Understanding Ciprofloxacin Interactions: A Comprehensive Guide

When should I avoid Cipro?

Certain health conditions or other factors could raise your risk of harm if you take Cipro. In such cases, your doctor may not prescribe Cipro for you. These are known as contraindications. The list below includes contraindications of Cipro.

• If you take tizanidine. If you take tizanidine (Zanaflex), your doctor likely won’t prescribe Cipro. Tizanidine is a muscle relaxer used to provide relief for muscle spasms. Taking Cipro with tizanidine could increase your risk of certain side effects from tizanidine. These include excessive sleepiness, low heart rate, and low blood pressure.
• If you’ve had an allergic reaction. If you’ve had an allergic reaction to Cipro or any of its ingredients, your doctor likely won’t prescribe Cipro. This is because taking the drug could cause another allergic reaction.

Does Cipro interact with alcohol?

It should be safe to drink alcohol during Cipro treatment. The drug is not known to interact with alcohol.

But keep in mind that drinking alcohol while taking Cipro could make certain side effects of the drug worse. Examples include nausea and vomiting.

If you drink alcohol, talk with your doctor about how much is safe to drink while you’re taking Cipro.

Does Cipro interact with other drugs?

The chart below lists drugs that may interact with Cipro. Keep in mind that this chart does not include all drugs that may interact with Cipro. For more information about some of these interactions, see the “Drug interactions explained” section below.

Quick tip: Before you start taking Cipro, create a medication list to share with your doctor and pharmacist about any prescription drugs, over-the-counter drugs, or supplements you take.

Drug interactions explained

Learn more about certain drug interactions that can occur with Cipro.

Interaction with certain antidepressants

Taking Cipro with certain antidepressants could increase the risk of side effects from Cipro and antidepressants.

Examples of these antidepressant medications include:

• duloxetine (Cymbalta)
• venlafaxine (Effexor XR)
• sertraline (Zoloft)
• citalopram (Celexa)
• fluoxetine (Prozac)

What could happen

Both Cipro and certain antidepressants have a risk of abnormal heart rhythm as a side effect. Taking Cipro with such antidepressants could further increase the risk of this side effect.

What you can do

Before taking Cipro, tell your doctor if you take an antidepressant. They’ll determine whether it’s safe to take these drugs together.

If you do take Cipro with an antidepressant, your doctor will advise you on your risk of abnormal heart rhythm as a side effect. If you develop an abnormal heart rhythm, you may not have any symptoms of this condition. But possible symptoms include:

• heart rate that feels faster or slower than usual
• fluttering sensation in your chest or neck
• the feeling of your heart skipping a beat

Tell your doctor if you have these symptoms. They’ll check your heart rhythm and recommend what to do if you have this side effect.

Interaction with omeprazole

Taking Cipro with omeprazole (Prilosec) could make Cipro less effective than usual.

Omeprazole is a proton pump inhibitor. The drug is used to treat conditions such as heartburn and gastroesophageal reflux disease (GERD).

What could happen

Taking Cipro with omeprazole could lower the level of Cipro in your body. Having a low level of Cipro could make the drug less effective for treating your condition.

What you can do

Before starting Cipro treatment, tell your doctor if you take omeprazole. They can recommend whether it’s safe for you to take these medications together.

If you take Cipro with omeprazole, your doctor may monitor you for symptoms of the infection you’re using Cipro to treat.

If your infection isn’t getting better, they may recommend that you stop taking omeprazole. This would allow the level of Cipro in your body to increase. And having a higher level of Cipro could make the drug more effective. Alternatively, your doctor may give you a different antibiotic.

Interaction with sildenafil (Viagra, Revatio)

Taking Cipro with sildenafil (Viagra, Revatio) could increase the risk of side effects from sildenafil.

The brand-name versions of sildenafil treat different conditions in adults: Viagra is used to treat erectile dysfunction (ED), and Revatio is used to treat pulmonary arterial hypertension (PAH).

What could happen

Taking Cipro with sildenafil could increase the level of sildenafil in your body. Having a high level of sildenafil could increase your risk of side effects from the drug.

What you can do

Before taking Cipro, tell your doctor if you take sildenafil or its brand-name versions. They’ll determine whether it’s safe to take these drugs together.

If you take Cipro with sildenafil, your doctor will tell you how to watch for sildenafil’s side effects. And they’ll recommend what to do if you have them.

Are there other interactions with Cipro?

Cipro may have other interactions. They could occur with supplements, foods, vaccines, or even lab tests. See below for details. Note that the information below does not include all other possible interactions with Cipro.

Cipro interactions with minerals and vitamins

Cipro may interact with mineral supplements such as magnesium, calcium, zinc, and iron. Taking these mineral supplements with Cipro can lower the level of Cipro in your body. This could make Cipro less effective than usual for treating your condition.

