Indomethacin with Ciprofloxacin Interaction Details
Brand Names Associated with Indomethacin
- Indocin®
- Indomethacin
- Tivorbex®
Brand Names Associated with Ciprofloxacin
- Cipro® Oral Suspension
- Cipro® Tablets
- Cipro® XR Extended-release Tablets
- Ciprofloxacin
- Proquin® XR Extended-release Tablets
Medical Content Editor Dr. Brian Staiger, PharmD
Last updated
Jan 02, 2024
Interaction Effect
Formation of indomethacin-ciprofloxacin precipitate deposits in the eye
Interaction Summary
An interaction may occur if ciprofloxacin and indomethacin ophthalmic solutions are used at the same time and therefore should be avoided. When the two solutions were combined in a 1:1 ratio, the altered pH caused the formation of a precipitate that contained both substances. In a case report of a 61-year-old patient who had undergone phototherapeutic keratectomy, the precipitate resulted in the formation of stromal deposits which required mechanical removal.
Severity
Major
Onset
Rapid
Evidence
Probable
How To Manage Interaction
Avoid concurrent use of ciprofloxacin and indomethacin eye drops at the same time, especially in the presence of a large epithelial defect. Formation of stromal deposits may result.
Mechanism Of Interaction
Altered pH of indomethacin and ciprofloxacin ophthalmic solutions
Literature Reports
A) Formation of an indomethacin-ciprofloxacin precipitate, resulting in stromal deposits, was described in a case report of a 61-year-old patient who, on her own, added indomethacin eye drops to her prescribed regimen of ciprofloxacin eye drops and eye gel following phototherapeutic keratectomy (PTK). The patient added the use of indomethacin eye drops (3 x) to the prescribed nightly ciprofloxacin (5 x) and eye gel regimen. The 5-day control examination revealed the central stroma was still not covered by epithelium, and whitish, round deposits were detected in the stroma. Subsequently, the whitish plaques and surrounding epithelium were removed mechanically and the surface was covered with a therapeutic contact lens. Chemical investigation of the solutions showed that prior to combining the two solutions, the pH of the ciprofloxacin eye drops (Ciloxan) was 4.7, and the pH of the indomethacin eye drops (Indosol) was 7.3. When the two eye drops were combined in a 1:1 ratio the pH of the mixture changed to 5.6, and a yellow precipitate formed. Analysis of the precipitate showed the presence of both indomethacin and ciprofloxacin. In addition, when the pH of both eye drops was set to 5.6 individually, a yellow precipitate was observed in the indomethacin, but the ciprofloxacin solution remained clear .
Indomethacin Overview
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Indomethacin is used to relieve moderate to severe pain, tenderness, swelling, and stiffness caused by osteoarthritis (arthritis caused by a breakdown of the lining of the joints), rheumatoid arthritis (arthritis caused by swelling of the lining of the joints), and ankylosing spondylitis (arthritis that mainly affects the spine). Indomethacin is also used to treat pain in the shoulder caused by bursitis (inflammation of a fluid-filled sac in the shoulder joint) and tendinitis (inflammation of the tissue that connects muscle to bone). Indomethacin immediate-release capsules and suspension (liquid) are also used to treat acute gouty arthritis (attacks of severe joint pain and swelling caused by a build-up of certain substances in the joints). Indomethacin is in a class of medications called NSAIDs. It works by stopping the body's production of a substance that causes pain, fever, and inflammation.
Ciprofloxacin Overview
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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.
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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.
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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:
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.