Drug interactions:

§ AA) Diclofenac

§ 1) Interaction Effect: increased ciprofloxacin plasma concentrations

§ 2) Summary: In a single-dose pharmacokinetic study, coadministration of ciprofloxacin

and diclofenac resulted in increased ciprofloxacin exposure and plasma levels, and
decreased ciprofloxacin Tmax and total body clearance (Iqbal et al, 2009). Although the
clinical significance of this interaction is unknown, consider monitoring patients receiving
these medications concomitantly for increased ciprofloxacin adverse events
(nervousness, nausea, and diarrhea).

§ 3) Severity: moderate

§ 4) Onset: unspecified

§ 5) Substantiation: established

§ 6) Clinical Management: Concomitant use of ciprofloxacin and diclofenac may cause

elevated ciprofloxacin plasma concentrations (Iqbal et al, 2009). Monitor patients for
increased ciprofloxacin adverse events (nervousness, nausea, and diarrhea).

§ 7) Probable Mechanism: unknown

Drug interactions Ciprofloxacin:

§ Metronidazole

§ a) Conflicting Data

§ 1) Incompatible

§ a) Ciprofloxacin 2 mg/mL with metronidazole 5 mg/mL, compatibility is

questionable; metronidazole concentration was reduced by about 10%
immediately after mixing (Jim, 1993k); however, ciprofloxacin 1.67 mg/mL with
metronidazole (ready to use) - 4.17 mg/mL, visually compatible and chemically
stable for 48 hours in Dextrose 5% in water or Sodium chloride 0.9% at 4 or 25
degrees C (Goodwin et al, 1991f)
§ 2) Compatible
§ a) Ciprofloxacin 1.67 mg/mL with metronidazole (ready to use) - 4.17 mg/mL,
visually compatible and chemically stable for 48 hours in Dextrose 5% in water or
Sodium chloride 0.9% at 4 or 25 degrees C (Goodwin et al, 1991e); however,
ciprofloxacin 2 mg/mL with metronidazole 5 mg/mL, compatibility is questionable;
metronidazole concentration was reduced by about 10% immediately after mixing
(Jim, 1993j)