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Pharmacy and Medications

Drug Interaction

08/15/2005

Question:

can you take ciprofloxacin and ibuprofen together and if so what harm can it do

Answer:

Ciprofloxacin is a fluoroquinolone antibiotic used to treat many different types of infection, and is often referred to as a "broad-spectrum" antibiotic. Ibuprofen is a non-steroidal anti-inflammatory (NSAID) used to treat mild to moderate pain, inflammation, fever, and arthritis. A definite drug-drug interaction has not been documented between these agents; however a potential warning is listed in the product information for ciprofloxacin. Seizures have been reported rarely during use of ciprofloxacin at very high doses.

About 40-50% of ciprofloxacin is removed from the body unchanged through the kidneys. Reduced elimination of drug through the kidneys could result in elevated blood levels potentially increasing the risk of seizures. For this reason, the manufacturers of ciprofloxacin recommend reducing the daily dose by 50% in patients with significantly impaired kidney function (creatinine clearance < 30ml/min).

The use of ibuprofen may worsen renal function in patients with significant renal impairment (creatinine clearance < 30ml/min). Taking ciprofloxacin and ibuprofen together in patients with significant renal impairment may further decrease the elimination of ciprofloxacin, resulting in elevated blood levels of this drug that may increase the incidence of seizures. The precautions section, but not the drug interactions section, of the package insert for Cipro®, (ciprofloxacin- Bayer) states that taking any NSAID with very high doses of ciprofloxacin may provoke seizures. However, we were unable to find any reports in the medical literature documenting the occurrence of seizures while an individual was taking ciprofloxacin and ibuprofen together.

The bottom line is that taking ibuprofen and ciprofloxacin is not likely to cause seizures in most patients. Patients with a history of seizure disorders, taking drugs that lower seizure threshold or patients with significantly impaired renal function may be at increased risk of developing seizures while taking this combination. Your doctor or a pharmacist who knows you can provide additional information if necessary.

Ciprofloxacin should be taken with a full glass of water, 2 hours before or after dairy products, antacids, vitamins, and iron supplements. Common side effects seen with ciprofloxacin are usually mild and may include headache, dizziness, nausea, vomiting, and diarrhea. Photosensitivity requiring the use sunscreen (minimum of SPF 15) or limited exposure to the sun may occur while taking this medication. Patients should not use a tanning bed while taking this medication. If any side effects persist or become severe, consult your physician.

Ibuprofen should be taken with food or milk to decrease the incidence of upset stomach. In addition to upset stomach, other relatively common side effects include dizziness or drowsiness. Avoid taking other NSAIDs such as naproxen, ketoprofen, aspirin, or other salicylates while taking ibuprofen unless instructed otherwise by your physician. Consult your physician if you experience dark tarry stools, stomach pain or cramping, or any other persistent or bothersome effects.

This response was prepared by Jason Glasgow, a PharmD candidate at the University of Cincinnati College of Pharmacy

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Response by:

Robert James Goetz, PharmD, DABAT
Assistant Professor of Pharmacy Practice
College of Medicine
University of Cincinnati