Cipro interactions: Alcohol, medications, and other factors

Cipro (ciprofloxacin) is a brand-name prescription drug used to treat bacterial infections. Examples include urinary tract infections (UTIs), lower respiratory tract infections, and certain skin and bone infections.

As with other medications, Cipro can interact with certain other drugs. It can also interact with some supplements and foods. An interaction occurs when one substance causes another substance to have a different effect than expected.

Cipro comes in different forms, and they have the same interactions. The forms are:

• oral tablet
• powder that’s mixed with water to form an oral liquid suspension

For details about Cipro’s interactions, keep reading. For additional information about Cipro, including details about its uses, see this article.

In some cases, factors or conditions could prevent your doctor from prescribing Cipro due to the risk of harm. These are known as contraindications. The contraindications of Cipro include:

Taking tizanidine

Doctors typically will not prescribe Cipro with tizanidine (Zanaflex). This drug is a muscle relaxer and is used to ease muscle spasms.

Taking Cipro with tizanidine could increase your risk of side effects from tizanidine. Specifically, you may have a higher risk of low blood pressure, low heart rate, and excessive sleepiness.

If you take tizanidine, talk with your doctor before starting Cipro treatment. They can recommend a different option for your condition.

Having had an allergic reaction to Cipro or any of its ingredients

If you have had an allergic reaction to Cipro or any of its ingredients, your doctor will likely not prescribe Cipro. Taking the drug could cause another allergic reaction. You can ask them about other treatments that may be better choices for you.

Note: Before you start treatment with Cipro, it’s important to tell your doctor if either of these contraindications apply to you. They can determine whether to prescribe Cipro.

Before you start treatment with Cipro, tell your doctor and pharmacist which prescription, over-the-counter, and other medications you take. By sharing this information with them, you may help prevent possible interactions.

If you have questions about drug interactions that may affect you, ask your doctor or pharmacist.

Here’s a chart of drugs that can interact with Cipro. Keep in mind that this chart does not include all drugs that may interact with Cipro. Some of these interactions are described in detail just below in “Drug interactions in depth.”

* For details about this interaction, see “When to avoid Cipro” above.
† Cipro has boxed warnings about risks of serious side effects. These are serious warnings from the Food and Drug Administration (FDA). To learn more, see “Boxed warnings” at the top of this article. You can also find information about Cipro’s side effects here.

There’s no known interaction between Cipro and alcohol.

Certain antibiotics, such as metronidazole (Flagyl), do interact with alcohol. Cipro is a type of antibiotic, but it isn’t known to have this interaction.

Keep in mind that drinking alcohol while taking Cipro could worsen some of the drug’s side effects. Examples include liver failure and digestive problems, such as nausea and vomiting. (For details about possible side effects of Cipro, see this article.)*

If you drink alcohol, talk with your doctor before starting Cipro treatment. They can recommend whether you should limit the amount of alcohol you consume while taking the drug.

* Cipro has boxed warnings about risks of serious side effects. These are serious warnings from the Food and Drug Administration (FDA). To learn more, see “Boxed warnings” at the top of this article.

Here’s a closer look at certain drug interactions of Cipro.

Warfarin

Warfarin is a blood thinner. It’s used to help prevent or treat blot clots in certain situations.

Interaction result. Taking Cipro in combination with warfarin can increase your risk of side effects with warfarin, such as bleeding.

Interaction explained. Two enzymes called cytochrome P450 1A2 (CYP1A2) and CYP3A4 break down warfarin in the body. An enzyme is a type of protein.

Cipro slows down the activity of CYP1A2 and CYP3A4. When the activity of these enzymes slows, it takes your system longer than usual to break down warfarin. This could lead to higher levels of warfarin in your body. As a result, you may have an increased risk of side effects from warfarin if you take it with Cipro.

Steps you or your doctor may take. If you take Cipro with warfarin, your doctor may order certain blood tests. These tests check the time it takes your blood to form a clot. This will help your doctor determine if your risk of bleeding is increased.

If you take Cipro with warfarin, tell your doctor if you have symptoms of bleeding. Examples of these symptoms include:

• coughing up blood
• bloody urine or stool
• bleeding from your gums or nose that takes a long time to stop
• unexplained bruising

Note: Warfarin is a generic drug that was previously available as brand-name Coumadin. However, Coumadin has been discontinued.

Omeprazole

Omeprazole (Prilosec) is a type of drug called a proton pump inhibitor (PPI). It’s used to treat conditions such as gastroesophageal reflux disease (GERD) and heartburn.

Interaction result. Taking Cipro with omeprazole could make Cipro less effective than usual.

Interaction explained. Omeprazole may lower the level of Cipro in your body. Having a lower level of Cipro could mean the drug won’t work as well as it should.

Steps you or your doctor may take. If you take omeprazole, be sure to tell your doctor before starting Cipro treatment. They’ll advise you on whether these medications can be taken together.

