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3 Interactions found for:

ciprofloxacin
Interactions Summary
  • 2 Major
  • 1 Moderate
  • 0 Minor
  • ciprofloxacin

Drug Interactions

A total of 736 medications are known to interact with ciprofloxacin. Add another medication to view potential interactions with this medication.

Drug and Food Interactions

Moderate
Ciprofloxacin + Food

The following applies to the ingredients: 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. "Product Information. Cipro (ciprofloxacin)." Bayer PROD (2002):
  2. 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
  3. 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
  4. Noer BL, Angaran DW "The effect of enteral feedings on ciprofloxacin pharmacokinetics." Pharmacotherapy 10 (1990): 254
  5. 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
  6. 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

The following applies to the ingredients: Ciprofloxacin

GENERALLY AVOID: The oral bioavailability of quinolone and tetracycline antibiotics may be reduced by concurrent administration of preparations containing polyvalent cations such as aluminum, calcium, iron, magnesium, and zinc. Therapeutic failure may result. The proposed mechanism is chelation of quinolone and tetracycline antibiotics by di- and trivalent cations, forming an insoluble complex that is poorly absorbed from the gastrointestinal tract. Reduced gastrointestinal absorption of the cations should also be considered.

MANAGEMENT: Concomitant administration of oral quinolone and tetracycline antibiotics with preparations containing aluminum, calcium, iron, magnesium, and/or zinc salts should generally be avoided. Otherwise, the times of administration should be staggered by as much as possible to minimize the potential for interaction. Quinolones should typically be dosed either 2 to 4 hours before or 4 to 6 hours after polyvalent cation preparations, depending on the quinolone and formulation. Likewise, tetracyclines and polyvalent cation preparations should typically be administered 2 to 4 hours apart. The prescribing information for the antibiotic should be consulted for more specific dosing recommendations.