Due to this risk, be sure to take Cipro at least 2 hours before or 6 hours after consuming magnesium, calcium, zinc, or iron supplements. Doing this should help prevent these supplements from affecting the Cipro level in your body.

There are currently no reports of Cipro interacting with vitamins. But multivitamins often contain magnesium, calcium, zinc, or iron, which are known to interact with Cipro. So it’s still important to check with your doctor or pharmacist before taking any vitamin products during Cipro treatment.

Cipro interactions with food

Cipro may interact with certain foods and drinks. These include dairy products, such as yogurt and milk, as well as juices that have calcium added to them.

Taking Cipro with these products may lower the level of Cipro in your body. Having a lower level of Cipro could make the drug less effective than usual at treating your condition.

Due to this risk, be sure to take Cipro at least 2 hours before or 6 hours after consuming any dairy products or juices that have calcium. Doing this should help prevent these foods and drinks from affecting the Cipro level in your body.

Does Cipro interact with vaccines?

Cipro may interact with vaccines for cholera and tuberculosis (TB). Getting a cholera or TB vaccine while taking Cipro could make these vaccines less effective.

For this reason, it’s best to wait to get these vaccines until at least 2 weeks after your last Cipro dose. Your doctor can tell you when it’s safe to get a cholera or TB vaccine after Cipro treatment ends.

Does my health history affect whether I should take Cipro?

Certain medical conditions or other health factors may raise the risk of interactions with Cipro. Before taking Cipro, talk with your doctor about your health history. They’ll determine whether Cipro is right for you.

Health conditions or other factors that might interact with Cipro include:

Tendon problems. Cipro may cause torn or swollen tendons. If you have tendon problems, taking Cipro might worsen them. In fact, Cipro has a boxed warning about risk of serious side effects such as this one. A boxed warning is a serious warning from the Food and Drug Administration (FDA). To learn more, see “Boxed warnings” at the beginning of this article.

Myasthenia gravis. Cipro may worsen myasthenia gravis in people who already have the condition. In fact, Cipro has a boxed warning about this risk. This is a serious warning from the FDA. To learn more, see “Boxed warnings” at the beginning of this article.

Liver problems. If you have liver problems, such as liver failure, tell your doctor before starting Cipro treatment. Having liver problems may increase your risk of certain liver side effects from Cipro. Your doctor can recommend whether Cipro is the right treatment for your condition.

Kidney problems. If you have kidney problems, such as kidney failure, tell your doctor before starting Cipro treatment. They may have you take a lower Cipro dosage than usual.

Seizures. Cipro may cause seizures as a side effect. The risk of this side effect may be higher for people who have a seizure disorder, such as epilepsy. Before starting Cipro treatment, tell your doctor if you have a seizure disorder. They’ll let you know whether it’s safe for you to take Cipro.

Diabetes. Cipro may affect blood sugar levels, especially in people who have diabetes and are taking diabetes medications. In rare cases, taking Cipro can cause severely low blood sugar levels that may lead to coma or may even be fatal for people with diabetes. If you have diabetes, your doctor can tell you whether it’s safe to take Cipro.

Abnormal heart rhythm. Cipro may cause an abnormal heart rhythm as a side effect. Your risk may be higher if you already have a condition that affects your heart’s electrical activity. An example is long QT syndrome. If you have an abnormal heart rhythm, talk with your doctor about whether you can safely take Cipro.

Pregnancy. It’s not known whether Cipro is safe to take during pregnancy. If you’re pregnant or planning a pregnancy, talk with your doctor before taking Cipro.

Breastfeeding. Cipro can pass into breast milk, which may cause side effects in a breastfed child. If you’re considering breastfeeding while taking Cipro, talk with your doctor.

Allergic reaction. If you’ve had an allergic reaction to Cipro or any of its ingredients, your doctor will likely not prescribe Cipro. This is because taking the drug could cause another allergic reaction. You can ask your doctor about other treatments that may be better choices for you.

Common questions about Cipro and interactions

Find answers to some frequently asked questions about Cipro and possible interactions.

Next steps: How can I prevent interactions?

Taking certain steps can help you avoid interactions with Cipro. Questions you may want to ask your doctor include:

• Does my Cipro dosage affect my risk of interactions?
• What should I do if I start a new medication while I’m taking Cipro?
• Do other antibiotics that treat my condition have similar interactions?

It’s also important to read Cipro’s label and other paperwork that may come with the drug. You may see colored stickers on the label that describe interactions. And the paperwork (sometimes called the patient package insert or medication guide) may have other details about interactions.

Taking Cipro exactly as prescribed can also help prevent interactions.