Ciprofloxacin with Calcium Interaction Details

Brand Names Associated with Ciprofloxacin

Brand Names Associated with Calcium

Medical Content Editor Dr. Brian Staiger, PharmD
Last updated Nov 19, 2023

Interaction Effect

Decreased ciprofloxacin efficacy

Interaction Summary

Fluoroquinolones are capable of forming chelate complexes with metal ions, including calcium, resulting in reduced bioavailability of the quinolone antibiotic. Concomitant use of calcium with ciprofloxacin should be avoided . Reductions in fluoroquinolone bioavailability are less marked if a low dose of calcium carbonate or staggered administration is used . Orange juice and calcium-fortified orange juice reduced ciprofloxacin bioavailability by 23% and 41%, respectively in a clinical trial .

Severity

Moderate

Onset

Rapid

Evidence

Probable

How To Manage Interaction

Concurrent administration of ciprofloxacin with calcium, including calcium-fortified foods and drinks such as orange juice, should be avoided. Ciprofloxacin may be taken two hours before or six hours after taking these products.

Mechanism Of Interaction

Reduced ciprofloxacin absorption

Literature Reports

A) Concomitant administration of either 2400 mg aluminum hydroxide tablets or 3400 mg calcium carbonate tablets significantly lowered plasma ciprofloxacin concentrations . Concomitant ciprofloxacin or enoxacin usage within two to four hours of antacids results in a reduced quinolone absorption by a minimum of 20% to 40%. If given concurrently within two hours of each other, absorption is reduced by 50% to 75% . Calcium carbonate 3400 mg or aluminum hydroxide 1800 mg reduced the bioavailability of ciprofloxacin 40% or 15%, respectively . Bioavailability of ciprofloxacin was 100% if antacid (30 milliliters Maalox(R)) was given at least six hours before or four hours after the ciprofloxacin dose. Ranitidine did not affect ciprofloxacin bioavailability, ruling out a simple pH-mediated mechanism. However, the authors caution that gastric emptying times may play a key role in the clinical impact of this interaction and extrapolation of results in healthy volunteers may not be appropriate. Ranitidine may be a better alternative to antacid therapy if this interaction is to be avoided .

Ciprofloxacin Overview

• Ciprofloxacin is used to treat or prevent certain infections caused by bacteria such as pneumonia; gonorrhea (a sexually transmitted disease); typhoid fever (a serious infection that is common in developing countries); infectious diarrhea (infections that cause severe diarrhea); and infections of the skin, bone, joint, abdomen (stomach area), and prostate (male reproductive gland), Ciprofloxacin is also used to treat or prevent plague (a serious infection that may be spread on purpose as part of a bioterror attack) and inhalation anthrax (a serious infection that may be spread by anthrax germs in the air on purpose as part of a bioterror attack). Ciprofloxacin may also be used to treat bronchitis, sinus infections, or urinary tract infections but should not be used for bronchitis and sinus infections, or certain types of urinary tract infections if there are other treatment options. Ciprofloxacin extended-release (long-acting) tablets are used to treat kidney and urinary tract infections; however, some types of urinary tract infections should only be treated with ciprofloxacin extended release tablets if no other treatment options are available. Ciprofloxacin is in a class of antibiotics called fluoroquinolones. It works by killing bacteria that cause infections.

• Antibiotics such as ciprofloxacin will not work for colds, flu, or other viral infections. Using antibiotics when they are not needed increases your risk of getting an infection later that resists antibiotic treatment.

Calcium Overview

• Calcium carbonate is a dietary supplement used when the amount of calcium taken in the diet is not enough. Calcium is needed by the body for healthy bones, muscles, nervous system, and heart. Calcium carbonate also is used as an antacid to relieve heartburn, acid indigestion, and upset stomach. It is available with or without a prescription.

• This medication is sometimes prescribed for other uses; ask your doctor or pharmacist for more information.

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Definitions

Severity Categories

Contraindicated

These drugs, generally, should not be used together simultaneously due to the high risk of severe adverse effects. Combining these medications can lead to dangerous health outcomes and should be strictly avoided unless otherwise instructed by your provider.

Major

This interaction could result in very serious and potentially life-threatening consequences. If you are taking this drug combination, it is very important to be under close medical supervision to minimize severe side effects and ensure your safety. It may be necessary to change a medication or dosage to prevent harm.

Moderate

This interaction has the potential to worsen your medical condition or alter the effectiveness of your treatment. It's important that you are monitored closely and you potentially may need to make adjustments in your treatment plan or drug dosage to maintain optimal health.

Minor

While this interaction is unlikely to cause significant problems, it could intensify side effects or reduce the effectiveness of one or both medications. Monitoring for changes in symptoms and your condition is recommended, and adjustments may be made if needed to manage any increased or more pronounced side effects.

Onset

Rapid: Onset of drug interaction typically occurs within 24 hours of co-administration.

Delayed: Onset of drug interaction typically occurs more than 24 hours after co-administration.

Evidence

Level of documentation of the interaction.

Established: The interaction is documented and substantiated in peer-reviewed medical literature.

Theoretical: This interaction is not fully supported by current medical evidence or well-documented sources, but it is based on known drug mechanisms, drug effects, and other relevant information.

How To Manage The Interaction

Provides a detailed discussion on how patients and clinicians can approach the identified drug interaction as well as offers guidance on what to expect and strategies to potentially mitigate the effects of the interaction. This may include recommendations on adjusting medication dosages, altering the timing of drug administration, or closely monitoring for specific symptoms.

It's important to note that all medical situations are unique, and management approaches should be tailored to individual circumstances. Patients should always consult their healthcare provider for personalized advice and guidance on managing drug interactions effectively.

Mechanism Of Interaction

The theorized or clinically determined reason (i.e., mechanism) why the drug-drug interaction occurs.

Disclaimer: The information provided on this page is for informational purposes only and should not be considered medical advice. Always consult with a qualified healthcare professional regarding your specific circumstances and medical conditions.

Where Does Our Information Come From?

Information for our drug interactions is compiled from several drug compendia, including:

• Gold Standard Drug Database
• Micromedex
• Lexicomp
• DrugBank

The prescribing information for each drug, as published on DailyMED, is also used. 

Individual drug-drug interaction detail pages contain references specific to that interaction. You can click on the reference number within brackets '[]' to see what reference was utilized.

The information posted is fact-checked by HelloPharmacist clinicians and reviewed quarterly.