Quinolone antibiotics and Cimetidine

Abstract/Summary
Cimetidine reduces the clearance of pefloxacin from the body, ranitidine reduces the absorption of enoxacin but neither cimetidine nor ranitidine appear to interact with cipro.

Clinical evidence, mechanism, importance and management
Neither cimetidine nor ranitidine affect the pharmacokrnetics of cipro12-5 but a study of the concurrent use of cimetidine and pefloxacin showed that the AUC was increased about 40% (from 49 to 69 /ig/h/ml”1), the half-life increased from 10.3 to 15.3 h and the clearance was reduced from 151 to 110 ml/mm. The clinical importance of this is uncertain but increased toxicity is a possibility. In contrast 50 mg ranitidine given intravenously 2 h before a single oral dose of enoxacin was found to have reduced the absorption by 26-40% which seemed to be related to change in gastric pH caused by the ranitidine. A reduced therapeutic response seems likely. Concurrent use should be monitored. More study is needed.

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