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Drug interactions between Cipro and ibuprofen

Results for the following 2 drugs:
Cipro (ciprofloxacin)
ibuprofen

Interactions between your drugs

Moderate

ciprofloxacin ↔ ibuprofen

Applies to:Cipro (ciprofloxacin) and ibuprofen

MONITOR: Coadministration with nonsteroidal anti-inflammatory drugs (NSAIDs) may potentiate the risk of central nervous system toxicity sometimes associated with fluoroquinolone use. The interaction has been reported most often with enoxacin. It may occur with other fluoroquinolones as well, but is poorly documented. The exact mechanism of interaction is unknown. Some investigators suggest that the piperazine ring of fluoroquinolones may inhibit the binding of gamma-aminobutyric acid (GABA) to brain receptors and that NSAIDs may synergistically add to this effect. Patients with a history of seizures may be at greater risk.

MANAGEMENT: Clinical monitoring for signs of CNS stimulation such as tremors, involuntary muscle movements, hallucinations, or seizures is recommended if fluoroquinolone antibiotics are prescribed in combination with NSAIDs.

References

  1. "Product Information. Raxar (grepafloxacin)." Glaxo Wellcome, Research Triangle Park, NC.
  2. "Product Information. Factive (gemifloxacin)." GeneSoft Inc, San Francisco, CA.
  3. "Product Information. Avelox (moxifloxacin)" Bayer, West Haven, CT.
  4. Davey PG "Overview of drug interactions with the quinolones." J Antimicrob Chemother 22(suppl c) (1988): 97-107
  5. "Product Information. Tequin (gatifloxacin)" Bristol-Myers Squibb, Princeton, NJ.
  6. Segev S. Rehavi M, Rubinstein E "Quinolones, theophylline, and diclofenac interactions with the gamma-aminobutyric acid receptor." Antimicrob Agents Chemother 32 (1988): 1624-6
  7. Domagala JM "Structure-activity and structure-side-effect relationships for the quinolone antibacterials." J Antimicrob Chemother 33 (1994): 685-706
  8. Hooper DC, Wolfson JS "The fluoroquinolones: pharmacology, clinical uses, and toxicities in humans." Antimicrob Agents Chemother 28 (1985): 716-21
  9. "Product Information. Cipro (ciprofloxacin)." Bayer, West Haven, CT.
  10. "Product Information. Levaquin (levofloxacin)." Ortho Pharmaceutical Corporation, Raritan, NJ.
  11. "Product Information. Floxin (ofloxacin)." Ortho Pharmaceutical Corporation, Raritan, NJ.
  12. Ball P "Ciprofloxacin: an overview of adverse experiences." J Antimicrob Chemother 18 (1986): 187-93
  13. "Product Information. Penetrex (enoxacin)." Rhone-Poulenc Rorer, Collegeville, PA.
  14. Ball P, Tillotson G "Tolerability of fluoroquinolone antibiotics: past, present and future." Drug Saf 13 (1996): 343-8
View all 14 references

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Drug and food interactions

Moderate

ciprofloxacin food

Applies to: Cipro (ciprofloxacin)

ADJUST DOSING INTERVAL: Concurrent ingestion of dairy products (milk, yogurt) or calcium-fortified foods (i.e., cereal, orange juice) may decrease the activity of certain oral fluoroquinolone antibiotics. The mechanism is chelation of calcium and the quinolone, resulting in decreased bioavailability. In the case of orange juice, inhibition of intestinal transport mechanisms (P-glycoprotein or organic anion-transporting polypeptides) by flavones may also be involved. One study reported an average 41% decrease in maximum plasma concentrations and a 38% decrease in AUC when ciprofloxacin was given with calcium-fortified orange juice instead of water. Administration of ciprofloxacin tablets with enteral nutrition may reduce its bioavailability and maximum serum concentrations. Data have been conflicting and variable by the type of enteral nutrition product, location of the feeding tube, and patient characteristics. Decreased absorption is expected if ciprofloxacin is given by jejunostomy tube.

MANAGEMENT: Oral ciprofloxacin should not be taken with dairy products or calcium-fortified foods alone, but may be taken with meals that contain these products. When taken alone, dairy products or calcium-fortified foods should be ingested at least 2 hours before or after ciprofloxacin administration. When ciprofloxacin tablets are administered to patients receiving continuous enteral nutrition, some experts recommend that the tube feeding should be interrupted for at least 1 hour before and 2 hours after the dose of ciprofloxacin is given. Patients should be monitored for altered antimicrobial efficacy and switched to intravenous ciprofloxacin if necessary. If no enteral route besides a jejunostomy tube is available, it is also recommended to switch to intravenous ciprofloxacin. According to the manufacturer, ciprofloxacin oral suspension should not be administered via nasogastric or feeding tubes due to its physical characteristics.

References

  1. Yuk JH, Nightingale CH, Sweeney KR, Quintiliani R, Lettieri JT, Forst RW "Relative bioavailability in healthy volunteers of ciprofloxacin administered through a nasogastric tube with and without enteral feeding." Antimicrob Agents Chemother 33 (1989): 1118-20
  2. Wohlt PD, Zheng L, Gunderson S, Balzar SA, Johnson BD, Fish JT "Recommendations for the use of medications with continuous enteral nutrition." Am J Health Syst Pharm 66 (2009): 1438-67
  3. Noer BL, Angaran DW "The effect of enteral feedings on ciprofloxacin pharmacokinetics." Pharmacotherapy 10 (1990): 254
  4. Neuhofel AL, Wilton JH, Victory JM, Hejmanowsk LG, Amsden GW "Lack of bioequivalence of ciprofloxacin when administered with calcium-fortified orange juice: a new twist on an old interaction." J Clin Pharmacol 42 (2002): 461-6
  5. "Product Information. Cipro (ciprofloxacin)." Bayer, West Haven, CT.
  6. Yuk JH, Nightingale CH, Quintiliani R "Absorption of ciprofloxacin administered through a nasogastric or a nasoduodenal tube in volunteers and patients receiving enteral nutrition." Diagn Microbiol Infect Dis 13 (1990): 99-102
View all 6 references

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Therapeutic duplication warnings

No therapeutic duplications were found for your selected drugs.

Drug Interaction Classification

The classifications below are a guideline only. The relevance of a particular drug interaction to a specific patient is difficult to determine using this tool alone given the large number of variables that may apply.
Major Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.
Moderate Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.
Minor Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan.
Unknown No information available.

Do not stop taking any medications without consulting your healthcare provider.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

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