Interaction between Ciprofloxacin and Pirfenidone
Major
Metabolism
| ID | DDInter384 and DDInter1477 |
| Interaction | Coadministration with moderate inhibitors of CYP450 1A2 such as ciprofloxacin may increase the plasma concentrations of pirfenidone, which is primarily (70% to 80%) metabolized by the isoenzyme. |
| Management | Caution is advised when pirfenidone is used with ciprofloxacin at a dosage of 1000 mg/day or less. Use with ciprofloxacin 1500 mg/day should be avoided if possible, otherwise a reduction of pirfenidone maintenance dosage to 534 mg three times a day is recommended. All patients receiving pirfenidone with ciprofloxacin should be closely monitored for adverse reactions such as hepatotoxicity, photosensitivity, rash, nausea, diarrhea, vomiting and dyspepsia, and consideration be given to dosage reduction, brief interruption, or permanent discontinuation of pirfenidone if clinically necessary in accordance with the product labeling. |
| References | |
| Alternative for Ciprofloxacin |
J01R
More
|
| Alternative for Pirfenidone |
L04A
More
|
Potential Metabolism Interactions
Substrate-Substrate Interaction：If more than one drug is metabolized by the same CYP, it is possible that its metabolism is inhibited because of the competition between the drugs. That means, it can be useful to lower the dosage of the drugs in the drug-cocktail because they remain longer in the organism than in monotherapy.
Inhibitor-Inhibitor Interaction：Combining two or more inhibitors of one CYP, should be compensated by lowering the dosage of these drugs because the metabolism is reduced and the drugs remain longer in the organism than in monotherapy. Not adapting the dosage bears the risk of even more side effects.
Inhibitor-Substrate Interaction：Combining drugs that have inhibitory effect and are substrates of one particular CYP, should be compensated by lowering the dosage. They rest longer in the organism than in monotherapy. Not adapting the dosage bears the risk of even more side effects.