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Drug Interactions between ciprofloxacin and Viagra

This report displays the potential drug interactions for the following 2 drugs:

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Interactions between your drugs

Major

ciprofloxacin sildenafil

Applies to: ciprofloxacin and Viagra (sildenafil)

Consumer information for this interaction is not currently available.

MONITOR CLOSELY: Coadministration with inhibitors of CYP450 3A4 may significantly increase the plasma concentrations and effects of sildenafil, which is primarily metabolized by the isoenzyme. Pharmacokinetic studies have been conducted in healthy male volunteers using erectile dysfunction dosing for sildenafil. When administered to volunteers on the moderate to strong CYP450 3A4 inhibitors erythromycin (500 mg twice daily) or un-boosted saquinavir (1200 mg three times daily), each at steady state, the systemic exposure (AUC) of oral sildenafil (100 mg) increased by approximately 182% and 210%, respectively. Similarly, sildenafil's AUC increased by approximately 2-fold in volunteers who received a single dose of the moderate CYP450 3A4 inhibitor ciprofloxacin (500 mg) followed 2 hours later by a single oral dose of sildenafil (50 mg). An analysis of population pharmacokinetic data from clinical trials in adult pulmonary hypertension patients indicated a reduction in sildenafil's clearance of approximately 30% when it was coadministered with moderate CYP450 3A4 inhibitors. This analysis found a wide concentration range for oral sildenafil, as a dosage of 80 mg three times a day led to a systemic exposure of sildenafil that was 5 times greater than the standard 20 mg three times daily dose. This wide range may therefore cover the potential increased exposure from coadministration with CYP450 3A4 inhibitors less potent than ketoconazole, itraconazole, and ritonavir. Pharmacokinetic models predict that this interaction may be more significant for oral rather than intravenous (IV) formulations of sildenafil, due at least partly to effects from first pass metabolism. However, one physiologically-based pharmacokinetic model used to analyze the effects of IV fluconazole on IV sildenafil predicted an increase in sildenafil's AUC of 2.11-fold in adults and 2.82-fold in infants.

MANAGEMENT: Caution and close clinical monitoring are advised if sildenafil is coadministered with a moderate CYP450 3A4 inhibitor. The severity of this interaction may be increased in the presence of renal and/or hepatic dysfunction, potentially requiring dosage adjustments. When used in the treatment of pulmonary arterial hypertension in adults, some authorities recommend considering a dose reduction for sildenafil to 20 mg oral (10 mg IV) twice daily in the presence of a 3A4 inhibitor like erythromycin. For erectile dysfunction, the US labeling recommends considering a starting dose of 25 mg in patients taking erythromycin or stronger CYP450 3A4 inhibitors. The labeling for the CYP450 3A4 inhibitor should also be consulted as some may have additional recommendations or guidance, such as specific information on the potency of the CYP450 3A4 inhibitor and how long the inhibition may persist after the last dose of the inhibitor. Regardless of indication, all patients should be advised to promptly notify their physician if they experience serious side effects from sildenafil such as pain or tightness in the chest or jaw, irregular heartbeat, nausea, shortness of breath, low blood pressure, sudden decrease or loss of hearing, visual disturbances, syncope, or prolonged erection (greater than 4 hours).

Drug and food interactions

Moderate

ciprofloxacin food

Applies to: ciprofloxacin

Do not take ciprofloxacin with dairy products such as milk or yogurt, or with calcium-fortified foods (e.G., cereal, juice). You may eat or drink dairy products or calcium-fortified foods with a regular meal, but do not use them alone when taking ciprofloxacin. They could make the medication less effective. When ciprofloxacin tablets are given with enteral (tube) feedings, ciprofloxacin may not work as well. You could interrupt the feeding for 1 hour before and 2 hours after the ciprofloxacin dose, or your doctor may decide to switch to a different treatment. Ciprofloxacin oral suspension should not be given via nasogastric tubes or feeding tubes. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

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Moderate

sildenafil food

Applies to: Viagra (sildenafil)

If you are receiving therapy with sildenafil you should avoid the regular consumption of large amounts of grapefruits and grapefruit juice. Grapefruit can raise the levels of sildenafil in your body and delay the time it takes for the medication to work. Do not increase or decrease the amount of grapefruit products in your diet without first talking to your doctor.

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Moderate

ciprofloxacin food

Applies to: ciprofloxacin

Ciprofloxacin and multivitamin with minerals should not be taken orally at the same time. Products that contain magnesium, aluminum, calcium, iron, and/or other minerals may interfere with the absorption of ciprofloxacin into the bloodstream and reduce its effectiveness. If possible, it may be best to avoid taking multivitamin with minerals while you are being treated with ciprofloxacin. Otherwise, ciprofloxacin should be taken 2 to 4 hours before or 4 to 6 hours after a multivitamin with minerals dose, ciprofloxacin should be taken at least 2 hours before and not less than 6 hours after Suprep Bowel Prep (magnesium/potassium/sodium sulfates), or ciprofloxacin and multivitamin with minerals should be taken as directed by your healthcare provider. Talk to your healthcare provider if you are unsure whether your medications contain something that could potentially interact or if you have questions on how to take this or other medications you are prescribed. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

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Moderate

ciprofloxacin food

Applies to: ciprofloxacin

Using caffeine together with ciprofloxacin may increase the effects of caffeine. Contact your doctor if you experience headache, tremor, restlessness, nervousness, insomnia, and increased blood pressure or heart rate. If your doctor does prescribe these medications together, you may need a dose adjustment or special test to safely use both medications. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

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Therapeutic duplication warnings

No warnings were found for your selected drugs.

Therapeutic duplication warnings are only returned when drugs within the same group exceed the recommended therapeutic duplication maximum.


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Drug Interaction Classification

These classifications are only a guideline. The relevance of a particular drug interaction to a specific individual is difficult to determine. Always consult your healthcare provider before starting or stopping any medication.
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 interaction information available.

Further information

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