References

  1. Polk RE, Helay 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 33 (1989): 1841-4
  2. Nix DE, Watson WA, Lener ME, et al. "Effects of aluminum and magnesium antacids and ranitidine on the absorption of ciprofloxacin." Clin Pharmacol Ther 46 (1989): 700-5
  3. Garrelts JC, Godley PJ, Peterie JD, Gerlach EH, Yakshe CC "Sucralfate significantly reduces ciprofloxacin concentrations in serum." Antimicrob Agents Chemother 34 (1990): 931-3
  4. 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 36 (1992): 830-2
  5. Yuk JH "Ciprofloxacin levels when receiving sucralfate." J Am Geriatr Soc 262 (1989): 901
  6. Neuvonen PJ "Interactions with the absorption of tetracyclines." Drugs 11 (1976): 45-54
  7. Deppermann KM, Lode H, Hoffken G, Tschink G, Kalz C, Koeppe P "Influence of ranitidine, pirenzepine, and aluminum magnesium hydroxide on the bioavailability of various antibiotics, including amoxicillin, cephalexin, doxycycline, and amoxicillin-clavulanic acid." Antimicrob Agents Chemother 33 (1989): 1901-7
  8. Nguyen VX, Nix DE, Gillikin S, Schentag JJ "Effect of oral antacid administration on the pharmacokinetics of intravenous doxycycline." Antimicrob Agents Chemother 33 (1989): 434-6
  9. Campbell NR, Kara M, Hasinoff BB, Haddara WM, McKay DW "Norfloxacin interaction with antacids and minerals." Br J Clin Pharmacol 33 (1992): 115-6
  10. Parpia SH, Nix DE, Hejmanowski LG, Goldstein HR, Wilton JH, Schentag JJ "Sucralfate reduces the gastrointestinal absorption of norfloxacin." Antimicrob Agents Chemother 33 (1989): 99-102
  11. Nix DE, Wilton JH, Ronald B, Distlerath L, Williams VC, Norman A "Inhibition of norfloxacin absorption by antacids." Antimicrob Agents Chemother 34 (1990): 432-5
  12. Akerele JO, Okhamafe AO "Influence of oral co-administered metallic drugs on ofloxacin pharmacokinetics." J Antimicrob Chemother 28 (1991): 87-94
  13. Gothoni G, Neuvonen PJ, Mattila M, Hackman R "Iron-tetracycline interaction: effect of time interval between the drugs." Acta Med Scand 191 (1972): 409-11
  14. Garty M, Hurwitz A "Effect of cimetidine and antacids on gastrointestinal absorption of tetracycline." Clin Pharmacol Ther 28 (1980): 203-7
  15. Gotz VP, Ryerson GG "Evaluation of tetracycline on theophylline disposition in patients with chronic obstructive airways disease." Drug Intell Clin Pharm 20 (1986): 694-6
  16. McCormack JP, Reid SE, Lawson LM "Theophylline toxicity induced by tetracycline." Clin Pharm 9 (1990): 546-9
  17. D'Arcy PF, McElnay JC "Drug-antacid interactions: assessment of clinical importance." Drug Intell Clin Pharm 21 (1987): 607-17
  18. Wadworth AN, Goa KL "Lomefloxacin: a review of its antibacterial activity, pharmacokinetic properties and therapeutic use." Drugs 42 (1991): 1018-60
  19. Shimada J, Shiba K, Oguma T, et al. "Effect of antacid on absorption of the quinolone lomefloxacin." Antimicrob Agents Chemother 36 (1992): 1219-24
  20. Upton RA "Pharmacokinetic interactions between theophylline and other medication (Part I)." Clin Pharmacokinet 20 (1991): 66-80
  21. Venho VM, Salonen RO, Mattila MJ "Modification of the pharmacokinetics of doxycycline in man by ferrous sulphate or charcoal." Eur J Clin Pharmacol 14 (1978): 277-80
  22. "Product Information. Minocin (minocycline)." Lederle Laboratories PROD (2002):
  23. 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 35 (1993): 302-4
  24. "Product Information. Declomycin (demeclocycline)." Lederle Laboratories PROD (2001):
  25. Lehto P, Kivisto KT "Effect of sucralfate on absorption of norfloxacin and ofloxacin." Antimicrob Agents Chemother 38 (1994): 248-51
  26. Noyes M, Polk RE "Norfloxacin and absorption of magnesium-aluminum." Ann Intern Med 109 (1988): 168-9
  27. Grasela TH Jr, Schentag JJ, Sedman AJ, et al. "Inhibition of enoxacin absorption by antacids or ranitidine." Antimicrob Agents Chemother 33 (1989): 615-7
  28. Campbell NR, Hasinoff BB "Iron supplements: a common cause of drug interactions." Br J Clin Pharmacol 31 (1991): 251-5
  29. Covington TR, eds., Lawson LC, Young LL "Handbook of Nonprescription Drugs." Washington, DC: American Pharmaceutical Association (1993):
  30. Lehto P, Kivisto KT "Different effects of products containing metal ions on the absorption of lomefloxacin." Clin Pharmacol Ther 56 (1994): 477-82
  31. Bateman FJ "Effects of tetracyclines." Br Med J 4 (1970): 802
  32. Neuvonen PJ, Gothoni G, Hackman R, Bjorksten K "Interference of iron with the absorption of tetracyclines in man." Br Med J 4 (1970): 532-4
  33. Greenberger NJ "Absorption of tetracyclines: interference by iron." Ann Intern Med 74 (1971): 792-3
  34. Neuvonen PJ, Penttila O "Effect of oral ferrous sulphate on the half-life of doxycycline in man." Eur J Clin Pharmacol 7 (1974): 361-3
  35. Spivey JM, Cummings DM, Pierson NR "Failure of prostatitis treatment secondary to probable ciprofloxacin-sucralfate drug interaction." Pharmacotherapy 16 (1996): 314-6
  36. "Product Information. Levaquin (levofloxacin)." Ortho McNeil Pharmaceutical PROD (2001):
  37. "Product Information. Raxar (grepafloxacin)." Glaxo Wellcome PROD (2001):
  38. "Product Information. Zagam (sparfloxacin)." Rhone Poulenc Rorer PROD (2001):
  39. "Product Information. Trovan (trovafloxacin)." Pfizer U.S. Pharmaceuticals PROD (2001):
  40. Teng R, Dogolo LC, Willavize SA, Friedman HL, Vincent J "Effect of Maalox and omeprazole on the bioavailability of trovafloxacin." J Antimicrob Chemother 39 Suppl B (1997): 93-7
  41. Zix JA, Geerdes-Fenge HF, Rau M, Vockler J, Borner K, Koeppe P, Lode H "Pharmacokinetics of sparfloxacin and interaction with cisapride and sucralfate." Antimicrob Agents Chemother 41 (1997): 1668-72
  42. Honig PK, Gillespie BK "Clinical significance of pharmacokinetic drug interactions with over-the-counter (OTC) drugs." Clin Pharmacokinet 35 (1998): 167-71
  43. Johnson RD, Dorr MB, Talbot GH, Caille G "Effect of Maalox on the oral absorption of sparfloxacin." Clin Ther 20 (1998): 1149-58
  44. Lober S, Ziege S, Rau M, Schreiber G, Mignot A, Koeppe P, Lode H "Pharmacokinetics of gatifloxacin and interaction with an antacid containing aluminum and magnesium." Antimicrob Agents Chemother 43 (1999): 1067-71
  45. Allen A, Vousden M, Porter A, Lewis A "Effect of Maalox((R)) on the bioavailability of oral gemifloxacin in healthy volunteers." Chemotherapy 45 (1999): 504-11
  46. Kamberi M, Nakashima H, Ogawa K, Oda N, Nakano S "The effect of staggered dosing of sucralfate on oral bioavailability of sparfloxacin." Br J Clin Pharmacol 49 (2000): 98-103
  47. "Product Information. Factive (gemifloxacin)." *GeneSoft Inc (2003):
  48. "Product Information. Suprep Bowel Prep Kit (magnesium/potassium/sodium sulfates)." Braintree Laboratories (2010):
  49. "Product Information. Baxdela (delafloxacin)." Melinta Therapeutics, Inc. (2017):
  50. "Product Information. Seysara (sarecycline)." Allergan Inc (2018):
  51. "Product Information. Nuzyra (omadacycline)." Paratek Pharmaceuticals, Inc. (2018):

