Why To Avoid Ciprofloxacin With Dairy Products

The pharmacist discusses why dairy products should be avoided when taking the antibiotic Cipro (ciprofloxacin).

Question

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?

Asked by Jacks On Jul 02, 2018

Answered by
Medical Content Reviewed By PharmacistAnswers Staff

On Jul 03, 2018

Cipro (ciprofloxacin) is well known to cause nausea and other gastrointestinal side effects including:

  • Vomiting
  • Diarrhea
  • Heartburn
  • Abdominal pain, discomfort and cramping
  • Flatulence


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 includes calcium, Ca2+) will chelate, or "bind" to ciprofloxacin, significantly reducing 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 hat 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 interactions cations, but is generally safe to take with meals, even if the meal contains them. Per the prescribing informaiton:

"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 heart beat (such as a fast or irregular heart beat). The interaction is considered uncommon but should be considered when prescribing both medicaitons, especially in those with a prior history of heart disease.

About the Pharmacist

Dr. Brian Staiger Pharm.D

Dr. Brian Staiger is a licensed pharmacist in New York State and the founder of PharmacistAnswers.com. He graduated from the University At Buffalo with a Doctor of Pharmacy degree in 2010. He has been featured in numerous publications including the Huffington Post as well as a variety of health and pharmacy-related blogs. Please feel free to reach out to him directly if you have any inquiries or want to connect! He's answered thousands of medication and pharmacy-related questions and he's ready to answer yours! Brian.Staiger@PharmacistAnswers.com Office: 716-389-3076

About Cipro (Ciprofloxacin)

Ciprofloxacin is a broad-spectrum antibacterial drug of the fluoroquinolone class, which are commonly known simply as "quinolones". It is FDA approved for the treatment of a variety of indications including mild to moderate and complicated urinary tract infections (UTIs), bronchitis, sinusitis, pneumonia, skin and skin structure infections, several types of infectious diarrhea and ear infections. Quinolone antibiotics like ciprofloxacin are associated with several serious side effects such as tendinitis and cardiovascular effects and are only be used for certain types of common infections (e.g. bronchitis) when alternative treatment options cannot be used. Ciprofloxacin is available in a variety of dosage forms including immediate release tablets, extended release tablets and as a suspension. Ciprofloxacin may be administered with or without meals but separated at least 2 hours before or 6 hours after any of the following: magnesium/aluminum antacids or other products containing calcium, iron, or zinc. However, ciprofloxacin may be taken with a meal that contains these products.

Recent Questions