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Ciprofloxacin

Also indexed as: Ciloxan, Cipro, Ciproxin

Illustration

Ciprofloxacin is member of the fluoroquinolone family of antibiotics. It is used to treat bacterial infections. Ciprofloxacin penetrates many hard-to-reach tissues in the body and kills a wide variety of bacteria.

Summary of Interactions with Vitamins, Herbs, and Foods
In some cases, a herb or supplement may appear in more than one category, which may seem contradictory. For clarification, read the full article for details about the summarized interactions.

Beneficial May Be Beneficial: Depletion or interference—The medication may deplete or interfere with the absorption or function of the nutrient. Taking these nutrients may help replenish them.

Vitamin K*
Beneficial May Be Beneficial: Side effect reduction/prevention—Taking these supplements may help reduce the likelihood and/or severity of a potential side effect caused by the medication.

Bifidobacterium longum*

Lactobacillus acidophilus*

Lactobacillus casei*

Saccharomyces boulardii*

Saccharomyces cerevisiae*

Vitamin K*
Beneficial May Be Beneficial: Supportive interaction—Taking these supplements may support or otherwise help your medication work better.

Saccharomyces boulardii*
Avoid Avoid: Reduced drug absorption/bioavailability—Avoid these supplements when taking this medication since the supplement may decrease the absorption and/or activity of the medication in the body.

Calcium, Copper, Iron, Magnesium, Manganese, Zinc (if taken at the same time)

Dandelion*

Fennel

Yoghurt
Avoid Avoid: Adverse interaction—Avoid these supplements when taking this medication because taking them together may cause undesirable or dangerous results.

Caffeine

An asterisk (*) next to an item in the summary indicates that the interaction is supported only by weak, fragmentary, and/or contradictory scientific evidence.

Interactions with Dietary Supplements

Minerals
Minerals such as aluminium, calcium, copper, iron, magnesium, manganese, and zinc can bind to ciprofloxacin, greatly reducing the absorption of the drug.1 2 3 4 Because of the mineral content, people are advised to take ciprofloxacin two hours after consuming dairy products (milk, cheese, yoghurt, ice cream, and others), antacids (Maalox®, Mylanta®, Tums®, Rolaids®, and others), and mineral-containing supplements.5

Probiotics
A common side effect of antibiotics is diarrhoea, which may be caused by the elimination of beneficial bacteria normally found in the colon. Controlled studies have shown that taking probiotic microorganisms—such as Lactobacillus casei, Lactobacillus acidophilus, Bifidobacterium longum, or Saccharomyces boulardii—helps prevent antibiotic-induced diarrhoea.6

The diarrhoea experienced by some people who take antibiotics also might be due to an overgrowth of the bacterium Clostridium difficile, which causes a disease known as pseudomembranous colitis. Controlled studies have shown that supplementation with harmless yeast—such as Saccharomyces boulardii7 or Saccharomyces cerevisiae (baker’s or brewer’s yeast)8 —helps prevent recurrence of this infection. In one study, taking 500 mg of Saccharomyces boulardii twice daily enhanced the effectiveness of the antibiotic vancomycin in preventing recurrent clostridium infection.9 Therefore, people taking antibiotics who later develop diarrhoea might benefit from supplementing with saccharomyces organisms.

Treatment with antibiotics also commonly leads to an overgrowth of yeast (Candida albicans) in the vagina (candida vaginitis) and the intestines (sometimes referred to as “dysbiosis”). Controlled studies have shown that Lactobacillus acidophilus might prevent candida vaginitis.10

Vitamin K
A few cases of excessive bleeding have been reported in people who take antibiotics.11 12 13 14 This side effect may be the result of reduced vitamin K activity and/or reduced vitamin K production by bacteria in the colon. One study showed that people who had taken broad-spectrum antibiotics had lower liver concentrations of vitamin K2 (menaquinone), though vitamin K1 (phylloquinone) levels remained normal.15 A few antibiotics appear to exert a strong effect on vitamin K activity, while others may not have any effect. Therefore, one should refer to a specific antibiotic for information on whether it interacts with vitamin K. Doctors of natural medicine sometimes recommend vitamin K supplementation to people taking antibiotics. Additional research is needed to determine whether the amount of vitamin K1 found in some multivitamins is sufficient to prevent antibiotic-induced bleeding. Moreover, most multivitamins do not contain vitamin K.

Interactions with Herbs

Dandelion (Taraxacum officinale)
In an animal study, administration of an extract of the whole plant dandelion (actually Taraxacum mongolicum, a close relative of the more common western dandelion, Taraxacum officinale) concomitantly with ciprofloxacin decreased absorption of the drug.16 The authors found this was due to the high mineral content of the dandelion herb. Until further information is available, ciprofloxacin should not be taken within two hours of any dandelion supplement including teas.

Fennel (Foeniculum vulgare)
Preliminary research in animals has shown that fennel may reduce the absorption of ciprofloxacin.17 This interaction may be due to the rich mineral content of the herb; it has not yet been reported in humans. People taking ciprofloxacin should avoid supplementing with fennel-containing products until more is known.