The following applies to the ingredients: Ciprofloxacin

MONITOR: Coadministration with certain quinolones may increase the plasma concentrations and pharmacologic effects of caffeine due to inhibition of the CYP450 1A2 metabolism of caffeine. Quinolones that may inhibit CYP450 1A2 include ciprofloxacin, enoxacin, grepafloxacin, nalidixic acid, norfloxacin, pipemidic acid, and pefloxacin (not all commercially available). In healthy volunteers, enoxacin (100 to 400 mg twice daily) increased systemic exposure (AUC) of caffeine by 2- to 5-fold and reduced its clearance by approximately 80%. Pipemidic acid (400 to 800 mg twice daily) increased AUC of caffeine by 2- to 3-fold and reduced its clearance by approximately 60%. Ciprofloxacin (250 to 750 mg twice daily) increased AUC and elimination half-life of caffeine by 50% to over 100%, and reduced its clearance by 30% to 50%. Norfloxacin 400 mg twice daily increased caffeine AUC by 16%, while 800 mg twice daily increased caffeine AUC by 52% and reduced its clearance by 35%. Pefloxacin (400 mg twice daily) has been shown to reduce caffeine clearance by 47%.

MANAGEMENT: Patients using caffeine-containing products should be advised that increased adverse effects such as headache, tremor, restlessness, nervousness, insomnia, tachycardia, and blood pressure increases may occur during coadministration with quinolones that inhibit CYP450 1A2. Caffeine intake should be limited when taking high dosages of these quinolones. If an interaction is suspected, other quinolones such as gatifloxacin, gemifloxacin, levofloxacin, lomefloxacin, moxifloxacin, and ofloxacin may be considered, since they are generally believed to have little or no effect on CYP450 1A2 or have been shown not to interact with caffeine.

