Ciprofloxacin with Sucralfate Interaction Details

Brand Names Associated with Ciprofloxacin

Brand Names Associated with Sucralfate

Medical Content Editor Dr. Brian Staiger, PharmD
Last updated Nov 25, 2023

Interaction Effect

Decreased oral ciprofloxacin effectiveness

Interaction Summary

Pharmacokinetic studies have shown that concomitant administration of oral ciprofloxacin with sucralfate decreases bioavailability and, potentially, therapeutic efficacy of ciprofloxacin. When prescribed concurrently, oral ciprofloxacin should be administered at least 2 hours before  or 6 hours after sucralfate . Patients may need to be monitored for ciprofloxacin efficacy.

Severity

Moderate

Onset

Unspecified

Evidence

Established

How To Manage Interaction

If oral ciprofloxacin and sucralfate are prescribed concurrently, advise patients to take ciprofloxacin at least 2 hours before or 6 hours after taking sucralfate . Patients may need to be monitored for ciprofloxacin therapeutic efficacy.

Mechanism Of Interaction

Binding of sucralfate to ciprofloxacin in the gastrointestinal tract

Literature Reports

A) In 12 healthy volunteers, ciprofloxacin plasma levels were significantly decreased if sucralfate 2 g was administered at the same time . However, if ciprofloxacin 750 mg was given 2 or 6 hours before sucralfate, the reduction in ciprofloxacin levels was not significant. Compared to ciprofloxacin administered alone, the relative bioavailability of ciprofloxacin was decreased to 4.3% with concurrent sucralfate; when ciprofloxacin was given 2 or 6 hours before sucralfate, the relative bioavailability was 83% or 97%, respectively. There was considerable interpatient variability. The studies of concurrent use of ciprofloxacin and sucralfate have been conducted in healthy volunteers and have shown mixed results. A substantial decrease in mean ciprofloxacin serum levels (from 2 to 0.2 mcg/mL (6 to 0.6 mcmol/L)) has been observed in 8 subjects when ciprofloxacin and sucralfate were coadministered . It should be kept in mind that, in patients with decreased intestinal motility or delayed gastric emptying, there may be a higher risk for decreased absorption of ciprofloxacin even when the administration of ciprofloxacin and sucralfate is separated by several hours.

B) Concurrent administration of ciprofloxacin with an aluminum-magnesium-containing antacid resulted in decreased absorption (by 85%) of ciprofloxacin . Sucralfate, an aluminum salt of sulfated sucrose, probably interferes with ciprofloxacin absorption in the same way, through the formation of relatively insoluble complexes of the antibiotic with aluminum.

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.

Sucralfate Overview

• Sucralfate is used to treat and prevent the return of duodenal ulcers (ulcers located in first part of the small intestine). Treatment with other medications, such as antibiotics, may also be necessary to treat and prevent the return of ulcers caused by a certain type of bacteria (H. pylori) Sucralfate is in a class of medications called protectants. It sticks to damaged ulcer tissue and protects against acid and enzymes so healing can occur.

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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.