Ciclodin IV Infusion Bag Drug Interactions

Ciprofloxacin is an inhibitor of human cytochrome P450 1A2 (CYP1A2) mediated metabolism. Co-administration of ciprofloxacin with other drugs primarily metabolized by CYP1A2 (e.g. theophylline, clozapine, olanzapine, ropinirole, tizanidine, duloxetine, agomelatine) results in increased plasma concentrations of these drugs and could lead to clinically significant adverse events of the co-administered drug. Concurrent administration of ciprofloxacin and theophylline can cause an undesirable increase in serum theophylline concentration. This can lead to theophylline-induced adverse reactions (e.g., cardiac arrest, seizure, status epilepticus, and respiratory failure) that may rarely be life threatening or fatal. If concomitant use cannot be avoided, monitor serum levels of theophylline and adjust dosage as appropriate.
Co-administration of ketoprofen with ciprofloxacin can rarely cause seizures, therefore it is not concurrently used. Co-administration of phenylacetic acid-derived (e.g. fenbufen, flubiprofen) or propionic acid-derived non-steroidal anti-inflammatory drugs with ciprofloxacin can rarely cause seizures, therefore concurrently use with caution. Non-steroidal anti-inflammatory drugs (but not acetyl salicylic acid) in combination of very high doses of quinolones have been shown to provoke convulsions in pre-clinical studies.
C_max and AUC of ciprofloxacin are slightly diminished when given concomitantly with omeprazole.
Simultaneous administration of ciprofloxacin with anti-coagulant drugs such as warfarin may augment its anti-coagulant 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 with anti-coagulant drugs.
As with other quinolones, hypoglycemia sometimes severe has been reported when ciprofloxacin and oral antidiabetic agents, mainly sulfonylureas (for example, glyburide, glimepiride), were co-administered.
Concomitant administration of cyclosporine with ciprofloxacin may increase serum concentration of cyclosporine and elevate serum creatinine. For these patients, it is necessary to monitor serum creatinine more frequently (twice a week).
Probenecid may interfere with renal tubular secretion of ciprofloxacin, decreasing therapeutic effect in treatment of urinary tract infections, and increase the level of ciprofloxacin in serum.
Renal tubular transport of methotrexate may be inhibited by concomitant administration of ciprofloxacin, potentially leading to increased plasma levels of methotrexate and increased risk of methotrexate-associated toxic reactions. Therefore, carefully monitor patients under methotrexate therapy when concomitant ciprofloxacin therapy is indicated.
In a clinical study with healthy subjects, there was an increase in serum tizanidine concentration (C_max increase: 7-fold, range: 4 to 21-fold; AUC increase: 10-fold, range: 6 to 24-fold) when given concomitantly with ciprofloxacin. Increased serum tizanidine concentration is associated with a potentiated hypotensive and sedative effect. Therefore, tizanidine must not be administered together with ciprofloxacin.
Simultaneous administration of ciprofloxacin and phenytoin may result in increased or reduced serum levels of phenytoin. To avoid the loss of seizure control associated with decreased phenytoin levels and to prevent phenytoin overdose-related adverse reactions upon ciprofloxacin discontinuation in patients receiving both agents, monitor phenytoin therapy, including phenytoin serum concentration during and shortly after co-administration of ciprofloxacin with phenytoin.
On concurrent administration of ciprofloxacin and caffeine or pentoxifylline, reduced clearance resulting in elevated levels and prolongation of serum half-life of caffeine or pentoxifylline.
The serum concentration of ciprofloxacin and metronidazole were not altered when these two drugs were given concomitantly.
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. Although ropinirole treatment was well tolerated, a possible interaction with ciprofloxacin associated with side effects may occur upon concomitant administration.
Lidocaine: It was demonstrated in healthy subjects that concomitant use of lidocaine containing medicinal products with ciprofloxacin, a moderate 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.
Ciprofloxacin may affect QT interval. It should be used with caution when treated with drugs such as Class IA or III anti-arrhythmic. Ciprofloxacin should be used with caution in patients receiving drugs known to prolong QT interval (e.g. Class IA and III anti-arrhythmic).
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 are advised.
Serum level and AUC of sildenafil twiced when co-administered with 50 mg of sildenafil and 500 mg of ciprofloxacin in healthy subject. Therefore, consider the benefits of treatment and the risks, closely monitor the patient in concomitant use of ciprofloxacin and sildenafil.
Agomelatine: Fluvoxamine, a strong inhibitor of CYP450 1A2 enzyme, remarkably inhibits the metabolism of agomelatine, resulting 60 times increase in exposure of agomelatine in clinical test. There is no clinical data supporting interactions between ciprofloxacin and agomelatine, but co-administration with agomelatine is contraindicated.
Zolpidem: It is not recommended to co-administer ciprofloxacin with zolpidem, for there is risk of increase in serum zolpidem level.