Cipro and Synjardy XR
Determining the interaction of Cipro and Synjardy XR and the possibility of their joint administration.
In the database of official manuals used in the service creation an interaction registered by statistical results of studies was found, which can either lead to negative consequences for the patient health or strengthen a mutual positive effect. A doctor should be consulted to address the issue of joint drug administration.
Consumer:Medications like ciprofloxacin can sometimes affect blood glucose levels. Both hyperglycemia (high blood glucose) and, less frequently, hypoglycemia (low blood glucose) have been reported. Severe cases of hypoglycemia have resulted in coma and even death, especially in the elderly and patients with kidney problems or severe infections using insulin or other diabetes medications that can commonly cause hypoglycemia. Talk to your doctor if you have any questions or concerns. Your doctor may be able to prescribe alternatives that do not interact, or you may need a dose adjustment or more frequent monitoring of your blood glucose levels to safely use both medications. Let your doctor know if you experience hypoglycemia or hyperglycemia, or if you notice a loss of blood glucose control. Symptoms of hypoglycemia include headache, dizziness, drowsiness, nervousness, confusion, tremor, nausea, hunger, weakness, perspiration, palpitation, and rapid heartbeat. Symptoms of hyperglycemia may include increased thirst, increased hunger, and increased urination. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.
Professional:MONITOR: Quinolone antibiotics may interfere with the therapeutic effects of insulin and other antidiabetic agents. The use of quinolones has been associated with disturbances in blood glucose homeostasis possibly stemming from effects on pancreatic beta cell ATP-sensitive potassium channels that regulate insulin secretion. Both hyperglycaemia and hypoglycemia have been reported, usually in diabetic patients receiving concomitant treatment with an oral hypoglycemic agent (e.g., sulfonylurea) or insulin. Although hyperglycaemia is significantly more common and infection itself may be an underlying risk factor, hypoglycemia may cause greater morbidity and mortality. An internal safety review conducted by the U.S. Food and Drug Administration (FDA) identified at least 67 reports of severe hypoglycemia associated with quinolone use resulting in coma, death, or permanent and disabling injuries, primarily in elderly and diabetic patients with renal impairment and/or complicated infections. This is in addition to the numerous cases that have been reported for gatifloxacin, which led to its withdrawal from the U.S. market in 2008. Of the five quinolones that the FDA reviewed, levofloxacin had the most cases (44), followed by ciprofloxacin (12), moxifloxacin (9), ofloxacin (2), and gemifloxacin (0). Other quinolones such as nalidixic acid and norfloxacin, as well as some others that have never been marketed or are no longer marketed such as clinafloxacin and temafloxacin, have also been associated with dysglycemia, thus it is generally believed to be a class effect, albeit with varying risks amongst the individual agents. Available data also seem to indicate different time frames for the development of hypo- and hyperglycaemia, with the former generally occurring within 1 to 3 days following quinolone initiation and the latter within 4 to 10 days later.
MANAGEMENT: Blood glucose should be closely monitored whenever quinolones are prescribed to diabetic patients, especially if they are elderly, have renal impairment, or are severely ill. Patients should be apprised of the increased risk of dysglycemia and be particularly alert to potential signs and symptoms of hypoglycemia such as headache, dizziness, drowsiness, nervousness, confusion, tremor, hunger, weakness, perspiration, palpitation, and tachycardia. If hypoglycemia occurs, patients should initiate appropriate remedial therapy immediately, discontinue the quinolone, and contact their physician. Alternative antibiotics may need to be considered.
- Gavin JR 3rd, Kubin R, Choudhri S, et al "Moxifloxacin and glucose homeostasis: a pooled-analysis of the evidence from clinical and postmarketing studies." Drug Saf 27 (2004): 671-86
- Kelesidis T, Canseco E "Quinolone-induced hypoglycemia: a life-threatening but potentially reversible side effect." Am J Med 123 (2010): e5-6
- Baker SE, Hangii MC "Possible gatifloxacin-induced hypoglycemia." Ann Pharmacother 36 (2002): 1722-6
- Khovidhunkit W, Sunthornyothin S "Hypoglycemia, hyperglycemia, and gatifloxacin." Ann Intern Med 141 (2004): 969
- Menzies DJ, Dorsainvil PA, Cunha BA, Johnson DH "Severe and persistent hypoglycemia due to gatifloxacin interaction with oral hypoglycemic agents." Am J Med 113 (2002): 232-4
- Edwards DJ, Bowles SK, Svensson CK, Rybak MJ "Inhibition of drug metabolism by quinolone antibiotics." Clin Pharmacokinet 15 (1988): 194-204
- Yip C, Lee AJ "Gatifloxacin-induced hyperglycemia: a case report and summary of the current literature." Clin Ther 28 (2006): 1857-66
- "Product Information. Tequin (gatifloxacin)" Bristol-Myers Squibb, Princeton, NJ.
- Graumlich JF, Habis S, Avelino RR, et al. "Hypoglycemia in inpatients after gatifloxacin or levofloxacin therapy: nested case-control study." Pharmacotherapy 25 (2005): 1296-302
- Lin G, Hays DP, Spillane L "Refractory hypoglycemia from ciprofloxacin and glyburide interaction." J Toxicol Clin Toxicol 42 (2004): 295-7
- Letourneau G, Morrison H, McMorran M "Gatifloxacin (Tequin): hypoglycemia and hyperglycemia. Available from: URL: http://www.hc-sc.gc.ca/dhp-mps/medeff/bulletin/carn-bcei_v13n3_e.html#1" ([2003 Jul]):
- Wang S, Rizvi AA "Levofloxacin-induced hypoglycemia in a nondiabetic patient." Am J Med Sci 331 (2006): 334-5
- Zvonar R "Gatifloxacin-induced dysglycemia." Am J Health Syst Pharm 63 (2006): 2087-2092
- "Product Information. Floxin (ofloxacin)." Ortho Pharmaceutical Corporation, Raritan, NJ.
