Albert is currently using ciprofloxacin and clindamycin (14 day course) to treat his

Diabetic foot infection. His Doctor has prescribed him Atorvastatin 20 mg for his
cholesterol and he is also experiencing occasional heart burn and he is in need of an
appropriate OTC medication for his Heart burn.
Actual DTP:

1.Atorvastatin-Diltiazem:
CYP3A4 Inhibitors and Substrates (e.g., amiodarone, clarithromycin, cyclosporine, diltiazem,
erythromycin, grapefruit juice, itraconazole, ketoconazole, protease inhibitors) can result in an
Increased plasma concentrations of atorvastatin, lovastatin and simvastatin due to decreased metabolism
resulting in myopathy with or without rhabdomyolysis.
Management:
Statins not metabolized by CYP3A4 (pravastatin, rosuvastatin) could be used as alternative agents.
If used concurrently, monitor for side effects such as unexplained muscle pain, muscle weakness and
darkened urine.

2. Ciprofloxacin-Warfarin:
Simultaneous administration of ciprofloxacin with an oral anticoagulant (e.g., vitamin K antagonist) may
augment its anticoagulant effects. There have been many reports of increases in oral anticoagulant
activity in patients receiving antibacterial agents, including quinolones.
Management:
INR and/or prothrombin time should be monitored frequently during and shortly after co-administration of
ciprofloxacin with an oral anticoagulant (e.g., warfarin)

3.Ciprofloxacin- Diltiazem:
Ciprofloxacin has been shown to prolong the QT interval in some patients.
Precaution should be taken when using ciprofloxacin with concomitant drugs that can result in
prolongation of the QT interval or in patients with risk factors for torsade de pointes (e.g., known QT
prolongation)
Management:
Closely monitor patient for any potential side effects and use of an alternative quinolone is suggested.

Ciprofloxacin- Metformin:

Disturbances of blood glucose, including symptomatic hyperglycemia and hypoglycemia, have been
reported with quinolones, including ciprofloxacin, usually in diabetic patients receiving concomitant
treatment with an oral antidiabetic agent.

Management:
In diabetic patients, careful monitoring of blood glucose is recommended. If a hypoglycemic reaction
occurs in a patient receiving ciprofloxacin, discontinue the drug immediately and an appropriate therapy
should be instituted.

Potential DTPs:
Ciprofloxacin-AL,Ca,Mg Ant-acids,Tums(CaCo3):
Concurrent administration of a quinolone, including ciprofloxacin, with multivalent cation-containing
products such as magnesium/aluminum antacids and products containing calcium, iron, or zinc may
substantially interfere with the absorption of the quinolone, resulting in serum and urine levels
considerably lower than desired.

Management:
Ciprofloxacin should be administered at least 2 hours before or 6 hours after these preparations.