Why You Should Avoid Taking Ciprofloxacin With Dairy Products
The pharmacist discusses why dairy products should be avoided when taking the antibiotic Cipro (ciprofloxacin).
I'm taking ciprofloxacin 500mg and now I'm nauseated all day long why is that? I don't take it with milk or dairy products. If I have dairy I have it 2 hours before or after I take ciprofloxacin so why am I still always nauseous? Could it be the Prozac I'm on also? Do they not mix?
Jul 19, 2022- Dairy products and calcium-containing supplements bind to ciprofloxacin and can reduce how much of the antibiotic your body absorbs by over 90 percent.
- Take ciprofloxacin at least 2 hours before or 6 hours after dairy products and calcium supplements, but it is safe to take with a full meal that contains these foods.
- If ciprofloxacin causes nausea, taking it with food can help reduce this side effect while still allowing adequate absorption of the medication.
Answer
Thanks for reaching out!
The recommendation to avoid dairy products like milk with ciprofloxacin isn't related to the gastrointestinal side effects. It is because foods that contain divalent or trivalent cations (which include calcium, Ca2+) will chelate, or "bind" to ciprofloxacin, significantly reducing the absorption of the antibiotic. In fact, the prescribing information for ciprofloxacin states that these cations, if given with the drug, can reduce bioavailability (i.e. the rate and extent of absorption) by over 90%.
Examples of compounds that contain divalent or trivalent cations include:
- Aluminum salts, (like aluminum hydroxide)
- Calcium salts (including calcium carbonate)
- Calcium-containing foods such as milk, cheese, and yogurt
- Magnesium salts
- Iron supplements
- Zinc products
To avoid the interaction, ciprofloxacin is recommended to be administered as follows:
- At least 2 hours before or 6 hours after any of the following products listed above that contain high amounts of divalent or trivalent cations listed above (e.g. milk and other dairy products which contain calcium)
According to the prescribing information for ciprofloxacin, the interaction is more of a concern when taking the antibiotic with single products that contain high levels of the interacting cations, but is generally safe to take with meals, even if the meal contains them. Per the prescribing information:
"Ciprofloxacin should not be taken with dairy products (like milk or yogurt) or calcium-fortified juices alone since absorption of ciprofloxacin may be significantly reduced; however, ciprofloxacin may be taken with a meal that contains these products."
If ciprofloxacin is causing nausea, taking it with a meal should help to reduce the side effects.
Additional Information
In terms of taking ciprofloxacin with Prozac, there is a potential interaction between the two, but it is not related to nausea. Taking these drugs together can increase the risk of a dangerous change in heartbeat or heart rhythm. Contact your prescriber immediately if you experience chest pain, dizziness, fainting or falling spells, palpitations, shortness of breath, or a change in your heartbeat (such as a fast or irregular heartbeat).
The interaction is considered uncommon but should be considered when prescribing both medications, especially in those with a prior history of heart disease.
References & sources
Glossary — Terms in This Answer
- Divalent cations
- Positively charged minerals with a charge of +2, such as calcium and magnesium, that can bind to and reduce medication absorption.
- Trivalent cations
- Positively charged minerals with a charge of +3, such as aluminum and iron, that can bind to and reduce medication absorption.
- Chelate
- To bind tightly to another substance, in this case when minerals attach to a medication and prevent it from being absorbed.
- Bioavailability
- The amount of a medication that actually enters the bloodstream and becomes available to work in the body.
- Absorption
- The process by which a medication passes from the digestive system or injection site into the bloodstream.
- Antibiotic
- A medication that kills bacteria or stops their growth to treat infections.
- Palpitations
- A sensation of feeling your heart beating, often described as a pounding, racing, or irregular heartbeat.
- Arrhythmia
- An abnormal or irregular heartbeat that may be too fast, too slow, or irregular in rhythm.
Dr. Brian Staiger, PharmD
Doctor of Pharmacy, board certified clinical pharmacist (BCPS), American Herbalist Guild, Medication Therapy Management certified
Brian Staiger, PharmD, BCPS, is a licensed pharmacist with more than 13 years of experience across retail pharmacy, clinical pharmacy, medication safety, pharmacy program development, and healthcare administration. He is the founder of HelloPharmacist.com, where he helps patients...
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