Possible Interaction: Ciprofloxacin and Calcium Supplement

“The release of ciprofloxacin from the cellulose membrane in the presence of aluminum, calcium , or iron ions was slower than that in the absence of these metal ions.”

“ Calcium therefore shares the same propensity as other cations in impairing the absorption of ciprofloxacin but not ofloxacin.”

“Maximum concentration of ciprofloxacin staggered with calcium was decreased in the noncompartmental model compared with ciprofloxacin alone (from 2.11 ± 0.72 to 1.60 ± 0.33, respectively; p<0.05).”

“Other statistically significant … maximum concentration of ciprofloxacin … calcium in serum compared with ciprofloxacin alone (from 1.76 ± 0.54 to 1.23 ± 0.52 h in the noncompartmental model; … the same parameter (from 1.92 ± 0.96 to 0.77 ± 0.53 in the compartmental model; p<0.005).”

“RESULTS: For 12 volunteers, the mean ± SD Fr of ciprofloxacin staggered with calcium was 0.87 ± 0.23 (noncompartmental model) and 0.98 ± 0.27 (compartmental model).”

“Although calcium carbonate decreased absorption to a lesser extent than aluminum hydroxide, these data suggest that antacids containing either aluminum or calcium should not be given concomitantly with Cipro.”

“In the presence of calcium, CIP forms complexes that reduce its oral absorption.”

“It is therefore recommended that patients being treated with ciprofloxacin for serious infections refrain from ingesting calcium supplements.”

“The concomitant oral administration of magnesium-, aluminium-, or calcium-containing antacids , sucralfate, iron preparations and multivitamins containing zinc significantly reduces the absorption of ciprofloxacin.”

“Concentrations of salivary total protein and calcium and gland DNA were reduced by all doses of Cipro.”

“Introduction Oral antimicrobials, including ciprofloxacin , levofloxacin and doxycycline, are susceptible to binding with enteral therapies such as calcium and iron therapies.”

“ Calcium ion interacted with … and CIP binding system in two distinct ways: Ca2+ shielded CO in amide I in EPS for CIP binding, whereas strengthened binding between CIP … functional groups including CO in carboxyl groups in extra-microcolony polymers and OH in extra-cellular polymers by forming ternary complexes.”