Possible interaction of ciprofloxacin with ferrous sulphate

Pennec, M. P. Le; Kitzis, Marie-Dominique; Terdjman, M.; Foubard, S.; Garbarz, E.; Hanania, G. I. H.

doi:10.1093/jac/25.1.184

Cited by 11 publications

(3 citation statements)

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“…Magnesium-aluminium antacids and sucralfate have the greatest effects (Garrelts et al 1990;Grasela et al 1989;Lomaestro & Bailie 1991b;Nix et al 1989a,b;Parpia et al 1989), followed by ferrous sulphate (LePennec et al 1990;Polk et al 1989), calcium ) and zinc ). Milk and yogurt reduce absorption of ciprofloxacin by 30% (Neuvonen et al 1991), although ofloxacin absorption appears unaffected (Marchbanks et al 1991).…”

Section: Metal Cationsmentioning

confidence: 99%

Pharmacokinetic Drug Interactions with Antimicrobial Agents

Gillum

Israel

Polk

1993

Clinical Pharmacokinetics

130

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As new classes of antimicrobial drugs have become available, and new uses found for older drugs, pharmacokinetic drug interactions with antimicrobials have become more common. Macrolides, fluoroquinolones, rifamycins, azoles and other agents can interact adversely with commonly used drugs, usually by altering their hepatic metabolism. The mechanisms by which antimicrobial agents alter the biotransformation of other drugs is increasingly understood to reflect inhibition or induction of specific cytochrome P450 enzymes. Macrolides inhibit cytochrome P450IIIA4 (CYP3A4), which appears to be the most common metabolic enzyme in the human liver and is involved in the metabolism of many drugs, including cyclosporin, warfarin and terfenadine. Some quinolones preferentially inhibit CYP1A2, which is partially responsible for methylxanthine metabolism. Azoles appear to be broad spectrum inhibitors of cytochromes P450. Within each of these antibiotic classes, there is a rank order of inhibitory potency towards specific cytochrome P450 enzymes. By contrast, rifampicin (rifampin) and rifabutin induce several cytochromes P450, including CYP3A4, and hence can enhance the metabolism of many other drugs. By using in vitro preparations of human enzymes it is increasingly possible to predict those antibiotics that will adversely affect the metabolism of other drugs. In addition, between-patient variability in frequency of interaction may relate to differences in the activities of these enzymes. Although the mechanisms and scope of these interactions are becoming well characterised, the remaining challenge is how to best inform the clinician so that the undesirable consequences of interactions may be prevented.

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Section: Metal Cationsmentioning

confidence: 99%

Pharmacokinetic Drug Interactions with Antimicrobial Agents

Gillum

Israel

Polk

1993

Clinical Pharmacokinetics

130

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“…Ciprofloxacin is a second generation quinolone antimicrobial with a broad spectrum of activity against common aerobic gram negative and gram positive bacterial pathogens (Walker & Wright, 1987). Although ciprofloxacin is readily absorbed, a variety of medications containing metal ions have been shown to interfere with its bioavailability (Davies & Maesen, 1989;Frost et al, 1989;La Pennec et al, 1990;Nix et al, 1989;Polk, 1989;Polk et al, 1989). The decreased bioavailability is presumably the result of formation of poorly absorbed metal ion-ciprofloxacin complexes (Davies & Maesen, 1989;Frost et al, 1989;Nix et al, 1989;Polk, 1989;Polk et al, 1989).…”

Section: Introductionmentioning

confidence: 99%

Clinical and chemical interactions between iron preparations and ciprofloxacin.

