jabennett2194 asked
I am starting an antibiotic tomorrow for a possible testicular infection from ureaplasma. It is called Cipro (ciprofloxacin) and it states to not take the drug around eating foods high in calcium. I drink milk and eat yogurt often. How much calcium are we talking? I am supposed to take this every 12 hours, can I take it immediately upon waking (roughly 7:30am on Mondays, Wednesdays, and Fridays and roughly 9am other days), and eat a calcium rich breakfast an hour later? Around 4:30pm my post-workout meal consists of oatmeal and whey protein, contributing 40% DV calcium. Can I then restrict calcium intake around dinner time (roughly 8:00pm) and take the second pill then? I also have Greek yogurt before bed (roughly 10:30pm).
Answer
Cipro (ciprofloxacin) is a fluoroquinolone antibiotic that is used for a variety of indications including pneumonia, respiratory infections and urinary tract infections. Ciprofloxacin can be administered with or without food but should not be taken with the following:
- Magnesium or aluminum antacids
- Calcium containing products
- Iron containing products
- Zinc containing products
Ciprofloxacin - Calcium Interaction
Co-administration of ciprofloxacin with calcium can significantly reduce the effectiveness of the antibiotic due to chelation. Chelation is the binding of a metal ion, such as calcium, to a molecule, such as ciprofloxacin. These bound, or chelated compounds, are known as "antibiotic-metal" chelates.
There are a few theories as to why ciprofloxacin, when bound to a metal ion, is ineffective. One possible mechanism is that when calcium is bound to ciprofloxacin, the absorption of the drug is significantly decreased. In addition, it is thought that the bound complex may inactivate ciprofloxacin's antibacterial effects on bacterial cells. Both possible mechanisms can potentially lead to lower drug levels in the body and therapeutic failure.
Ciprofloxacin - Calcium Administration Recommendations
To avoid any type of chelation interaction, it is recommended to administer ciprofloxacin at least 2 hours before or 6 hours after any interacting compound (e.g. calcium, magnesium, iron etc...). This precaution applies to "fortified" dietary products such as dairy products or calcium-fortified juices.
Studies are conflicted on whether there is a significant interaction between ciprofloxacin and the calcium that is contained in normal amounts in food (e.g. non-calcium fortified products). The prescribing information for ciproflopaxin recommends the following: "Do not administer with dairy products or calcium-fortified products alone; however, ciprofloxacin may be taken with a meal that contains these products". Therefore, as long as you don't take ciprofloxacin with a calcium fortified product alone (e.g. with calcium antacids, calcium supplements etc...), it should be okay to take with a regular meal.
