Ciprobay Drug Interactions

Drugs known to prolong QT interval: Ciprofloxacin (Ciprobay), like other fluoroquinolones, should be used with caution in patients receiving drugs known to prolong the QT interval (e.g. Class IA and III anti-arrhythmics, tricyclic antidepressants, macrolides, antipsychotics) (see Precautions).
Probenecid: Probenecid interferes with renal secretion of ciprofloxacin. Co-administration of probenecid containing medicinal products and Ciprofloxacin (Ciprobay) increases the ciprofloxacin serum concentrations.
Tizanidine: In a clinical study in healthy subjects, there was an increase in tizanidine serum concentrations (C_max increase: 7-fold, range: 4 to 21-fold; AUC increase: 10-fold, range: 6 to 24-fold) when given concomitantly with ciprofloxacin. Associated with the increased serum concentrations was a potentiated hypotensive and sedative effect (see Cytochrome P450 under Precautions). Tizanidine containing medicinal products must not be administered together with Ciprofloxacin (Ciprobay) (see Contraindications).
Theophylline: Concurrent administration of ciprofloxacin and theophylline containing medicinal products can cause an undesirable increase in the serum theophylline concentration. This can lead to theophylline-induced undesirable effects. In very rare cases, these undesirable effects can be life threatening or fatal.
If concurrent use of the two medicinal products is unavoidable, the serum theophylline concentration should therefore be checked and the theophylline dose appropriately reduced (see Cytochrome P450 under Precautions).
Other xanthine derivatives: On concurrent administration of ciprofloxacin and caffeine or pentoxifylline (oxpentifylline) containing products, raised serum concentrations of these xanthine derivatives were reported.
Phenytoin: Altered (decreased or increased) serum levels of phenytoin were observed in patients receiving Ciprofloxacin (Ciprobay) and phenytoin simultaneously. To avoid the loss of seizure control associated with decreased phenytoin levels, and to prevent phenytoin overdose-related undesirable effects when Ciprofloxacin (Ciprobay) is discontinued in patients receiving both agents, monitoring of phenytoin therapy, including phenytoin serum concentration measurements, is recommended during and shortly after co-administration of Ciprofloxacin (Ciprobay) with phenytoin.
Methotrexate: Renal tubular transport of methotrexate may be inhibited by concomitant administration of Ciprofloxacin (Ciprobay), potentially leading to increased plasma levels of methotrexate. This might increase the risk of methotrexate-associated toxic reactions. Therefore, patients under methotrexate therapy should be carefully monitored when concomitant Ciprofloxacin (Ciprobay) therapy is indicated.
NSAID: Animal studies have shown that the combination of very high doses of quinolones (gyrase inhibitors) and certain non-steroidal anti-inflammatory agents (but not acetylsalicylic acid) can provoke convulsions.
Cyclosporin: A transient rise in the concentration of serum creatinine was observed when ciprofloxacin and cyclosporin containing medicinal products were administered simultaneously. Therefore, it is frequently (twice a week) necessary to control the serum creatinine concentrations in these patients.
Vitamin K antagonists: Simultaneous administration of Ciprofloxacin (Ciprobay) with a vitamin K antagonist may augment its anticoagulant effects. The risk may vary with the underlying infection, age and general status of the patient so that the contribution of ciprofloxacin to the increase in INR (international normalized ratio) is difficult to assess. The INR should be monitored frequently during and shortly after co-administration of Ciprofloxacin (Ciprobay) with a vitamin K antagonist (e.g. warfarin, acenocoumarol, phenprocoumon, or fluindione).
Duloxetine: In clinical studies, it was demonstrated that concomitant use of duloxetine with strong inhibitors of the CYP450 1A2 isozyme such as fluvoxamine, may result in an increase of AUC and C_max of duloxetine. Although no clinical data are available on a possible interaction with ciprofloxacin, similar effects can be expected upon concomitant administration (see Cytochrome P450 under Precautions).
Ropinirole: It was shown in a clinical study that concomitant use of ropinirole with ciprofloxacin, a moderate inhibitor of the CYP450 1A2 isozyme, results in an increase of C_max and AUC of ropinirole by 60% and 84%, respectively. Monitoring ropinirole-related undesirable effects, dose adjustment as appropriate is recommended during and shortly after co-administration with Ciprofloxacin (Ciprobay) (see Cytochrome P450 under Precautions).
Lidocaine: It was demonstrated in healthy subjects that concomitant use of lidocaine containing medicinal products with ciprofloxacin, a moderate inhibitor of CYP450 1A2 isozyme, reduces clearance of intravenous lidocaine by 22%. Although lidocaine treatment was well tolerated, a possible interaction with ciprofloxacin associated with side effects may occur upon concomitant administration.
Clozapine: Following concomitant administration of 250 mg ciprofloxacin with clozapine for 7 days, serum concentrations of clozapine and N-desmethylclozapine were increased by 29% and 31%, respectively. Clinical surveillance and appropriate adjustment of clozapine dosage during and shortly after co-administration with Ciprofloxacin (Ciprobay) are advised (see Cytochrome P450 under Precautions).
Sildenafil: C_max and AUC of sildenafil were increased approximately twofold in healthy subjects after an oral dose of 50 mg given concomitantly with 500 mg ciprofloxacin. Therefore, caution should be used prescribing Ciprofloxacin (Ciprobay) concomitantly with sildenafil taking into consideration the risks and the benefits.
Agomelatine: In clinical studies, it was demonstrated that fluvoxamine, as a strong inhibitor of the CYP450 1A2 isoenzyme, markedly inhibits the metabolism of agomelatine resulting in a 60-fold increase of agomelatine exposure. Although no clinical data are available for a possible interaction with ciprofloxacin, a moderate inhibitor of CYP450 1A2, similar effects can be expected upon concomitant administration (see Cytochrome P450 under Precautions).
Zolpidem: Co-administration of ciprofloxacin may increase blood levels of zolpidem, concurrent use is not recommended.
Film-coated tablet: Chelation complex formation: The simultaneous administration of Ciprofloxacin (Ciprobay) and multivalent cation-containing medicinal products and mineral supplements (e.g. calcium, magnesium, aluminum, iron), polymeric phosphate binders (e.g. sevelamer, lanthanum carbonate), sucralfate or antacids, and highly buffered drugs (e.g. didanosine tablets) containing magnesium, aluminum, or calcium reduce the absorption of ciprofloxacin. Consequently, Ciprofloxacin (Ciprobay) should be administered either 1-2 hours before or at least 4 hours after these preparations.
The restriction does not apply to antacids belonging to the class of H₂ receptor blockers.
Food and dairy products: The concurrent administration of dairy products or mineral-fortified drinks alone (e.g. milk, yoghurt, calcium-fortified orange juice) and Ciprofloxacin (Ciprobay) should be avoided because absorption of ciprofloxacin may be reduced. Dietary calcium as part of a meal, however, does not significantly affect absorption.
Metoclopramide: Metoclopramide accelerates the absorption of ciprofloxacin resulting in a shorter time to reach maximum plasma concentrations. No effect was seen on the bioavailability of ciprofloxacin.
Omeprazole: Concomitant administration of ciprofloxacin and omeprazole containing medicinal products results in a slight reduction of C_max and AUC of ciprofloxacin.