Interactions with Foods and Other Compounds

Food
Food in general18 and yoghurt in particular has been found to reduce absorption of ciprofloxacin. Ciprofloxacin should be taken two hours before eating.19

Calcium supplements are known to interfere with the absorption of ciprofloxacin. The same interference has been shown to occur when calcium-fortified orange juice is taken at the same time as ciprofloxacin.20

Caffeine
Caffeine is found in coffee, tea, soft drinks, chocolate, guaraná (Paullinia cupana), nonprescription drug products, and supplement products containing caffeine. Ciprofloxacin may decrease the elimination of caffeine from the body, causing increased caffeine blood levels and unwanted actions.21 People taking ciprofloxacin may choose to limit their caffeine intake to avoid problems. They should read food, drink, drug, and supplement labels carefully for caffeine content.

References

1. Campbell NR, Hasinoff BB. Iron supplements: A common cause of drug interactions. Br J Clin Pharmacol 1991;31:251–5.

2. Lim D, McKay M. Food-drug interactions. Drug Information Bull 1995;15(2) [review].

3. Threlkeld DS, ed. Systemic Anti-Infectives, Fluoroquinolones. In Facts and Comparisons Drug Information. St. Louis, MO: Facts and Comparisons, Feb 1994, 340n–40o.

4. Holt GA. Food & Drug Interactions. Chicago: Precept Press, 1998, 74.

5. Threlkeld DS, ed. Systemic Anti-Infectives, Fluoroquinolones. In Facts and Comparisons Drug Information. St. Louis, MO: Facts and Comparisons, Feb 1994, 340n–40o.

6. Elmer GW, Surawicz CM, McFarland LV. Biotherapeutic agents. A neglected modality for the treatment and prevention of selected intestinal and vaginal infections. JAMA 1996;275:870–6 [review].

7. Elmer GW, Surawicz CM, McFarland LV. Biotherapeutic agents. A neglected modality for the treatment and prevention of selected intestinal and vaginal infections. JAMA 1996;275:870–6 [review].

8. Schellenberg D, Bonington A, Champion CM, et al. Treatment of Clostridium difficile diarrhoea with brewer’s yeast. Lancet 1994;343:171–2.

9. Surawicz CM, Elmer GW, Speelman P, et al. Prevention of antibiotic-associated diarrhea by Saccharomyces boulardii: A prospective study. Gastroenterol 1989;96:981–8.

10. Elmer GW, Surawicz CM, McFarland LV. Biotherapeutic agents. A neglected modality for the treatment and prevention of selected intestinal and vaginal infections. JAMA 1996;275:870–6 [review].

11. Suzuki K, Fukushima T, Meguro K, et al. Intracranial hemorrhage in an infant owing to vitamin K deficiency despite prophylaxis. Childs Nerv Syst 1999;15:292–4.

12. Huilgol VR, Markus SL, Vakil NB. Antibiotic-induced iatrogenic hemobilia. Am J Gastroenterol 1997;92:706–7.

13. Bandrowsky T, Vorono AA, Borris TJ, Marcantoni HW. Amoxicllin-related postextraction bleeding in an anticoagulated patient with tranexamic acid rinses. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1996;82:610–2.

14. Kaiser CW, McAuliffe JD, Barth RJ, Lynch JA. Hypoprothrombinemia and hemorrhage in a surgical patient treated with cefotetan. Arch Surg 1991;126:524–5.

15. Conly J, Stein K. Reduction of vitamin K2 concentration in human liver associated with the use of broad spectrum antimicrobials. Clin Invest Med 1994;17:531–9.

16. Zhu M, Wong PY, Li RC. Effects of Taraxacum mongolicum on the bioavailability and disposition of ciprofloxacin in rats. J Pharm Sci 1999;88:632–4.

17. Zhu M, Wong PY, Li RC. Effect of oral administration of fennel (Foeniculum vulgare) on ciprofloxacin absorption and disposition in the rat. J Pharm Pharmacol 1999;51:1391–6.

18. Ledergerber B, Bettex JD, Joos B, et al. Effect of standard breakfast on drug absorption and multiple-dose pharmacokinetics of ciprofloxacin. Antimicrob Agents Chemother 1985;27:350–2.

19. Threlkeld DS, ed. Systemic Anti-Infectives, Fluoroquinolones. In Facts and Comparisons Drug Information. St. Louis, MO: Facts and Comparisons, Feb 1994, 340n–40o.

20. Neuhofel AL, Wilton JH, Victory JM, et al. Lack of bioequivalence of ciprofloxacin when administered with calcium-fortified orange juice: a new twist on an old interaction. J Clin Pharmacol 2002;42:461–6.

21. Threlkeld DS, ed. Systemic Anti-Infectives, Fluoroquinolones. In Facts and Comparisons Drug Information. St. Louis, MO: Facts and Comparisons, Feb 1994, 340n–40o.