If you do take Cipro with omeprazole, your doctor may closely watch the symptoms of your infection. (Cipro is an antibiotic, and it’s used to treat various infections.) If the infection you’re taking Cipro to treat isn’t getting better, your doctor may suggest you stop taking omeprazole. This would allow the level of Cipro in your body to increase, which could help Cipro be more effective. Or your doctor may prescribe a different antibiotic for you instead.

Antacids

Antacids are used to ease symptoms of conditions such as indigestion and heartburn.

Interaction result. Taking Cipro with certain antacids could make Cipro less effective than usual. This includes antacids that contain calcium, magnesium, or aluminum.

Interaction explained. When you take Cipro with an antacid, the calcium, magnesium, or aluminum in the antacid may attach to Cipro. This could prevent your body from absorbing Cipro, reducing the level of the drug in your body. Having a low level of Cipro could keep the drug from working as well as it should.

Examples of antacid drugs. Examples of antacids that may interact with Cipro include:

• calcium carbonate (TUMS)
• aluminum hydroxide/magnesium hydroxide (Maalox)

Steps you or your doctor may take. Due to this risk, you should take Cipro at least 2 hours before or 6 hours after taking an antacid that contains calcium, magnesium, or aluminum. This should help prevent calcium, magnesium, and aluminum from affecting the level of Cipro in your body.

Before taking any antacids with Cipro, talk with your doctor or pharmacist. They can help you determine whether an antacid contains calcium, magnesium, or aluminum.

Cipro may have other interactions, such as with supplements, foods, vaccines, or even lab tests. You’ll find details below. Keep in mind that the following information does not include all other possible interactions with Cipro.

Cipro interactions with supplements

Before you start treatment with Cipro, tell your doctor and pharmacist which supplements, herbs, and vitamins you take. By sharing this information with them, you may help prevent possible interactions.

If you have questions about drug interactions that may affect you, ask your doctor or pharmacist.

Cipro and herbs

There have not been reports of herbs interacting with Cipro. However, it’s still important to check with your doctor or pharmacist before taking any of these products during Cipro treatment.

Cipro interactions with minerals and vitamins

Here’s some information on Cipro, minerals, and vitamins.

Minerals

Mineral supplements such as calcium, iron, zinc, and magnesium may interact with Cipro. If you take these minerals with Cipro, they could decrease the level of the drug in your body. This may make Cipro less effective than usual at treating your condition.

Due to this risk, you should take Cipro at least 2 hours before or 6 hours after taking calcium, iron, zinc, or magnesium supplements. This should help prevent those minerals from affecting the level of Cipro in your system.

Vitamins

Vitamins have not been reported to interact with Cipro. However, multivitamins may contain the minerals calcium, iron, zinc, and magnesium, which are known to interact with Cipro. (For details, see “Minerals” above.)

Before taking any vitamin products with Cipro, talk with your doctor or pharmacist. They can help you determine whether a product contains any calcium, iron, zinc, or magnesium.

Cipro interactions with food

Certain foods and drinks could reduce the level of Cipro in your body. This includes dairy products, such as milk and yogurt, as well as juices that contain calcium. With a decreased level of Cipro in your system, the drug could be less effective than usual at treating your condition.

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

If you have questions about specific foods or drinks and Cipro, talk with your doctor or pharmacist.

Cipro interactions with vaccines

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

For this reason, you should wait at least 2 weeks after taking your last Cipro dose before getting the cholera vaccine. Your doctor will recommend when it’s safe to receive a TB vaccine after Cipro treatment.

Before you receive any vaccines, be sure your doctor knows you’re taking Cipro. If you have questions about getting vaccines during Cipro treatment, talk with your doctor or pharmacist.

Cipro and lab tests

No interactions between Cipro and lab tests have been reported. To learn more about having certain lab tests during treatment with Cipro, talk with your doctor.

Cipro and cannabis or CBD

Cannabis (often called marijuana) and cannabis products, such as cannabidiol (CBD), have not been specifically reported to interact with Cipro. However, as with any drug or supplement, talk with your doctor before using cannabis in combination with Cipro. The impact of cannabis may affect how well you stick to your Cipro treatment plan.

Note: Cannabis is illegal at a federal level but is legal in many states to varying degrees.

Certain medical conditions and other factors may increase the risk of interactions with Cipro. Before you take Cipro, be sure to talk with your doctor about your health history. Cipro may not be the right treatment option for you if you have certain medical conditions or other factors affecting your health.

Health conditions or factors that might interact with Cipro include:

