Calcium-fortified orange juice blocks absorption of ciprofloxacin - Literature Review & Commentary - Brief Article

Townsend Letter for Doctors and Patients,  July, 2002  by Alan R. Gaby

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Fifteen healthy volunteers participated in a randomized, crossover study in which they consumed single doses of oral ciprofloxacin with water, with orange juice, and with calcium-fortified orange juice. Compared with water, the peak serum concentration (Cmax) of ciprofloxacin was significantly lower when the drug was given with orange juice (-23%; p = 0.001) and with calcium-fortified orange juice (-41%; p < 0.001). The 24-hour ciprofloxacin area under the concentration-time curve (AUC) was also decreased with both forms of the orange juice (-22% and -38%, respectively). The Cmax and AUC was 22% (p = 0.005) and 21% (p = 0.015) lower with fortified than with nonfortified orange juice.

Comment: Current FDA labeling states that ciprofloxacin and most other fluoroquinolones are safe to take with food and dietary calcium but not with calcium supplements. The results of the present study indicate that calcium-fortified orange juice behaves more like a calcium supplement than a food, with respect to ciprofloxacin bioavailability. Concurrent administration of calcium-fortified orange juice significantly reduces the bioavailability of ciprofloxacin, possibly leading to decreased efficacy and the promotion of antibiotic resistance.

Neuhofel AL, et al. Lack of bioequivalence of ciprofloxacin when administered with calcium-fortified orange juice: a new twist on an old interaction. J Clin Pharmacol 2002;42:461-466.

COPYRIGHT 2002 The Townsend Letter Group
COPYRIGHT 2002 Gale Group