Drug interactions
Ciprofloxacin + Ferrous Fumarate and Folic Acid
For healthcare professionals — reference only. This page is a brief summary, not medical advice and not a substitute for official labeling or clinical judgement. Always verify before prescribing or dispensing.
Overview
Oral ciprofloxacin exposure is significantly reduced when taken with iron (ferrous fumarate) due to chelation, risking treatment failure; folic acid is not contributory.
Mechanism of action
Pharmacokinetic—divalent iron chelates ciprofloxacin in the GI tract forming nonabsorbable complexes, decreasing bioavailability (Cmax/AUC).
Clinical management
Avoid concomitant administration. If coadministration cannot be avoided, give ciprofloxacin at least 2 hours before or 6 hours after iron-containing products; monitor clinical response. Consider IV ciprofloxacin or an alternative antibiotic if separation is not feasible or in severe infections.
Drug reference
References
- Ciprofloxacin (Cipro) Prescribing Information – Drug Interactions (Products Containing Multivalent Cations) — FDA Label
- Ciprofloxacin: Drug Information – Interactions with multivalent cations (iron, zinc, magnesium, aluminum, calcium) — Lexicomp
- Fluoroquinolones: Pharmacology and drug interactions (chelation with divalent/trivalent cations) — UpToDate
Frequently asked questions
Can I take Ciprofloxacin with Ferrous Fumarate and Folic Acid?
The interaction is rated: Moderate. Oral ciprofloxacin exposure is significantly reduced when taken with iron (ferrous fumarate) due to chelation, risking treatment failure; folic acid is not contributory.
How serious is the interaction between Ciprofloxacin and Ferrous Fumarate and Folic Acid?
The interaction is rated: Moderate. Evidence level: High.
How is the interaction between Ciprofloxacin and Ferrous Fumarate and Folic Acid managed?
Avoid concomitant administration. If coadministration cannot be avoided, give ciprofloxacin at least 2 hours before or 6 hours after iron-containing products; monitor clinical response. Consider IV ciprofloxacin or an alternative antibiotic if separation is not feasible or in severe infections.
Why do Ciprofloxacin and Ferrous Fumarate and Folic Acid interact?
Pharmacokinetic—divalent iron chelates ciprofloxacin in the GI tract forming nonabsorbable complexes, decreasing bioavailability (Cmax/AUC).
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