Ciprofloxacin with Mycophenolate Mofetil Interaction Details

Brand Names Associated with Ciprofloxacin

Brand Names Associated with Mycophenolate Mofetil

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

Interaction Effect

Decreased mycophenolic acid plasma exposure

Interaction Summary

Median trough mycophenolic acid (MPA; active metabolite of mycophenolate mofetil) concentration was reduced by about 50% from baseline at 3 days after introduction of oral ciprofloxacin. The reduction in exposure diminished within 14 days of antimicrobial therapy and ceased within 3 days of discontinuation of the antibiotic. When coadministration of mycophenolate mofetil plus ciprofloxacin is required, monitor patients for alterations in efficacy or mycophenolate mofetil-related adverse reactions. Obtaining MPA plasma levels before and after the initiation or discontinuation of concomitant medications may be necessary to ensure MPA levels remain stable.

Severity

Major

Onset

Rapid

Evidence

Established

How To Manage Interaction

Concomitant use of ciprofloxacin and mycophenolic acid (MPA) may lead to decreased exposure to the active metabolite mycophenolic acid and decreased efficacy of mycophenolate mofetil. When such coadministration is required, monitor patients for alterations in efficacy or mycophenolate mofetil-related adverse reactions. Obtaining MPA plasma levels before and after the initiation or discontinuation of concomitant medications may be necessary to ensure MPA levels remain stable.

Mechanism Of Interaction

Inhibition of enterohepatic recirculation of mycophenolic acid by ciprofloxacin

Literature Reports

A) A 17-year-old female bone marrow transplant recipient was switched from cyclosporine to IV mycophenolate mofetil 1800 mg/day (30 mg/kg or 1100 mg/m(2)) on treatment day 5 of immunosuppression therapy. On day 7, mycophenolic acid (MPA) AUC was measured at 30.3 mg x hr/L (therapeutic range, 30 to 60 mg x hr/L). On day 8, IV ciprofloxacin was started for recurrence of fever. On day 13 (six days of ciprofloxacin therapy), MPA AUC was 10.7 mg x hr/L, even though mycophenolate mofetil dosage was unchanged; mycophenolate mofetil dose was increased to 4500 mg/day. Ciprofloxacin therapy was completed on day 15. On day 18, MPA AUC was measured at 26 mg x hr/L. Due to adverse effects, mycophenolate mofetil dose was decreased to 3000 mg/day on day 18, and on day 22 the patient developed severe graft-versus-host disease. On day 24, MPA AUC was measured at 20.3 mg x hr/L. Due to the persistence of gastrointestinal adverse effects, mycophenolate mofetil was discontinued on day 33. The Horn drug interaction probability scale indicated a probable drug interaction between IV mycophenolate mofetil and IV ciprofloxacin .

B) In a study of kidney transplant recipients (N=64), ciprofloxacin 500 mg orally twice daily and amoxicillin with clavulanic acid 375 mg 3 times daily  were administered to two groups of patients (group 1 received 7 days of antibiotics; group 2 received at least 14 days of antibiotics). There was a significant decrease in MPA levels in both groups within 3 days of starting antibiotics (median day 3 level, 46% to 48% of baseline) with no further decrease in MPA level by day 7. In group 1, levels returned to normal 3 days after the completion of antibiotic therapy; in group 2, MPA levels on day 14 were significantly higher than on day 3 or day 7 (median day 14 level, 79% of baseline). No dosage adjustments of mycophenolate mofetil were done in either group. There was no significant difference in the effect on MPA levels between ciprofloxacin or amoxicillin with clavulanic acid. There were no deaths, graft losses, acute rejection episodes, or gastrointestinal adverse effects during antibiotic therapy .

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.

Mycophenolate Mofetil Overview

• Mycophenolate (CellCept) is used with other medications to help prevent transplant organ rejection (attack of the transplanted organ by the immune system of the person receiving the organ) in adults and children 3 months of age and older who have received kidney, heart, or liver transplants. Mycophenolate (Myfortic) is used with other medications to help prevent the body from rejecting kidney transplants in adults and children 5 years of age and older. Mycophenolate is in a class of medications called immunosuppressive agents. It works by weakening the body's immune system so it will not attack and reject the transplanted organ.

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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.