• Myasthenia gravis. Cipro may worsen myasthenia gravis if you already have this condition. In fact, Cipro has a boxed warning about this risk. This is a serious warning from the Food and Drug Administration (FDA). For more information, see “Boxed warnings” at the beginning of this article.
• Tendon problems. Cipro may cause tendon inflammation or tearing. In fact, Cipro has a boxed warning about this risk. This is a serious warning from the FDA. You may have a higher risk of this side effect if you already have tendon problems before taking the drug. For additional details, see “Boxed warnings” at the beginning of this article.
• Diabetes. Cipro may affect blood sugar levels, particularly if you have diabetes and are taking diabetes drugs. In rare cases, taking Cipro can cause severely low blood sugar levels that lead to coma or possibly be fatal in people with diabetes. If you have diabetes, your doctor can tell you whether it’s safe to take Cipro.
• Kidney problems. If you have kidney problems, such as kidney failure, be sure to tell your doctor before taking Cipro. They may give you a lower dosage of the drug than usual if you have kidney problems.
• Liver problems. Before you start treatment with Cipro, tell your doctor if you have liver problems. An example is liver failure. In rare cases, Cipro may cause certain liver problems. Your risk of liver side effects may be higher if you already have a liver problem. Your doctor can determine whether to prescribe Cipro for you.
• Seizures. Cipro may cause seizures. The risk of this side effect may increase if you have a seizure disorder, such as epilepsy. Before taking Cipro, tell your doctor if you have a seizure disorder. They can recommend whether Cipro is safe to take.
• Abnormal heart rhythm. Before taking Cipro, tell your doctor if you have long QT syndrome. Cipro may cause 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. You should talk with your doctor about whether Cipro is a safe treatment option for you.
• Pregnancy. It’s not known for certain whether Cipro is safe to take during pregnancy. If you’re pregnant or planning a pregnancy, talk with your doctor before you take Cipro. For details about the medication’s use during pregnancy, see this article.
• Breastfeeding. Cipro passes into the breast milk during breastfeeding, which could cause side effects in a breastfed child. If you’re breastfeeding or considering it, talk with your doctor before taking Cipro. To learn more about the drug’s use while breastfeeding, see this article.
• Allergic reaction. If you’ve had an allergic reaction to Cipro or any of its ingredients, your doctor will likely not prescribe Cipro. For details, see “When to avoid Cipro” above.

Here are some frequently asked questions about Cipro and possible interactions.

Is Cipro compatible with Lactated Ringer’s (LR)?

The form of Cipro that may have been used with lactated Ringer’s (LR) has been discontinued.

LR is an IV fluid that’s commonly used in hospitals. Healthcare professionals give LR in certain situations, such as treating dehydration or helping administer IV medications.

Cipro currently comes in two forms: an oral tablet and a powder that’s mixed with water to form an oral liquid suspension. This article addresses interactions for only these oral forms of Cipro.

In the past, Cipro was available as an IV solution that was given by a healthcare professional. You may be wondering if the IV form of Cipro is safe to use with LR. However, all brand-name forms of Cipro IV solution have been discontinued. So, healthcare professionals aren’t likely to use Cipro with LR.

If you have additional questions, talk with your doctor.

Do Cipro and Macrobid interact?

No, there isn’t an interaction between Cipro and nitrofurantoin (Macrobid).

Cipro and Macrobid are antibiotics. Both drugs are approved to treat urinary tract infections (UTIs) and certain other bacterial infections. However, in most cases, doctors won’t prescribe Cipro and Macrobid together. Instead, they’ll prescribe one drug or the other to treat your infection.

If you have questions about Cipro and Macrobid, talk with your doctor or pharmacist.

Can I take Cipro with Synthroid?

Yes, it should be safe to take Cipro with levothyroxine (Synthroid). Cipro and Synthroid aren’t known to interact with each other.

Synthroid is a synthetic version of a certain thyroid hormone found naturally in the body. Synthroid is drug used to treat thyroid cancer and hypothyroidism in specific situations.

To learn more about taking Cipro with Synthroid, talk with your doctor or pharmacist.

Does Cipro interact with Xarelto?

No, Cipro isn’t known to interact with rivaroxaban (Xarelto).

Xarelto is a blood thinner. It’s used to help prevent or treat blood clots in certain situations.

Cipro is known to interact with a different blood thinner called warfarin (Jantoven). For details about this interaction, see “Warfarin” in the “Drug interactions in depth” section above.

If you’d like to learn more about Cipro and Xarelto, talk with your doctor or pharmacist.

You can take certain steps to help prevent interactions with Cipro. Your doctor and pharmacist are key resources, so reach out to them before starting treatment. For example, you should plan to do the following:

• Tell them about any other medications you take, as well as any supplements, herbs, and vitamins.
• Create a medication list, which your doctor and pharmacist can help you fill out.

It’s also important to read the Cipro label and other paperwork that may come with the drug. The label may have colored stickers that mention an interaction. And the paperwork, sometimes called the medication guide or patient package insert, may contain details about interactions. (If Cipro doesn’t come with paperwork, you can ask your pharmacist to print a copy.) If you have questions about the information, ask your doctor or pharmacist.

You can also help prevent interactions with Cipro by taking it exactly as your doctor prescribes.

Besides learning about interactions, you may want to find out more about Cipro. These resources might help:

• Overview of Cipro. For a general overview of Cipro, you can see this article.
• Side effects. If you’re interested in the side effects of Cipro, see this article. Another option is to refer to the Cipro prescribing information.
• Drug comparison. For information about how Cipro compares with Bactrim, Macrobid, levofloxacin, and cephalexin, read this article.
• Facts about your condition. To learn more about infections caused by bacteria, see this list of articles related to infections.

Disclaimer: Medical News Today has made every effort to make certain that all information is factually correct, comprehensive, and up to date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or another healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.