References

  1. Polk RE "Drug-drug interactions with ciprofloxacin and other fluoroquinolones." Am J Med 87 (1989): s76-81
  2. Healy DP, Polk RE, Kanawati L, Rock DT, Mooney ML "Interaction between oral ciprofloxacin and caffeine in normal volunteers." Antimicrob Agents Chemother 33 (1989): 474-8
  3. Harder S, Fuhr U, Staib AH, Wolf T "Ciprofloxacin-caffeine: a drug interaction established using in vivo and in vitro investigations." Am J Med 87 (1989): 89-91
  4. Carbo ML, Segura J, De la Torre R, et al. "Effect of quinolones on caffeine disposition." Clin Pharmacol Ther 45 (1989): 234-40
  5. "Product Information. Penetrax (enoxacin)." Rhone-Poulenc Rorer, Collegeville, PA. (1993):
  6. Mahr G, Sorgel F, Granneman GR, et al. "Effects of temafloxacin and ciprofloxacin on the pharmacokinetics of caffeine." Clin Pharmacokinet 22 (1992): 90-7
  7. "Product Information. Cipro (ciprofloxacin)." Bayer PROD (2002):
  8. "Product Information. Noroxin (norfloxacin)." Merck & Co., Inc PROD (2001):
  9. Staib AH, Stille W, Dietlein G, et al. "Interaction between quinolones and caffeine." Drugs 34 Suppl 1 (1987): 170-4
  10. Stille W, Harder S, Micke S, et al. "Decrease of caffeine elimination in man during co-administration of 4-quinolones." J Antimicrob Chemother 20 (1987): 729-34
  11. Harder S, Staib AH, Beer C, Papenburg A, Stille W, Shah PM "4-Quinolones inhibit biotransformation of caffeine." Eur J Clin Pharmacol 35 (1988): 651-6
  12. Nicolau DP, Nightingale CH, Tessier PR, et al. "The effect of fleroxacin and ciprofloxacin on the pharmacokinetics of multiple dose caffeine." Drugs 49 Suppl 2 (1995): 357-9
  13. "Product Information. Raxar (grepafloxacin)." Glaxo Wellcome PROD (2001):
  14. Carrillo JA, Benitez J "Clinically significant pharmacokinetic interactions between dietary caffeine and medications." Clin Pharmacokinet 39 (2000): 127-53
  15. Fuhr U, Wolff T, Harder S, Schymanski P, Staib AH "Quinolone inhibition of cytochrome P-450 dependent caffeine metabolism in human liver microsomes." Drug Metab Dispos 18 (1990): 1005-10
  16. Kinzig-Schippers M, Fuhr U, Zaigler M, et al. "Interaction of pefloxacin and enoxacin with the human cytochrome P450 enzyme CYP1A2." Clin Pharmacol Ther 65 (1999): 262-74
  17. Healy DP, Schoenle JR, Stotka J, Polk RE "Lack of interaction between lomefloxacin and caffeine in normal volunteers." Antimicrob Agents Chemother 35 (1991): 660-4

Drug and Pregnancy Interactions

The following applies to the ingredients: Ciprofloxacin

This drug should not be used during pregnancy unless the benefit outweighs the risk to both fetus and mother.
-According to some authorities: As a precaution, avoiding use during pregnancy is preferred.

AU TGA pregnancy category: B3
US FDA pregnancy category:
-Oral tablets, suspension and IV injection: Not assigned
-Extended-release tablets: C

Risk summary: Malformative risk with the use of this drug in pregnant women is unlikely.

Animal studies have failed to reveal evidence of embryotoxicity or teratogenicity. In rabbits, gastrointestinal toxicity was observed with oral doses and resulted in maternal weight loss and increased incidence of abortion, intrauterine deaths, and fetal retardation (but no teratogenicity); no maternal toxicity (and no embryotoxicity or teratogenicity) observed with IV doses. There are no controlled data in human pregnancy.

This drug distributes into amniotic fluid. Levels reported were 57% (at 2 to 4 hours post-dose) to 1000% (at 10 to 12 hours post-dose) of that found in maternal serum.

An expert review by the Teratogen Information System concluded that substantial teratogenic risk is unlikely using therapeutic doses; data insufficient to state there is no risk.

In a controlled prospective observational study, 200 women exposed to fluoroquinolones (52.5% to ciprofloxacin and 68% during the first trimester) during gestation were followed. No increased risk of major malformations associated with in utero fluoroquinolone exposure during embryogenesis. Major congenital malformation rates were 2.2% for the fluoroquinolone group and 2.6% for the control group; background rate of major malformations was 1% to 5%. Rates of spontaneous abortions, prematurity, and low birth weight were not different between the groups; no clinically significant musculoskeletal dysfunctions observed in infants (up to 1 year of age) exposed to this drug.

A prospective follow-up study by the European Network of Teratology Information Services reported on 549 pregnancies with fluoroquinolone exposure; 93% were first-trimester exposures and included all 70 exposures to ciprofloxacin. Malformation rates among live-born babies exposed to this drug and fluoroquinolones overall were within background rates in the general population. No specific patterns of congenital abnormalities were found. The study did not expose any clear side effects due to in utero ciprofloxacin exposure.

In the US Michigan Medicaid surveillance study of 229,101 pregnancies, major birth defects were reported in 3 of 132 exposed neonates. An association between this drug and congenital defects is not supported by these data.

Berkovitch and colleagues reviewed 35 pregnancies in women who received norfloxacin or ciprofloxacin during the first trimester for urinary tract infection. No malformations were observed among the infants of these women. There were no joint problems or walking delays, and when compared to nonexposed infants, there was no apparent difference in the acquisition of milestones.

