Effects of Lanthanum Carbonate on the Absorption and Oral Bioavailability of Ciprofloxacin

Abstract

Background and objectives: Phosphate binders such as calcium salts or sevelamer, a cationic polymer, can markedly reduce absorption of oral ciprofloxacin. This randomized, open-label, two-way, crossover study examined the influence of the cation lanthanum on systemic ciprofloxacin exposure after oral administration.Design, setting, participants, & measurements: Twelve patients randomly received in a crossover manner a single oral dose of ciprofloxacin 750 mg alone and plus lanthanum carbonate 1 g three times daily with meals for six doses, with a washout interval of 7 to 14 d. Serial blood and urine samples were collected for 24 h after ciprofloxacin administration, and ciprofloxacin concentrations were determined using reverse-phase HPLC. Pharmacokinetic parameters of ciprofloxacin were calculated by noncompartmental methods, and the effect of lanthanum on ciprofloxacin pharmacokinetic parameters was assessed using ANOVA.Results: Lanthanum decreased (P < 0.001) the mean ciprofloxacin area under the plasma concentration-time curve by 54% and the maximum plasma concentration by 56%. The 24-h urinary recovery of ciprofloxacin was reduced by 52% by lanthanum (P < 0.001). No statistically significant differences in ciprofloxacin time to maximum plasma concentration, elimination half-life, and renal clearance occurred between the two arms.Conclusions: Lanthanum carbonate significantly reduces the systemic exposure to orally administered ciprofloxacin. Concomitant administration of both drugs should be avoided to prevent possible suboptimal response to ciprofloxacin.

Potential high-risk drug-drug interactions among elderly outpatients with dementia: a cross-sectional stud

“…Other pharmacokinetic PDDI occurred when the drugs were administered with calcium carbonate, which is mainly used in the treatment of osteoporosis, it reduces the absorption of other medications and, therefore, the bioavailability of various drugs. 28,29 The pharmacokinetic interactions during absorption are easy to manage. In most cases, it can be done simply by changing the medication administration timing to ensure the absorption of both drugs.…”

Phosphate binders in patients with chronic kidney disease

“…Other medicines should be given separately as phosphate binders can interfere with the absorption of drugs such as oral iron 13 and ciprofloxacin. 14 …”

No effect of protein binding ratio of levofloxacin in hemodialysis patients

“…Four patients received medications with known interactions with LVFX. Fluoroquinolones are known to interact with drugs containing calcium [12], iron [13], and lanthanum [14] via chelation interactions; they are also known to interact with sevelamer [15], manifesting as decreased oral bioavailability. It is unclear whether these drugs affected LVFX concentrations in this study.…”