NR. Clinical and chemical interactions between iron preparations and ciprofloxacin. Br J Clin Pharmacol 1991 Mar;31(3):257-61.
27.Polk RE, Healy DP, Sahai J, Drwal L, Racht E. Effect of ferrous sulfate and multivitamins with zinc on absorption of ciprofloxacin in normal volunteers. Antimicrob Agents Chemother 1989 Nov;33(11):1841-4.
28.How PP, Fischer JH, Arruda JA, Lau AH. Effects of lanthanum carbonate on the absorption and oral bioavailability of ciprofloxacin. Clin J Am Soc Nephrol 2007 Nov;2(6):1235-40.
29.Nix DE, Lebsack ME, Chapelsky M, Sedman AJ, Busch J, Norman A. Effect of oral antacids on disposition of intravenous enoxacin. Antimicrob Agents Chemother 1993 Apr;37(4):775-7.
30.Grasela TH Jr, Schentag JJ, Sedman AJ, Wilton JH, Thomas DJ, Schultz RW, Lebsack ME, Kinkel AW. Inhibition of enoxacin absorption by antacids or ranitidine. Antimicrob Agents Chemother 1989 May;33(5):615-7.
31.Martinez Cabarga M, Sanchez Navarro A, Colino Gandarillas CI, Dominguez-Gil A. Effects of two cations on gastrointestinal absorption of ofloxacin. Antimicrob Agents Chemother 1991 Oct;35(10):2102-5.
32.Pai MP, Allen SE, Amsden GW. Altered steady state pharmacokinetics of levofloxacin in adult cystic fibrosis patients receiving calcium carbonate. J Cyst Fibros 2006 Aug;5(3):153-7.
33.Nix DE, Wilton JH, Ronald B, Distlerath L, Williams VC, Norman A. Inhibition of norfloxacin absorption by antacids. Antimicrob Agents Chemother 1990 Mar;34(3):432-5.
34.Campbell NR, Kara M, Hasinoff BB, Haddara WM, McKay DW. Norfloxacin interaction with antacids and minerals. Br J Clin Pharmacol 1992 Jan; 33(1):115-6.
35.Sanchez Navarro A, Martinez Cabarga M, Dominguez-Gil Hurle A. Oral absorption of ofloxacin administered together with aluminum. Antimicrob Agents Chemother 1994 Oct;38(10):2510-2.
36.Akerele JO, Okhamafe AO. Influence of oral co-administered metallic drugs on ofloxacin pharmacokinetics. J Antimicrob Chemother 1991 Jul; 28(1):87-94.
37.Flor S, Guay DR, Opsahl JA, Tack K, Matzke GR. Effects of magnesium-aluminum hydroxide and calcium carbonate antacids on bioavailability of ofloxacin. Antimicrob Agents Chemother 1990 Dec; 34(12):2436-8.
38.Johnson RD, Dorr MB, Talbot GH, Caille G. Effect of Maalox on the oral absorption of sparfloxacin. Clin Ther 1998 Nov-Dec;20(6):1149-58.
39.Phansalkar S, van der Sijs H, Tucker AD, Desai AA, Bell DS, Teich JM, Middleton B, Bates DW. Drug-drug interactions that should be non-interruptive in order to reduce alert fatigue in electronic health records. J Am Med Inform Assoc 2012 Sep 25.