- Bhasin R, Arce FC, Pasmantier R "Hypoglycemia associated with the use of gatifloxacin." Am J Med Sci 330 (2005): 250-3
- "Product Information. Baxdela (delafloxacin)." Melinta Therapeutics, Lincolnshire, IL.
- Rubinstein E "History of quinolones and their side effects." Chemotherapy 47 Suppl 3 (2001): 3-8
- Park-Wyllie LY, Juurlink DN, Kopp A, et al. "Outpatient gatifloxacin therapy and dysglycemia in older adults." N Engl J Med 354 (2006): 1352-61
- Greenberg AL, Decerbo M, Fan J "Gatifloxacin therapy associated with hypoglycemia." Clin Infect Dis 40 (2005): 1210-1
- "Product Information. Cipro (ciprofloxacin)." Bayer, West Haven, CT.
- Brogan SE, Cahalan MK "Gatifloxacin as a possible cause of serious postoperative hypoglycemia." Anesth Analg 101 (2005): 635-6
- "Product Information. Raxar (grepafloxacin)." Glaxo Wellcome, Research Triangle Park, NC.
- Friedrich LV, Dougherty R "Fatal hypoglycemia associated with levofloxacin." Pharmacotherapy 24 (2004): 1807-12
- Blommel AL, Lutes RA "Severe hyperglycemia during renally adjusted gatifloxacin therapy." Ann Pharmacother 39 (2005): 1349-52
- Saraya A, Yokokura M, Gonoi T, Seino S "Effects of fluoroquinolones on insulin secretion and beta-cell ATP-sensitive K(+) channels." Eur J Pharmacol 497 (2004): 111-7
- Tomita T, Onishi M, Sato E, Kimura Y, Kihira K "Gatifloxacin induces augmented insulin release and intracellular insulin." Biol Pharm Bull 30 (2007): 644-7
- Donaldson AR, Vandiver JR, Finch CK "Possible gatifloxacin-induced hyperglycemia." Ann Pharmacother 38 (2004): 602-5
- "Product Information. Trovan (trovafloxacin)." Pfizer US Pharmaceuticals, New York, NY.
- Gajjar DA, LaCreta FP, Kollia GD, et al. "Effect of multiple-dose gatifloxacin or ciprofloxacin on glucose homeostasis and insulin production in patients with noninsulin-dependent diabetes mellitus maintained with diet and exercise." Pharmacotherapy 20 (6 Pt 2) (2000): s76-86
- "Hypoglycemia and hyperglycemia with fluoroquinolones." Med Lett Drugs Ther 45 (2003): 64
- "Product Information. Levaquin (levofloxacin)." Ortho Pharmaceutical Corporation, Raritan, NJ.
- Kanbay M, Aydogan T, Bozalan R, et al. "A rare but serious side effect of levofloxacin: hypoglycemia in a geriatric patient." Diabetes Care 29 (2006): 1716-7
- Frothingham R "Glucose homeostasis abnormalities associated with use of gatifloxacin." Clin Infect Dis 41 (2005): 1269-76
- Roberge RJ, Kaplan R, Frank R, Fore C "Glyburide-ciprofloxacin interaction with resistant hypoglycemia." Ann Emerg Med 36 (2000): 160-3
- "Product Information. Factive (gemifloxacin)." GeneSoft Inc, San Francisco, CA.
- "Product Information. Noroxin (norfloxacin)." Merck & Co, Inc, West Point, PA.
- Zhanel GG, Fontaine S, Adam H, et al. "A Review of New Fluoroquinolones : Focus on their Use in Respiratory Tract Infections." Treat Respir Med 5 (2006): 437-465
- LeBlanc M, Belanger C, Cossette P "Severe and resistant hypoglycemia associated with concomitant gatifloxacin and glyburide therapy." Pharmacotherapy 24 (2004): 926-31
- Happe MR, Mulhall BP, Maydonovitch CL, Holtzmuller KC "Gatifloxacin-induced hyperglycemia." Ann Intern Med 141 (2004): 968-9
- Biggs WS "Hypoglycemia and hyperglycemia associated with gatifloxacin use in elderly patients." J Am Board Fam Pract 16 (2004): 455-7
Generic Name: ciprofloxacin
Brand name: Cipro, Cipro XR, Proquin XR, Cipro IV
Synonyms: n.a.
Generic Name: empagliflozin / metformin
Brand name: Synjardy, Synjardy XR
Synonyms: n.a.
In the course of checking the drug compatibility and interactions, data from the following reference sources was used: Drugs.com, Rxlist.com, Webmd.com, Medscape.com.
- Cipro-Synribo
- Cipro-Syntest D.S.
- Cipro-Syntest H.S.
- Cipro-Synthamin 17
- Cipro-Synthroid
- Cipro-Synthroid Injection
- Synjardy XR-Cipro (Ciprofloxacin Oral Suspension)
- Synjardy XR-Cipro (Ciprofloxacin Tablets)
- Synjardy XR-Cipro I.V.
- Synjardy XR-Cipro I.V. injection
- Synjardy XR-Cipro Iv Minibags
- Synjardy XR-Cipro Tablets