No differences in rates of prematurity, spontaneous abortions, or birth weight observed in women exposed to this drug during pregnancy; however, most data was from short-term, first-trimester exposure during small postmarketing epidemiology studies, which were not sufficient to assess risk for less common defects or to enable reliable, definitive conclusions regarding the safety of this drug in pregnant women and their developing fetuses.

In mass casualty settings after release of biological weapons, the US CDC and Working Group on Civilian Biodefense have recommended ciprofloxacin as the preferred drug for postexposure prophylaxis and treatment of anthrax, tularemia, and plague. The risk of drug use during pregnancy is outweighed by the high fatality rates from these infections.

Cartilage damage and arthropathy have been reported in immature animals of various species giving rise to concern over possible toxic effects on human fetal bone formation. Because safer alternatives are generally available, some experts consider ciprofloxacin contraindicated during pregnancy, especially during the first trimester.

AU TGA pregnancy category B3: Drugs which have been taken by only a limited number of pregnant women and women of childbearing age, without an increase in the frequency of malformation or other direct or indirect harmful effects on the human fetus having been observed. Studies in animals have shown evidence of an increased occurrence of fetal damage, the significance of which is considered uncertain in humans.

US FDA pregnancy category C: Animal reproduction studies have shown an adverse effect on the fetus and there are no adequate and well-controlled studies in humans, but potential benefits may warrant use of the drug in pregnant women despite potential risks.

US FDA pregnancy category Not Assigned: The US FDA has amended the pregnancy labeling rule for prescription drug products to require labeling that includes a summary of risk, a discussion of the data supporting that summary, and relevant information to help health care providers make prescribing decisions and counsel women about the use of drugs during pregnancy. Pregnancy categories A, B, C, D, and X are being phased out.

References

  1. "Product Information. Cipro (ciprofloxacin)." Bayer PROD (2002):
  2. Schaefer C, Amouraelefant E, Vial T, Ornoy A, Garbis H, Robert E, Rodriguezpinilla E, Pexieder T, Prapas N, Merlob P "Pregnancy outcome after prenatal quinolone exposure: evaluation of a case registry of the european network of teratology information services (ENTIS)." Eur J Obstet Gynecol Reprod Biol 69 (1996): 83-9
  3. Briggs GG, Freeman RK, Yaffe SJ.. "Drugs in Pregnancy and Lactation." Baltimore, MD: Williams & Wilkins (1998):
  4. Dennis DT, Inglesby TV, Henderson DA, et al. "Tularemia as a biological weapon: medical and public health management." JAMA 285 (2001): 2763-73
  5. "Product Information. Cipro XR (ciprofloxacin)." Bayer Pharmaceutical Inc (2004):
  6. Ramakrishnan K, Scheid DC "Diagnosis and management of acute pyelonephritis in adults." Am Fam Physician 71 (2005): 933-42
  7. Cerner Multum, Inc. "UK Summary of Product Characteristics." O 0
  8. Cerner Multum, Inc. "Australian Product Information." O 0
  9. et al; Workgroup on Anthrax in Pregnant and Postpartum Women, Greanga AA, Zotti ME, Meaney-Delman D "Special considerations for treatment of anthrax in pregnant and postpartum women. http://dx.doi.org/10.3201/eid2002.130611" (2015):
  10. Centers for Disease Control and Prevention "Plague - Resources for clinicians. https://www.cdc.gov/plague/healthcare/clinicians.html" (2017):
  11. "Product Information. Cipro (ciprofloxacin)." Bayer Pharmaceutical Inc (2024):
  12. "Product Information. Cipro I.V. (ciprofloxacin)." Bayer Pharmaceutical Inc (2024):

Drug and Breastfeeding Interactions

The following applies to the ingredients: Ciprofloxacin

LactMed: Use is considered acceptable with monitoring of the infant for possible effects on the gastrointestinal flora (e.g., diarrhea or candidiasis [thrush, diaper rash]); avoiding breastfeeding for 3 to 4 hours after maternal dosing should decrease the infant's exposure to this drug in breast milk.
-According to some authorities: A decision should be made to discontinue breastfeeding or discontinue the drug, taking into account the importance of the drug to the mother.

Excreted into human milk: Yes

Comments:
-The effects in the nursing infant are unknown; potential risk of serious side effects (including articular damage) in the nursing infant.
-This drug is considered compatible with breastfeeding by the American Academy of Pediatrics.