Kara

Hasinoff

McKay

et al. 1991

Brit J Clinical Pharma

105

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1. The effect of ferrous sulphate (300 mg), ferrous gluconate (600 mg), and a combination tablet of iron (10 mg), magnesium (100 mg), zinc (15 mg), calcium (162 mg), copper (2 mg), and manganese (5 mg) (Centrum Forte) co‐administration on ciprofloxacin bioavailability was tested in eight healthy subjects. 2. Peak serum ciprofloxacin concentrations and area under the curve (AUC) were significantly reduced when ciprofloxacin was administered with 300 mg ferrous sulphate (3.0 vs 2.0 mg l‐1, P less than 0.05 and 12.3 vs 6.7 mg l‐1 h, P less than 0.01, respectively). Reductions in peak ciprofloxacin concentrations and AUC also occurred when ciprofloxacin was ingested with 600 mg ferrous gluconate (1.3 mg l‐1, P less than 0.01 and 4.1 mg l‐1 h, P less than 0.01, respectively) and a Centrum Forte tablet (1.4 mg l‐1, P less than 0.01 and 5.4 mg l‐1 h, P less than 0.01, respectively). 3. When ferrous ion was mixed with ciprofloxacin, rapid spectral changes occurred (t1/2 = 1.9 min). Additional studies were consistent with oxidation of the ferrous form of iron to its ferric form, which is followed by rapid formation of a Fe(3+)‐ciprofloxacin complex. Ciprofloxacin seems to bind to ferric ion in a ratio of 3:1 by interacting with the 4‐keto and 3‐carboxyl groups on ciprofloxacin. 4. The formation of a ferric ion‐ ciprofloxacin complex is probably the cause of the reduction in ciprofloxacin bioavailability in the presence of iron.

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“…At least 95% of the reports analysed in our review involved healthy adult volunteers, which aligns with FDA recommendations. The remaining studies that recruited infected individuals were conducted in the 1980s and early 1990s, and their quality was low (high or moderate risk of bias) [30,[49][50][51][52][53].…”

Section: Patients' Health Statementioning

confidence: 99%

Together or Apart? Revealing the Impact of Dietary Interventions on Bioavailability of Quinolones: A Systematic Review with Meta-analyses

Wiesner,

Zagrodzki,

Gawalska

et al. 2024

Clin Pharmacokinet

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Background and Objective Managing drug-food interactions is essential for optimizing the effectiveness and safety profile of quinolones. Following PRISMA guidelines, we systematically reviewed the influence of dietary interventions on the bioavailability of 22 quinolones. Methods All studies describing or investigating the impact of food, beverages, antacids, and mineral supplements on pharmacokinetic parameters or pharmacokinetic/pharmacodynamic indices of orally taken quinolones were considered for inclusion. We excluded reviews, in vitro and in silico studies, studies performed on animals, and those involving alcohol. We performed the search in Medline (via PubMed), Embase, and Cochrane Library, covering reports from database inception to December 2022. We used the following tools to assess the risk of bias: version 2 of the Cochrane risk-of-bias tool for parallel trials, the Cochrane risk-of-bias tool for cross-over studies, and the NIH quality assessment tool for before-after studies. We performed quantitative analyses for each quinolone if two or more food-effect studies with specified and comparable study designs were available. If meta-analyses were not applicable, we qualitatively summarized the results. ResultsWe included 109 studies from 101 reports. Meta-analyses were conducted for 12 antibiotics and qualitative synthesis was employed for the remaining drugs. Of the studies, 60.5% were open-label, cross-over, as recommended by FDA. We judged 46% of studies as having a high risk of bias and only 4% of having a low risk of bias. Among 19 quinolones with available food impact data, 14 (74%) had potentially clinically important interactions. For nalidixic acid, oxolinic acid, and tosufloxacin, food exerted a high positive impact on bioavailability (AUC or C max increased by > 45%), whereas, for all the remaining drugs, postprandial absorption was lower. The most significant negative influence of food (AUC or C max decreased by > 40%) occurred for delafloxacin capsules and norfloxacin, whereas the moderate influence (AUC or C max decreased by 30-40%) occurred for nemonoxacin and rufloxacin. All 14 analysed quinolones showed a substantial reduction in bioavailability when co-administered with antacids and mineral supplements, except for calcium preparations. The impact of beverages was evaluated for 10 quinolones, with 50% experiencing significantly reduced absorption in the presence of milk (the highest negative impact for ciprofloxacin). Moreover, both ciprofloxacin and levofloxacin demonstrated compromised bioavailability when consumed with orange juice, particularly calcium-fortified. Discussion Several factors may influence interactions, including the physicochemical characteristics of quinolones, the type of intervention, drug formulation, and the patient's health status. We assessed the quality of evidence as low due to the poor actuality of included studies, their methodological diversity, and uneven data availability for individual drugs.

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Possible interaction of ciprofloxacin with ferrous sulphate

Cited by 11 publications

References 0 publications

Pharmacokinetic Drug Interactions with Antimicrobial Agents

Pharmacokinetic Drug Interactions with Antimicrobial Agents

Clinical and chemical interactions between iron preparations and ciprofloxacin.

Together or Apart? Revealing the Impact of Dietary Interventions on Bioavailability of Quinolones: A Systematic Review with Meta-analyses

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