Cartilage erosion and arthropathy have been reported in immature animals giving rise to concern over toxic effects in the developing joints of nursing infants; however, some studies suggest risk is low. Absorption of the small amounts of fluoroquinolones in milk may be blocked by the calcium in milk; data insufficient to prove or disprove.

Levels found in breast milk have ranged from 85% (at 24 hours postdose) to 214% (at 4 hours postdose) of maternal serum level.

Postpartum (time not specified), 10 lactating women received 750 mg orally every 12 hours for 3 doses. At 2 hours after the third dose, milk drug levels were highest and averaged 3.79 mg/L. Milk levels then declined and averaged 2.26 mg/L at 4 hours, 0.86 mg/L at 6 hours, 0.51 mg/L at 9 hours, 0.2 mg/L at 12 hours, and 0.02 mg/L at 24 hours after the dose. Based on peak milk levels in this study, an exclusively breastfed infant would receive up to 0.57 mg/kg daily (estimated) with this maternal dose regimen, which is much lower than the dose used to treat neonates.

A single 500 mg oral dose was given to a mother recovering from acute renal failure; this dose was administered with a prenatal vitamin and ferrous sulfate, which would be expected to decrease ciprofloxacin bioavailability. Milk levels were 3.5 mg/L at 4, 8, and 12 hours after the dose and 2.3 mg/L at 16 hours after the dose. Levels were probably elevated and elimination prolonged due to the renal dysfunction.

A woman took 500 mg orally daily for 10 days. Drug level in breast milk was 0.98 mg/L at 10 hours and 40 minutes after the last dose. After breastfeeding once (8 hours after the dose), this drug was not detectable (less than 30 mcg/L) in the infant's serum 2.7 hours after nursing.

In 1 case report, a 2-month-old girl with history of necrotizing enterocolitis developed perforated pseudomembranous colitis, most likely due to ingestion of this drug via her mother's milk, and subsequently required a bowel resection. The mother admitted self-treatment while breastfeeding her infant.

This drug was used as part of multi-drug regimens to treat 3 pregnant women with multidrug-resistant tuberculosis throughout pregnancy and postpartum. Their 3 infants were breastfed (extent and duration not specified). At age 1.25, 1.8, and 3.9 years, 2 of the children were developing normally while the other child had failure to thrive, possibly due to contracting tuberculosis after birth.

This drug is recommended by the US CDC as a preferred agent for postexposure prophylaxis and treatment of anthrax in lactating women.

References

  1. Giamarellou H, Kolokythas E, Petrikkos G, Gazis J, Aravantinos D, Sfikakis P "Pharmacokinetics of three newer quinolones in pregnant and lactating women." Am J Med 87 (1989): s49-51
  2. Gardner DK, Gabbe SG, Harter C "Simultaneous concentrations of ciprofloxacin in breast milk and in serum in mother and breast-fed infant." Clin Pharm 11 (1992): 352-4
  3. Cover DL, Mueller BA "Ciprofloxacin penetration into human breast milk: a case report." Ann Pharmacother 24 (1990): 703-4
  4. "Product Information. Cipro (ciprofloxacin)." Bayer PROD (2002):
  5. Briggs GG, Freeman RK, Yaffe SJ.. "Drugs in Pregnancy and Lactation." Baltimore, MD: Williams & Wilkins (1998):
  6. American Academy of Pediatrics Committee on Drugs "The transfer of drugs and other chemicals into human milk" Pediatrics 108 (2001): 776-789
  7. "Product Information. Cipro XR (ciprofloxacin)." Bayer Pharmaceutical Inc (2004):
  8. Cerner Multum, Inc. "UK Summary of Product Characteristics." O 0
  9. Cerner Multum, Inc. "Australian Product Information." O 0
  10. United States National Library of Medicine "Toxnet. Toxicology Data Network. http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT" (2013):
  11. Sachs HC; Committee on Drugs, Frattarelli DAC, et al. "The transfer of drugs and therapeutics into human breast milk: an update on selected topics." Pediatrics 132 (2013): e796-e809
  12. et al; Workgroup on Anthrax in Pregnant and Postpartum Women, Greanga AA, Zotti ME, Meaney-Delman D "Special considerations for treatment of anthrax in pregnant and postpartum women. http://dx.doi.org/10.3201/eid2002.130611" (2015):

Therapeutic Duplication Warnings

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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.

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